How to Apply for Disability Benefits (SSDI) in Pennsylvania

Applying for Social Security Disability benefits can be an arduous process.  First, people are in physical or emotional distress relating to their illness and have a tremendous lifestyle change in stopping employment. The process can be both financially and emotionally taxing for the Claimant as well as the Claimant’s family.  The following is a brief guide as to what to expect when applying for Social Security Disability or Supplemental Social Security Income benefits in Pennsylvania.

Each year, hundreds of thousands of disabled Pennsylvanians apply for monthly disability benefits through social security programs administered by the Social Security Administration, or SSA.  If you have a health condition which prevents you from working, depending on factors like your employment history and financial resources you may be eligible for SSI (Supplemental Security Income), or SSDI (Social Security Disability Insurance), both of which provide federal financial assistance.

However, while numerous applicants are successful, many more are rejected.  In Pennsylvania, only about 32% of claims are accepted after the initial application is made. The SSA’s eligibility criteria are notoriously strict, and there are plentiful technical and medical reasons a claim might be denied.  When you’re up against such challenging odds, you need to take every possible step to make your claim as strong and compelling as it can be.  The more you understand the application process, the better equipped you will be to deal with the social security system.

The experienced Pennsylvania disability benefits lawyers of Young, Marr & Associates can help you prepare. To schedule a confidential legal consultation completely free of charge, call our law offices right away at (609) 755-3115 in New Jersey or (215) 701-6519 in Pennsylvania.

The Differences Between Social Security Disability (SSDI) and Supplemental Social Security Income (SSI) Benefits

Social Security oversees two (2) distinct programs, Social Security Disability Insurance benefits (SSDI) and Supplement Security Income benefits (SSI).  In order to qualify for SSDI, you must meet both medical requirements and have the requisite work history, i.e., work credits that are accumulated over a sufficient number of years.  In contrast, SSI is available for individuals who have a limited work history and have limited assets.  To qualify for SSI benefits, you must not have assets (excluding your primary residence and a car) in excess of $2000.  Generally, SSDI benefits are higher in dollar amount than SSI benefits particularly for those who have had a successful work history.  Children may also be eligible for benefits if they are disabled and the spouse may be eligible for benefits if he/she is 62 or older or caring for a disabled child or for widow’s/widower’s benefits if you are a widow/widower of a deceased, disabled spouse and you are disabled and over the age of 50.

Pennsylvania Disability Agencies

In Pennsylvania, the Bureau of Disability Determination assists the federal government in processing applications. According to the agency’s website, examiners in Pennsylvania process more than 140,000 applications for disability benefits each year. They employ examiners, physicians, and psychologists to review medical records and conduct independent assessments of applicant medical conditions to make benefits determinations.

Understanding the Disability Requirements

Before you take the time to file a claim, you should understand the SSA’s basic eligibility requirements:

  • You must be disabled.
  • Your disability must be so severe that it prevents you from working, either in your old job or in a new, less exerting job.
  • Your disability must have lasted or be projected to last for no fewer than 12 consecutive months, or to result in death.
  • You must not be earning more than $1,070 per month for SSDI (or $1,800 per month for blind claimants).  For SSI, the income limit is the current Federal Benefit Rate (FBR) of $721 per month, although not all of your income may be counted toward that limit.
  • If you are applying for SSDI, you must have earned a certain amount of work credits depending on your age.
  • If you are applying for SSI, you must have limited income and other financial resources.

Medical Eligibility

To qualify for either Social Security Disability or Supplemental Social Security Income benefits, you must have a disabling condition that has either lasted a twelve (12) month period or is expected to last a minimum of a twelve (12) month period.  In order to qualify, you must either have a condition that meets a specific criterion under Social Security Disability listing (known as “The Blue Book”) or a condition or a combination of conditions that would prevent a Claimant from performing not only past relevant work but other work that would exist in that national economy.  When making that determination, Social Security Administration is considering various factors including your prior work history, your age, your educational background as well as any transferrable skills and how your medical conditions will affect the ability to have transferability to other occupations.

How to File for Disability Benefits in Pensylvania

There are three ways you can start the process of filing a monthly benefits claim in Pennsylvania.  You can:

  • Apply in person, by going to your nearest convenient social security field office.  You can find your local office by using the SSA’s Social Security Office Locator, which will prompt you for your zip code.  You should schedule an appointment before you arrive.
  • Apply via phone, by calling (800) 772-1213, Monday through Friday, during the hours of 7 A.M. through 7 P.M.  If you are hearing impaired, call (800) 325-0778.
  • Apply online, by visiting the SSA’s website.

The SSA will confirm that your application has been received.

The Process for Filing and Obtaining Disability Benefits in Pennsylvania

Because the SSA constantly receives millions of applications from around the country, it works with smaller, state-level organizations to expedite claims processing.  In Pennsylvania, the SSA is assisted by the Bureau of Disability Determination (BDD), which processes approximately 145,000 applications on an annual basis.  That’s nearly 400 claims for every single day of the year, which means processing does tend to take some time.  Generally speaking, unless a case is fast-tracked with the Compassionate Allowances (CAL) program due to advanced or terminal illness, most claims take about three to four months for review.

Once a review of your application is complete, the SSA will mail you notification of its decision.  If your claim is approved, your notification will include a notice of award letter, which will contain information about the payment you will receive, and when payments will start.  If your claim is rejected, your notification will include a denial letter explaining the reasoning behind the rejection.  While some denials are made on a technical basis, such as earning too much income, the majority are rooted in medical reasons, such as a health condition not being severe enough.

How to Prepare a Strong Disability Claim

Clearly stating how your medical condition limits your daily activities is the most important component of your application. If the records and statements included by your doctor in your application don’t make that known, state examiners may ask for additional information. The Bureau of Disability Determination may also ask you to submit to a special examination so examiners can better understand your limitations, including your ability to perform work-related tasks such as writing, lifting objects and sitting.

Submit all tests, including diagnostic images, and their results along with your application. If you have a team of Pennsylvania SSD attorneys working for you, they can compile the materials on your behalf. This eliminates the need for you to hunt down all the medical files on your own. You should also hand over treatment records and documentation of how you’ve responded to them. Incomplete treatment records can lead to a denial of benefits, if you haven’t explored all options to relieve your pain and restore your ability to work.

Initial Application

To file an application for benefits, you must start by completing various forms including the application, the disability report form as well as the Authorization to Disclose Medical Information to the Social Security Administration.  At that time, you will need information on your work history, citizenship and birth and residence history, details of your medical treatment including hospitalization, clinicians’ names and phone numbers as well as personal financial information.  Unfortunately, this is usually not the end of the process as the majority of Claimants are denied on an initial application.  This process takes approximately 3 – 5 months in totality.  If you receive a favorable Decision, the process ends however, if you are denied, you must complete the next step to move forward with the process.

The Disability Hearing

If you are denied on a Reconsideration, your final administrative step is to request a hearing before an Administrative Law Judge.  The delay between Reconsideration and Request for Hearing is significant as the hearing will usually not occur for 6 – 9 months after that request.  However, the good news is your chance of success is the highest at the hearing level.  The necessity of the hearing is based upon the Social Security Administration’s belief that the best opportunity to provide a complete assessment of your condition occurs by not only examining your medical evidence but also by hearing your testimony.   Along with an Administrative Law Judge, there will usually be a Vocational Expert present to assess your prior work history as well as your transferability skills and in some instances a Medical Expert may be present.  The great majority of successful Claimants are represented by counsel and have an opportunity to provide a history as to their prior work, their medical conditions as well as the limitations resulting therefrom.  The hearings are relatively short in duration (usually less than 1 hour) and are informal compared to other legal proceedings.  There is no requirement that Claimant be represented by counsel although many ALJ’s will attempt to persuade an unrepresented Claimant to obtain counsel so that grounds for appeal does not exist based upon failure to properly present a claim.

If Your Disability Claim Application is Denied in Pennsylvania

A denial doesn’t have to be final.  You can appeal the SSA’s initial determination and may be able to have your claim approved after a reevaluation. The social security application process can take months or even years from start to finish.

Even if you are denied, that isn’t necessarily the end of the process.  If the SSA rejects your claim, you can appeal.  The first step to the appeals process is called Reconsideration, which may be requested by using an online application, or by downloading and printing out paper forms to send in the mail.

Wherever you are in this complex process, the experienced Pennsylvania disability benefits attorneys of Young, Marr & Associates can help. To set up a free and private case evaluation, call our law offices at (609) 755-3115 in New Jersey or (215) 701-6519 in Pennsylvania, or contact us online today.

Reconsideration

The Reconsideration is the second step in the Disability process.  It generally takes less time than the initial application as you are only supplementing that application with additional medical information.  At this stage, your application will be sent to the Social Security Administration for a second review.  While the same office will generally be handling that review, it would be examined by a new Examiner with any additional information being provided for use in the Reconsideration process.  You have sixty (60) days upon initial denial to request Reconsideration, however, it is best to forward a request as soon as possible to avoid potential delays.  Furthermore, unfortunately, your chances of success at the Reconsideration stage is even less probable then at the initial application.  However, failing to request Reconsideration will cause your claim to be dropped and therefore it is important that request be made. There are no in-person meetings during the Reconsideration stage and it generally takes 2 – 3 months upon receipt for a determination.  

The average Pennsylvania acceptance rate during Reconsideration is only about 21% (which is still better than the national average of about 10%), but don’t get discouraged. The next available appeals stage, known as the ALJ (Administrative Law Judge) Hearing, has a significantly higher average approval rate: approximately 60%, both nationally and in Pennsylvania.  Therefore, if you reach this stage of appeals, your claim is actually more likely to be accepted than rejected. Furthermore, Pennsylvania residents can actually skip the Reconsideration stage and proceed straight to the ALJ Hearing, provided they file a request within 60 days.

Appeals Council Hearing

If you are denied at the hearing level, your final administrative remedy comes at the Appeals Council.  The Appeals Council will review the determination made the Administrative Law Judge to see if grounds exist for the case to be remanded for a new hearing or in rare instances reversed.  

You can request an ALJ Hearing by submitting Form HA-501 (Request for Hearing by Administrative Law Judge), in addition to Forms SSA-3441 and SSA-827 as noted above.

Federal Court

Finally, if the Appeals Council has not sought to review your matter, your final remedy comes at the Federal Court level.   A Federal Court Complaint may be filed against the Administration and is solely a paper review.  You will not be present at another hearing and will not testify. 

Our Pennsylvania Disability Attorneys Can Help

The Social Security process is tedious and arduous in nature.  Claimants who are represented generally have a greater chance of success as they are more likely to meet deadlines and to properly submit evidence and testimony.

Filing for benefits can be a daunting task.  The social security system is highly complex, and imposes stringent technical requirements on disability claimants.  When you’re already seriously ill or injured, you shouldn’t have to struggle with navigating the system on your own: you deserve the support of a knowledgeable Philadelphia SSDI lawyer.

At Young, Marr & Associates, our legal team has over 20 years of experience helping the residents of Pennsylvania obtain the benefits they deserve.  Whether you’re still in the process of filing or ready to appeal a denial, we can help guide you through the process. Call us today to talk about how we can assist you.