Social Security Disability Insurance (“SSDI”) benefits are for people who have worked, paid into Social Security (by way of FICA contributions), and have accumulated sufficient work credits. There are no income or asset limitations. However, you must show you are “insured” for disability by generally having worked at least 40 quarters before your disability began, with 20 of those quarters occurring in the 10 years immediately preceding the date you became disabled. Each SSDI applicant has a date last insured, which means the date by which their disability must have started in order for them to qualify for SSDI benefits.
EXAMPLE: If you worked 10 years straight but stopped working December 24, 2010, your date last insured would be December 31, 2015. This means that in order to qualify under SSDI’s non-medical rules, you will have to show that your disability started on or before December 31, 2015.
Assuming you qualify for SSDI under the medical and non-medical rules, your monthly payment is determined by how much you paid into the system. This is called your primary insured amount (“PIA”). In 2014 the average SSDI benefit amount was $1,148 per month. However, your amount could be higher or lower, up to a maximum in 2014 of $2,642. If you want to find out the amount of your SSDI benefit, or PIA, you can get this information online at ssa.gov/mystatement.
In addition to ongoing monthly SSDI payments, successful SSDI applicants can also receive substantial lump sum back pay awards. SSA will pay back pay retroactive to the SSDI entitlement date. The SSDI entitlement date is based on the date the applicant became disabled but is limited by two factors. The first factor is the date the SSDI claim was filed. Under SSA rules, SSDI back pay awards cannot go back farther than one year prior to the date the claim was filed. The second factor is the 5-month waiting period. SSDI benefits are not payable for the first five months after the applicant became disabled. An SSDI back pay award will be retroactive to the end of the 5-month waiting period, or one year prior to the application date, whichever is later. This is called the “entitlement date.”
Here are some examples of how the “entitlement date” calculation works:
EXAMPLE 1: Bill stops working November 10, 2011, and applies for SSDI the same day. On his SSDI application, Bill alleges that he became disabled on November 10, 2011. If the judge agrees that Bill became disabled November 10, 2011, because of the 5-month waiting period (the 5-month period starts on the first day of the month following the month in which the applicant became disabled), Bill’s benefits would be retroactive to May 1, 2012, which would become his SSDI entitlement date.
EXAMPLE 2: Bill stops working November 10, 2011. However, because he thinks he will get better and return to work, he delays filing for SSDI benefits for almost two years, until December 1, 2013. If the judge finds that Bill became disabled November 10, 2011, despite the termination of the 5-month waiting period on May 1, 2012, his entitlement to SSDI benefits would not start until December 1, 2012, which is one year prior to his application date. Thus, by delaying the filing of his application, Bill lost out on 7 months of benefits. If his PIA was $1,500 per month, that would mean his delay cost him $10,500!
The above examples show how important it is to apply for benefits as soon as you become disabled!
Successful SSDI applicants automatically qualify for Medicare, the federal medical insurance program. However, Medicare eligibility does not start until two years after the SSDI entitlement date. This is another reason why it pays to apply for SSDI as soon as possible.