How Do I Know if I’m Eligible for SSDI Back Payments?

Richard Dudley, via FreeimagesThe process of applying for benefits through the Social Security Disability Insurance (SSDI) program in Massachusetts and the rest of the United States is often complicated and lengthy. Once a person files an application, it can take months for the Social Security Administration (SSA) to make an initial determination in their case. Considering that few claims are approved at the initial stage, the process can take much longer once you factor in requests for reconsideration and hearing before an Administrative Law Judge (ALJ): in many cases it can take 2 years or longer to receive a final approval at the hearing level.  This is not to mention those cases where appeals beyond a judge hearing level take place and ultimately get approved following an Appeals Council or Federal District Court process (which may involve an additional hearing before an ALJ.

Once the SSA approves your claim, however, the claimant will be owed retroactive benefits for the period of time they have been waiting for their final approval.  These past-due SSDI benefits are commonly known as “retroactive benefits.” Three factors may affect when your period of eligibility for back pay begins:  (1) the date you applied for benefits; (2) the alleged onset date (AOD) of your disability and the established onset date (EOD) determined by the SSA, which might not be the same date; and (3) the mandatory five-month waiting period from your EOD to the date SSDI benefit payments are payable.

Backlogs in SSDI Applications

The SSDI program is one of the most backlogged programs in the federal government. A report in the Washington Post in October 2014 stated that the program had a total of 990,399 claims awaiting attention. A 2008 review of backlogs by the SSA’s Inspector General found that the agency took an average of 131 days to process initial SSDI applications. Requests for reconsideration took an average of 279 days, and appeals to an administrative law judge (ALJ) took 811 days on average. Claims that went before the SSA Appeals Council or into the federal court system took much longer. The SSA’s back pay system is intended to compensate beneficiaries who are forced to wait for benefits.

Retroactive Disability Benefits

SSDI (Social Security disability income benefits) are payable as far back as one (1) year prior to the date of one’s application, assuming a five (5) full month waiting period has been met.  Thus, for example, if one were to file in November, 2015, benefits would be payable as far back as November, 2014 assuming the eligible claimant has been found disabled at least five (5) full months before November, 2014.  Thus, for an applicant who has remained disabled since June 1, 2014, they would be entitled to receive retroactive SSDI benefits going back to November, 2014.   In the event of a claimant who is likely to remain disabled a year or longer or whose disabling condition is likely to result in death, there may be no entitlement to retroactive benefits given the need to meet the five (5) full month waiting period.  For example, in the event of someone who becomes so disabled on November 1, 2015 and is likely to remain disabled until November 1, 2016, and who files on November 15, 2015 for benefits, there would be no benefit payable during the months of November, 2015 through March, 2016, and a first check for the month of April, 2016 would be payable a month later in May, 2016.  Thus, there is not always entitlement to retroactive benefits.

Alleged and Established Onset Date

The SSA’s determination of a claimant’s EOD is important to the amount of retroactive benefits they are entitled to receive. In the initial SSDI application, a claimant must identify an AOD—the date their disability began. When an application is approved, the EOD is set. If the application is approved at the initial stage or at reconsideration, a disability examiner determines the EOD.  At the next stage, the hearing stage, an ALJ would make the determination.

In some cases, the SSA will set a claimant’s EOD later than the AOD, effectuating what is called a partially favorable decision. This can have several effects on their claim, including rendering the claimant ineligible to receive any or all of the retroactive benefits they were seeking.   A claimant may request reconsideration of an initial decision that does not provide for a fully favorable decision (that is, does not provide them with all of the retroactive benefits they were seeking).  However, in doing so, the Agency will make a new determination de novo (that is, as of new) that may be even less favorable (or may in fact be a denial of the claim outright).  Thus,  it is important to consult with an experienced lawyer before deciding to appeal a partially favorable decision.

Reopening of Prior Claims

In many circumstances, individual claimants are bringing a claim for disability benefits having brought a prior claim for such benefits previously.  In certain circumstances, one may be able to reopen a past Social Security disability insurance claim if doing so within time limits set forth by federal law.   The general guidelines for reopeing a past claim is that one may do so as a matter of course within one (1) year of the initial denial date of the prior application, and that one may do so within four (4) years for what is deemed to be “good cause.”  In order to find out additional information about the reopening rules, please feel free to visit our website.

Disbursement of Back Pay

Once the SSA approves a claim for SSDI benefits and calculates the amount of back pay and retroactive benefits owed to the claimant, it disburses that amount in a lump sum payment.  Ordinarily, the retroactive payment will arrive first (in a direct deposit to one’s banking account, assuming one has set up an account) with the explanation of the decision (called the notice of award) coming approximately within 1 to 2 weeks after receipt of payment.

For additional information as to what you may be entitled to receive in retroactive Social Security disability benefits, Contact the Law Offices of Russell J. Goldsmith online or at 1-800-773-8622 today to schedule a free and confidential consultation so we can help you get started on your SSDI claim.

More Blog Posts:

Failing to Follow Your Doctor’s Prescribed Therapy When Making an SSDI Claim in Massachusetts and Around the Country, Social Security Disability Lawyer Blog, August 21, 2015

Requesting Reconsideration of an Application for SSDI in Maine and Elsewhere, Social Security Disability Lawyer Blog, August 2, 2015

How to Apply for SSDI Benefits in Maine and Beyond, Social Security Disability Lawyer Blog, July 1, 2015