By David S. Bross, Esquire
Julia Robertson (a pseudonym) is a 42 year-old mother of two. After earning her associates’ degree in nursing, she worked full time as an RN for several area hospitals for 14 years. When she decided eight years ago to stop working so that she and her husband could start and raise a family, she was earning over $75,000.00. Julia had intended to return to work on a part-time basis when her youngest child entered kindergarten this past fall.
Julia’s plan to return to work was put on hold, however, when she began experiencing debilitating symptoms of weakness and fatigue last summer. Many days were now spent on the couch, and she often barely had the energy to do the grocery shopping or play with her children. Julia’s husband, Eric, who had always shared the household chores with Julia, was now forced to be both the household’s sole breadwinner and primary caretaker of the house and family.
Julia was devastated when her rheumatologist diagnosed SLE (lupus), an autoimmune disease. Although Julia was upset that she would have to indefinitely postpone returning to the nursing work she loved, she assumed that she could at least receive Social Security Disability benefits. This additional income would be critical, as Eric had to cut his own hours at work so he could spend more time at home caring for Julia and the household. Also, Eric’s employer was cutting back on health insurance benefits for employees, and Julia would need the Medicare benefit that comes with Social Security Disability if she and Eric could no longer afford medical coverage.
Julia had heard from friends and colleagues, and had also seen for herself with some of her patients, that Social Security Disability benefits were routinely denied, particularly for workers under age 50. However, she had also heard that applicants willing to persevere, especially with the help of a disability attorney, stood a good chance of ultimately being awarded those benefits.
Julia was shocked when, after having filed her online application with the Social Security Administration, going through five months of completing long and confusing forms, reminding her doctors to send their records, and submitting to several medical examinations with “Social Security” doctors, she received a “form letter” from the Social Security Administration telling her that her claim had been denied. What Julia found particularly confusing and upsetting was not only wasn’t she “disabled,” but rather, that she was not properly “insured” for disability benefits.
What Julia encountered is, sadly, a problem I have come across hundreds of times. Few applicants for Social Security Disability benefits are aware that the Social Security Act requires that, not only must a worker have accrued sufficient “quarters of coverage” through the payment of FICA taxes, but that there must also be sufficient recent earnings in order to be eligible for disability benefits. In Social Security parlance, one must not only be “fully insured,” but must also be “disability insured” in order to be eligible for benefits.
This means that, if you are age 31 or older, you must have earned at least 20 “quarters of coverage” (QC’s) in the 40 calendar quarter period ending with the quarter in which disability is alleged/established. (NB: “Quarters” are often referred to as “points” or “credits.”) In 2011, a quarter of coverage is earned for every $1,120.00 of taxed earnings. If you earn four times or more of the quarterly amount, four “QC’s” are received. If you earn three times or more, but less than four times the quarterly amount, you receive three “QC’s.” The same proportion exists for earnings being more or less than one, two, or three times the quarterly amount for each year. No more than four “QC’s” can ever be earned for any year.
In Julia’s case, because she had not worked for earnings more than five years (20 “QC’s”) prior to her having become disabled, she was not “disability insured” and therefore was ineligible for Social Security Disability.