Timing and deadlines, part one: Insured Status and The Date Last Insured

by | Apr 16, 2020 | Firm News

One of the most important elements of advancing an SSD/SSI claim is timing.  You need to know when to file for maximum benefits and when to complete each step of the process along the way.  You may have seen my other detailed post going step by step through the claim process, but these next few posts will be a more abbreviated summary of some of the key dates and deadlines to keep in mind.  

First, a word on the eligibility timeline.  This differs for the two types of benefits.  For SSD claims, something called “insured status” comes into play.  Insured status is whether and when you are actually covered for disability benefits based on when you last worked.  The general rule is the “20/40” rule, meaning that to be covered, you have to have paid a certain amount into the system in 20 out of the last 40 calendar quarters.  (The rule varies slightly for young workers.)  Essentially, it means you have to have worked five out of the last ten years as of the time you become disabled to qualify for benefits.  We call this expiration date  the date last insured.  If you become disabled at a date later than that, or if the government decides that your disability status started after that, you don’t qualify for SSD benefits.  

You can get your date last insured from your account on ssa.gov, which contains a copy of your full earnings report.  Because it can be easily looked up, there’s no need for most people to know how to calculate it, but for most people who have worked full-time continually, it will be the end of the fifth calendar year after you stop working.  

You don’t have to file your claim before the DLI to qualify, but you need to prove that you were disabled as of that date.  Sometimes that means that you need to prove that you were disabled long ago, which could require getting old medical records and, this is the hard part, a retroactive medical opinion.  Because claims sometimes take so long to process, it often happens that someone’s DLI will pass while they are fighting for benefits, and at that point the attorney needs to adjust their strategy accordingly.  

The DLI concept isn’t applied to SSI claims, because the SSI benefit is not dependent on you paying in.  For SSI, the only date that really matters to your eligibility, in most cases anyway, is the date you filed your application.  

So now that you’ve read this far, let me get into the nitty gritty of how DLI is calculated.  It’s kind of mucky, but it makes sense in the end.  

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The above image is an excerpt from a “certified earnings record” document in a disability claim file.  The important columns here are Year and “QC”.  “QC” stands for “quarters of coverage.”  It’s represented graphically to make it easy for us to “count back” to calculate the DLI.  Every year has a dollar amount that constitutes a QC.  Here’s the link to the current data: https://www.ssa.gov/OACT/COLA/QC.html So in 2020, a QC corresponds to $1410 in earnings.  Most full-time workers will max out their QCs for a year by spring, but minimum wage workers will need to work half the year to get there.  Regardless of how long it takes, every time you earn a QC worth of income and pay taxes on it, you are covered for another quarter.  SSA tallies up the quarters automatically on your earnings record, and does in fact run a calculation automatically for the DLI.  The calculation simply consists of counting back from the most recent quarter on the graph until you’ve counted 20, and then adding ten years to that quarter.  In the above example, it’s nice and simple because the last years of work form a nice even block of 20 quarters.  So we can see that counting back 20 quarters takes us to the end of 2007; adding ten years to that, we get a DLI of 12/31/2017.  As long as this person could prove they were disabled by that date, they would qualify for benefits.  

Calculating a DLI is sometimes more complicated, because sometimes disabled people have sporadic work histories; there may be a bunch of years with no quarters in between years with just one or two, for example, instead of neat blocks of four quarters per year, but the process is still the same: count back 20 QCs, then forward 10 years.  

When I am interviewing a potential client to evaluate for a new claim, or if you contact us through our Facebook ads, one of the questions we will ask is whether you’ve worked five out of the last ten years.  This is why: so that we can determine whether you are likely to still have insured status.  

If someone doesn’t have insured status when they become disabled, it’s not necessarily the end of the claim.  They may still qualify for SSI benefits, if their household assets and income are low enough, as long as they are medically qualified.  

Finding out your insured status and whether you need to apply special care to a claim because of it is a great reason to contact us.