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Ponder v. Colvin: Insurance Coverage Periods in SSDI Cases

Ponder v. Colvin, an appeal from the United States Court of Appeals for the Eighth Circuit, involved a claimant who alleged she had been disabled since January of 2005. Her claim for total disability was based upon depression, anxiety, swelling in her hands and feet, joint deterioration, obesity, chronic obstructive pulmonary disease (COPD), insomnia, tissue pain, fatigue, complications from brain surgery, and other medical conditions.

surgery-565751-m.jpgClaimant stated in her application she can only sit in a chair for less than 45 minutes due to knee pain and can only walk one city block before needing to stop and rest. She also stated that can perform light housework, including cooking, cleaning, and grocery shopping. She can also drive a vehicle and go to church and family visits. Her application for disability benefits was denied.

As our Boston SSDI attorneys can explain, social security disability insurance is actually treated like insurance by the Social Security Administration, in that applicants must have worked and paid into the system for a significant number of years in order to qualify for benefits.

On appeal, the court spent a considerable amount of time looking at the issue of whether she had applied before her disability insurance status expired. Claimant first became ill when a surgeon removed a cyst from her brain in July of 2012. Her surgeon opined she would do very well with her prognosis in the long run, following the successful surgery. After recovery, claimant returned to work at a rice mill from 2003 to 2005 without any follow-up treatment.

In the years following surgery, she regularly went for checkups with her primary care physician (PCP). In October of 2009, claimant went to PCP for an annual physical. Her doctor noted claimant may have a degenerative joint disease and osteoarthritis. He also noted that her back, neck, hands, and feet were normal. Her doctor said she was in no acute stress and did not impose any work restrictions. It was not until after the end of 2010 that she was diagnosed with any debilitating conditions.

The main issue during the appeal centered on whether she was disabled before her insurance status expired. As the court noted, under the Social Security Act, to qualify for disability benefits, you must have been covered for a certain number of quarters, depending on your age, and you must have earned at least one quarterly credit the year before you become 62 or the year before you became disabled, whichever happens first. These yearly requirements begin once you turn 21 years of age.

If you do not meet these requirements, you are not considered covered by SSDI. In this case, ALJ found claimant was not disabled under the SSA guidelines until after she stopped working for more than one year and had not earned any credits to qualify in the previous year. ALJ also found claimant was not disabled due to her being able to perform a significant amount of housework.

Ultimately, on appeal, the court agreed with ALJ’s findings and affirmed his denial of SSDI benefits.

If you are seeking Social Security Disability Insurance in Boston, call for a free and confidential appointment at 1-888-367-2900.

Additional Resources:

Ponder v. Colvin, November 4, 2014, U.S Court of Appeals for the Eighth Circuit
More Blog Entries:

Williams v. Colvin: Determining the Date of Disability for the Purpose of SSDI, August 10, 2014, Boston Disability Lawyers Blog