When you are filling out your application for Social Security Disability, there are a lot of words that are thrown around during the application process that have very specific meaning and often don’t necessarily have the meaning that they would seem to have.
Social Security will throw them around if you’re doing the application down in the field office. If you’re doing the application yourself at home, it can get pretty confusing. I’ll throw them around at the application, but I would be able to explain them to you if you were with me.
So I wanted to go through some of those phrases that you may come across that may seem a little confusing, if you’ve never done an application before.
And hopefully, this is the first and only time you’ll have to do this. So that said, let’s get started and go through some of those questions that might come up when you’re doing the application the first time.
Date Last Insured
The first one that usually comes up, and that is frequently brought up by the Social Security Administration is “date last insured”, and that causes a lot of confusion. People are wondering if that means like their Blue Cross/Blue Shield, their personal health insurance, “what do you mean am I insured?”
What “date last insured” basically means is are you insured for Social Security Disability Insurance. And that’s one thing that a lot of people don’t realize, is Social Security Disability is an insurance program. You pay for it when you work. They take FICA out of every check. And that’s how you become eligible for SSDI, Social Security Disability Insurance. It’s an insurance program, and the FICA is a premium.
SSDI expires 5-Years after you stop working.
When you stop working, your premiums expire five years after you stop working. So, even if you’ve worked your whole life, and I get that question all the time, is – “What do you mean? I’ve worked 40 years. I’ve been working my whole life.” Well, if you wait more than five years after you stop working, even if you’ve been working for 40 years, you’re not eligible for Social Security Disability Insurance. You quit paying your premiums, and five years later your premiums lapse. Your insurance is no longer valid. So even if you’ve worked your whole life, you’re past your date last insured, you’re no longer eligible for benefits.
Another key thing to understand is “date last insured” doesn’t mean that you have to apply by that date. What “date last insured” means is you have to be disabled by your date last insured. So, if your date last insured is December 31st of 2016, and you apply on January 31st of 2017, you can be okay if you tell them you were disabled in January of 2016, because you’re saying you were disabled before your date last insured. So I know that’s confusing. We’ll actually come up to that in a minute, but you just have to be disabled before your date last insured.
One of the other issues that comes up with “date last insured” is under the table work or self-employment. And that has to do with what I talked about a minute ago and that’s the FICA. If you’re not paying taxes when you’re working, so if you’re a construction worker, and you’re being paid cash under the table. You’re not paying your FICA. You’re not paying your premium for Social Security Disability Insurance. You’re not eligible for Social Security Disability. And same with self-employment. If you don’t pay your self-employment FICA taxes, even though you’ve been paying some of your other taxes, if you’re not paying your FICA, you’re not eligible for Social Security Disability.
Alleged Onset Date vs Application Date
So the next question that comes up is what I touched on briefly, is the difference between your alleged onset date, and your application date. So when I was saying, if you apply on January 31st of 2017, but you allege onset date of January 31st of 2016, you’re okay. Your alleged onset date must be before your date last insured.
So if your date last insured is December 31st of 2016, as long as you say you’re disabled before December 31st of 2016, you’re okay. It doesn’t really matter when you apply. So you can apply after your date last insured, as long as you say you’re disabled before your date last insured. So alleged onset date is the day that you are claiming that you became disabled. That’s the day that you stopped working. The day that your condition became so severe that you were no longer able to work. If you’re still able to work, you’re not onset. You’re not disabled. The application date, obviously that’s the day you apply.
So once again, the alleged onset date must be before your date last insured, but not necessarily before your application date. You just have to when you apply, just say, “I know it took me a year to apply, but I was disabled two years ago.”
So what are some other questions that come up? The big ones that usually come up, number one is always, “How far back are they going to pay me?”
“How far back are they going to pay me?”
So let’s say, like I said before, your disability insurance runs for five years after you stop working. So somebody applies four and a half years after they stop working, are they going to pay me back four and a half years? How far back will they pay me? The answer to that is no. They will pay you back up to 12 months before the day you apply.
So back to our same scenario. If you apply on January 31, 2017, and you tell them that you became disabled on January 31st of 2012, five years before. They won’t pay you back to January 31, 2012. They’ll pay you back to January 31st of 2016. 12 months before you applied for benefits. That’s as far back as they’ll pay you.
“How far back will they pull medical records?”
Typically they’ll pull medical records back a year to a year and a half. They won’t go back and pull your medical records from when you had surgery 10 years ago, or when you had an appendectomy when you were a kid. They only care about, usually, the year leading up to your disability. So like I said, typically about a year, year and a half. They’re not going to pull all the way back.
“Is there a waiting period for cash benefits and medical insurance?”
Another big question, “Is there a waiting period for cash benefits and medical insurance?” The answer to that is, yes. Your alleged onset date. If that is the date that is accepted. If Social Security says, “We agree. You said you became disabled on January 31, 2016. We agree that you were disabled on January 31, 2016.” You then begin your waiting period. There is a
Your alleged onset date. If that is the date that is accepted. If Social Security says, “We agree. You said you became disabled on January 31, 2016. We agree that you were disabled on January 31, 2016.” You then begin your waiting period. There is a five-month waiting period for cash. So they will not pay February, March, April, May, June. Your first check would be July of 2016. That’s your five month waiting period.
Medical insurance, your Medicare, you will get Medicare, but there’s a 24 month waiting period. The confusion on that usually comes in when the 24 months starts. It does not start on January 31, 2016. It starts when your cash starts. So July 1st of 2016 is when your cash started. 24 months later on July 1st of 2018 is when your Medicare will start.
I know I’m doing this quickly, and these are things that you’re going to want to talk to a social security disability attorney about. We can explain this in detail. I can write it down for you so that it makes better sense. But it’s just something to know that there are waiting periods, and there’s some math that we’re going to have to do on that.
“Is Social Security going to send me to a doctor if I don’t have one?”
Another question we get a lot is people, obviously, they aren’t working, they have medical conditions, but they can’t afford to go to the doctor, and they want to know, “Is Social Security going to send me to a doctor if I don’t have one?” Typically if you don’t have any treatment, Social Security will send you to one of their doctors. It’s called a Consultative Examination.
They’ll send you to a one-off examination. It’s just one time. The doctor will give you a full exam, either a mental or a physical examination depending on what your claims are for disability. That doctor will give a full report to Social Security, and they will then use that report to make a determination. You won’t get to return to that doctor. It’ll just be that one-time examination.
Typically those doctors are fairly conservative and don’t tend to help the case a lot. So I always recommend establishing treatment. There’s a lot of clinics that will give free or low-cost treatment locally. So you’re really going to want to take advantage of those if you can. I have a list of those, you can contact this office, and we’ll help steer you in the right direction.
Get a free, no-obligation consultation.
So that’s a list of a lot of the questions that arise at application. There’s a whole lot more that come up, but I don’t want to take up too much of your time. If you have any questions, we’re always here to help. Contact us today for a free, no-obligation consultation. Our phone number is (800) 848-6168.
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