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I have had conversations recently with disability claimants having problems with their date last insured (DLI).

Social Security disability is an insurance program, and a portion of the FICA payroll taxes withheld from every paycheck pays the disability premium. However, if you stop working, you stop paying the premium. Eventually, your disability insurance will lapse. The date your insured status ends is called the “date last insured.” The date last insured is always the last day of a quarter. So the date is always March 31, June 30, September 30 or December 31.

The date last insured can be a trap for the disability claimant. If you have a date last insured that is in the past, or will be in the past by the time of your hearing, then you must pay special attention to this issue.

To prevail with a Social Security disability claim, you must show that your were disabled prior to your date last insured.  It does not matter how badly disabled you are today. If you cannot demonstrate that you were disabled prior to your DLI, you will be denied disability benefits (you still may be elegible for SSI benefits, but you must qualify financially for SSI benefits).

I spoke with a new client whose claim was denied by DDS due to lack of medical evidence prior to her date last insured of December 31, 2008. For the years immediately around the DLI she was without medical insurance, and could not afford treatment. So there are no contemporaneous medical records to be had. However, there is still a path to benefits for her claim. First, her main impairment is peripheral artery disease (PAD), which is a progressive disease. So it’s not like she became disabled overnight. Secondly, she was having severe symptoms prior to her DLI, and these symptoms put her out of work. For this claim, it seems to me that the DLI problem can be resolved favorably with a strong retrospective opinion from her treating physician.

Social Security Ruling 83-20 governs the onset of disability. The Ruling recognizes the need for inferences, and states that:

In some cases, it may be possible, based on the medical evidence to reasonably infer that the onset of a disabling impairment(s) occurred some time prior to the date of the first recorded medical examination, e.g., the date the claimant stopped working. How long the disease may be determined to have existed at a disabling level of severity depends on an informed judgment of the facts in the particular case.

Be sure to read Ruling 83-20 carefully if you need to infer an onset date. Notably for my new client, the example used in the Ruling to infer an onset date involves peripheral artery disease, so the Ruling is right on point for this new case. Also, the Ruling states that lay evidence is relevant to the onset date inquiry.

Not all DLI problems can be favorably resolved. I met a gentleman last week with a date last insured of December 31, 2006. He has severe COPD, and would certainly be found disabled today. However, he worked abroad as a pilot for several years, and was not required to pay U.S. taxes, including Social Security taxes, during those years. So his date last insured for Social Security disability was reached in 2006, even though he was still working abroad through 2007. Unfortunately, there is nothing I can do for this fellow. He has too many assets for SSI, and he cannot qualify for Social Security disability as of his DLI, since he was working above the SGA level at that time.

If you have a date last insured that has passed, please consider involving a Social Security disability attorney right away. Without specific development of the medical record on the issue of DLI, you are at best rolling the dice at the hearing level. If you get the right judge, you might be okay. But even the most sympathetic judge is still bound by the medical evidence.