When Does Disability Begin?
By Pitt Dickey
When Cole Porter wrote “Begin the Beguine” back in 1935 it was easy to tell when the music began. It is not so easy to tell when a medical problem becomes so serious that it qualifies a person for Social Security disability benefits. The Social Security Administration (SSA) must not only decide if a disabled person meets the qualifications for disability but the date when he first met the qualifications. This date is called the “onset date”.
The onset date is vital as it determines when the person’s disability payments begin and even if the person is eligible for disability benefits depending upon his work history. There are two types of disability programs operated by the SSA. Supplemental Security Income (SSI) is for disabled workers who have not worked enough quarters to be eligible for Disability Insurance Benefits. The other program is called Disability Insurance Benefits (DIB) and is for disabled workers who have worked long enough to qualify for DIB in what is called “insured status.” The DIB benefits are based on the worker’s reported income and are typically higher than SSI benefits. To be eligible for SSI or DIB the person must have a medical condition that prevents him from performing full time work for a period expected to last at least 12 months from his onset date or result in death in a shorter period.
Anyone who files an application for either SSI or DIB will be required to list an Alleged Onset Date (AOD) which is the date he claims he was no longer able to work due to his disability. Most claimants do not file for SSI or DIB immediately so their application date is typically several months or even years after their AOD. The question then arises as to whether there are retroactive benefits payable to the claimant if he is found to meet the requirements for disability benefits. In SSI claims there are no retroactive disability payments due. The date of the filing of the application for SSI is the date used for determining the first payment of disability benefits. In DIB cases, benefits may be paid retroactively up to one year from the date of the application if the onset date is established prior to the application date.
For example, John is in a bad accident which paralyzes him in February 2006. He does not file for SSI benefits until March 2008. The SSA then determines that he met the eligibility requirements for SSI effective February 2006. Because there are no retroactive SSI benefits payable, John would not be eligible to be paid SSI until March 2008 when he filed his claim. If John files a DIB claim with the same facts, he would be eligible for retroactive payments from March 2007 which one year prior to his filing date of March 2008. John would lose any DIB benefits prior to the one year look back period from his application of March 2008. Accordingly it is important to apply for SSI and/or DIB as soon as a person believes that he cannot return to work so as to protect his benefits claim.
Some onset dates are easier to determine than others. Disabilities based on a traumatic origin like a motor vehicle accident can be fairly clear using the date of the accident if the injuries are severe enough. In disabilities due to non-traumatic origin such as diabetes, cancer, degenerative disk disease, the onset date can be more difficult to determine. The SSA will consider the claimant’s medical condition, work history, and educational background. The SSA will begin with the AOD stated by the claimant in his application. This AOD can and is frequently amended as the claim progresses. The last date the claimant worked is highly relevant. As long as a non-blind claimant is working and earning above $940 a month in 2008 as an employee, he is performing “substantial gainful activity” and is not eligible for DIB or SSI. Even though the person may be very ill and forcing himself to go into work when a lesser person would stay home, he is not eligible for disability benefits as long as he is performing substantial gainful activity.
The SSA will rely strongly on the claimant’s medical records in determining the onset date. If the claimant has a slowly progressing impairment it can be more difficult to determine the onset date. The SSA will consider the medical records and the claimant’s vocational skills in deciding if he is eligible for disability. For many reasons such as lack of insurance or finances, a person may not seek medical attention when his impairments cause him to stop working. For example Jim may have developed diabetes but doesn’t know he has it. All he knows is that he is tired, has burning in his feet and can’t stand our walk without pain like he used to. When Jim finally goes into a diabetic coma and is treated at the emergency room his diabetes is discovered. The SSA can use a medical advisor at Jim’s hearing to listen to his testimony, review the existing medical records and infer that Jim’s diabetic disability began well before he was admitted to the emergency room. The SSA can also consider information from Jim’s family, friends, co-workers and former employers in determining his onset date of disability if medical evidence is not available.
Cole Porter’s “Begin the Beguine” lyrics invoked “…music so tender/ it brings back a night/ of tropical splendor” There is nothing tender or splendid about the onset of disability, but establishing the onset date is a crucial part of the puzzle. Establishing the onset date requires pinning down the date in the past when the worker first became unable to work according to the Social Security law.