Social Security Disability Insurance benefits are available to those who have a condition that lasts or is expected to last for at least twelve months or result in death that has prevented the person from engaging in normal work activities. In addition, the person must have worked and paid taxes on their earnings in order to maintain eligibility for benefits, as SSDI benefits are funded through payroll tax revenues. When evaluating a claim for SSDI benefits, Social Security will calculate your Date Last Insured. This is the last date of “coverage” that you have earned based on your work credits. To be eligible for benefits, you must prove that you became disabled before the date last insured. For example, if your date last insured expired on December 31, 2020, you must prove that your disability occurred prior to that date. In addition to proving that your medical condition occurred prior to that date, you must also have stopped working or engaging in “substantial gainful activity” prior to that date – meaning, any income that you have earned from work activities must fall under Social Security’s threshold. The guidelines are updated on an annual basis and are calculated on a per month basis. In 2022, the substantial gainful activity threshold is $1350 per month in gross earnings. Therefore, following the example noted above where the date last insured expired on December 31, 2020, you must establish that you stopped working or engaging in substantial gainful activity prior to that date AND that your medical condition occurred and you were receiving treatment for it prior to that date.
The date last insured is primarily calculated based on the work earnings that you have paid taxes on. Social Security divides each year into quarters (3-month increments). The agency looks at the last 40 quarters, which equates to 10 years. To maintain insured status, you must have worked and paid taxes on your earnings for at least 20 of the last 40 quarters – meaning, roughly 5 of the last 10 years. Your date last insured is updated on a quarterly basis with every quarter of earnings which you acquire through working. If you are wondering what your date last insured is, you can call your local Social Security office and they will be able to provide you with that date.
If your date last insured has expired, you are still eligible to apply for benefits; however, the approval process is a bit more complex. First, as stated above, you will need to establish that you became disabled prior to your date last insured. This means that you will need to have medical records from that time period establishing your diagnosis and treatment. Next, be aware that Social Security will only be evaluating your condition during your insured status period. In other words, following the example above of an insured status expiring on December 31, 2020, Social Security will not be evaluating your symptoms or treatment in 2021. If your case reaches the hearing phase, the administrative law judge will ask you only to testify about the state of your conditions from the date you became disabled until your date last insured expired. So, if your date of disability was June 1, 2020, and your date last insured expired on December 31, 2020, the administrative law judge will specifically ask about your symptoms and treatment during the last six months of 2020. However, this does not mean that you will not be eligible for ongoing benefits if you are approved. It simply means that you must establish disability prior to your insured status expiring.
The biggest challenge that those with an expired date last insured face is obtaining medical records from the period during which they were insured. It is important to be aware that medical providers are not required to maintain your medical records for extended periods of time, so if you are advising Social Security that you became disabled over 10 years ago, it may be extremely difficult to obtain medical records from that time frame proving that you were disabled. The best way to prevent this problem from occurring is to submit an application as soon as you become unable to work due to your conditions. The closer in time that your application date is to the date that you became disabled, the easier it will be to communicate with your medical providers and obtain the documentation that you need for your case to be approved. In addition, if you are still seeing the same medical providers, you can obtain supporting statements from them that further support that you are unable to perform work-like activities due to your medical conditions. It is much more difficult to obtain such statements if you have not seen the providers that you were treated with for several years. Some people avoid applying because they are hopeful for improvement in their conditions. However, even if your condition may improve in the future, it is best to proactively proceed with applying for benefits. The approval process can take several months or even years at times. If you return to work before your case is approved, you can request a closed period of benefits if the period of time where you needed to stop working due to your conditions lasted at least twelve months. If Social Security approves your case and finds that your condition is expected to improve, it may request a medical reevaluation after a certain period of months or years after approval. Further, if you are approved for benefits and become well enough to return to work, you can enter a trial work period with Social Security. Therefore, there is no risk involved with applying early – but waiting to apply can often make your case much more difficult to win.
The best course of action for getting your claim approved is to hire an experienced disability attorney. Call LaBovick Law Group at (561) 625-8400. We will evaluate your case for free, and get your application started as quickly as possible.