DI 25501: Onset
TN 11 (11-12)
A. Policy for EOD and DFI
1. The claimant must be insured on the EOD
Insured status is the earnings requirement a claimant must meet to establish entitlement to Disability Insurance Benefits (DIB). For DIB claims, we determine insured status based on a claimant’s past earnings. There are several types of insured statuses. For more information on the types of insured status, see RS 00301.101 Insured Status Overview. If a claimant is neither fully nor currently insured, no DIB benefits are payable to the claimant based on his or her earnings.
2. What is the date first insured?
The date first insured (DFI) is the first day of the quarter a claimant first meets insured status.
3. The insured status requirement differs between statutory blindness and disability
A claimant who meets our statutory definition of blindness must be fully insured at the time he or she meets our statutory definition of blindness. A claimant who meets our statutory definition of disability must be both currently and fully insured at the time he or she meets our medical and technical requirements for disability.
4. Who establishes the DFI?
The field office (FO) establishes the DFI. The FO considers the DFI when establishing a potential onset date (POD).
5. Do not establish onset prior to the DFI
The claimant must meet insured status for entitlement to DIB. The EOD cannot be before the DFI. However, the disability adjudicator may consider the period before the DFI to determine if the claimant’s condition meets the 12-month duration requirement.
6. Disability Insured Status Calculator (DISCO) and the Disability Wizard (DIBwiz)
The DISCO program retrieves online earnings, NUMIDENT, and Supplemental Security Record data to produce DIB insured status calculations. DISCO determines whether a claimant is insured for title II benefits. The Disability Wizard Quality Management Tool (DIBwiz QMT) helps to establish proper EODs and to identify prior entitlement and title II (T2) insured status. The FO may use either of these tools to assess key technical entitlement issues, such as insured status, earnings, and prior filings.
Additional information on DISCO, DIBwiz, and other tools are available on the toolbar support website, available at http://toolbar.ssahost.ba.ssa.gov/
B. Component roles concerning using DFI as a factor in establishing the EOD
1. Field office (FO)
The FO calculates and establishes the DFI and considers DFI when determining a POD.
2. Disability Determination Services (DDS)
The DDS considers the DFI when establishing the EOD. The DDS will not establish the EOD or blindness prior to the DFI.
C. Component instructions concerning using DFI as a factor in establishing the EOD
1. Field office (FO)
Determine the DFI and record your findings on SSA-3367 (Disability Report-Field Office). See Teleservice Center Operating Guide (TSCOG) TC 11001.010E.
See RS 00301.120, RS 00301.140, and RS 00301.150 for more information on calculating DIB insured status.
To determine the DFI, you are encouraged to use electronic tools such as DISCO and DIBWiz.
2. Disability Determination Services (DDS)
When establishing an EOD for DIB claims, do not establish the EOD before the DFI.
If the claimant’s medical condition was disabling prior to the DFI, and meets all other eligibility requirements prior to the DFI, enter the DFI in item 15A of the SSA-831.
If the claimant’s medical condition was disabling prior to the DFI, enter “Item 15A is based on date first insured. Impairment(s) was of disabling severity, for purposes of the duration requirement, as of [date].” in item 34.
If the EOD is partially favorable, prepare a personalized disability explanation (PDE) notifying the claimant, and the claimant’s appointed representative, if applicable, of the partially favorable determination. The PDE must explain why you established the partially favorable EOD. Send the PDE with an SSA-L1157–DI. (See DI 25501.280 Notifying Claimants of Partially Favorable Allowances.)