Philadelphia Disability (SSDI) Benefits Lawyer
You need a committed and experienced Philadelphia disability Lawyer throughout the process of your Social Security Disability Insurance (SSDI) application. If you are temporarily or permanently disabled in Philadelphia and you do not have private long-term insurance, your best option is applying for SSDI.
While some people expect this process to move along quickly and fairly, most SSDI applicants find that this process can be excruciating and confusing. Meritorious applications are frequently denied because the legal requirements are not evident to Social Security claims examiners. With the assistance of a skilled team of attorneys, you can avoid a lengthy and convoluted SSDI application and appellate process.
If you or someone you know is applying for or has been denied a social security disability application in Philadelphia, you should contact the law offices of Young, Marr, Mallis & Associates. Whether the SSDI is intended for you, your child, or your spouse, you are likely experiencing a tough time making ends meet due to disability.
The Social Security Administration (SSA) has internal methods of evaluating applications that the experienced team at Young, Marr, Mallis & Associates understands in depth. Some of our lawyers used to work there and they understand what you are going through. Call (215) 515-2954 to schedule a free and private consultation with a Philadelphia Disability Lawyer today.
Overview of Social Security Disability Benefits in Philadelphia
Social Security disability benefits consist of monthly payments that help support a person who has become too disabled to work. While Philadelphia doesn’t have state-funded disability programs under state law, people with a disabling condition can be eligible to apply for:
- Supplemental Security Income (SSI)
- Social Security Disability Insurance
For 2021, the maximum amount of these two types of disability benefits a person can receive per month is $3,895. This reflects a 1.3% cost of living increase (COLA) from 2020.
Applying for Social Security Financial Assistance Programs
If you have a disability and you don’t have long-term care insurance, you can seek support from the SSA as well as other programs designed to help people in your situation. One of the most significant dilemmas for the disabled is handling medical expenses and making ends meet. You can seek many sources of disability funding with the help of your attorney.
Strict Limits on Your Attorney’s Fees
No one’s first thought in applying for financial assistance is to hire a lawyer. However, there are areas of law — such as disability law and bankruptcy law — where a qualified attorney best represents people’s interests. Laws limiting legal fees are designed to protect citizens in vulnerable situations. Everyone recognizes that the application process can be difficult for a layperson, and a lawyer can help people assert their rights effectively.
The Difference Between Social Security and SSDI
Social Security is different from SSDI because Social Security ordinarily only becomes available upon a person reaching the age of 62. However, SSDI is available before your retirement age if you become disabled after having accumulated enough points by paying social security payroll taxes.
The Difference Between SSDI and SSI
The major difference between SSDI and SSI is that SSDI is available only to those who have worked for a certain number of years and earned enough work credits, while SSI is available to any disabled low-income individual, even if that person has never worked. As such, those receiving SSDI benefits tend to receive more money. For example, the average monthly SSDI payment in 2021 is $1,543, while the average SSI payment is $586.
In some instances, if your SSDI payment is on the low end, you may also be eligible to receive SSI benefits. This usually occurs when you have a short work history or have not worked in a while. Furthermore, because SSDI takes five months for approval, you can sometimes receive SSI benefits in the interim while you are waiting to be approved. Generally speaking, you should always apply for SSDI over SSI.
Access to Subsidized Health Insurance
Medicare and Medicaid are the health insurance services available to people with disabilities. After receiving SSDI for at least two years, you will be eligible to access Medicare. Alternatively, depending on your income, you can apply for Medicaid.
Supplemental Nutrition Assistance Program (SNAP)
Depending on your income, if you have a disability, you can access supplemental assistance to purchase your food.
Definitions of Disability for the Purpose of SSDI Benefits in Philadelphia
For the purposes of receiving SSDI benefits, a person is considered disabled in Philadelphia if they have a condition or impairment that is “medically determinable.” Furthermore, the medical condition (or a combination of conditions) must be considered severe. An impairment or combination of impairments is considered severe “if it significantly limits an individual’s physical or mental abilities to do basic work activities.”
A condition is medically determinable if it can be definitively shown to exist through clinical and laboratory diagnostic techniques accepted by the medical community. This condition or impairment can be either physical or mental. It must either have prevented the applicant from working to earn a substantial or gainful income for 12 straight months, be expected to prevent the applicant from working to earn a substantial income for 12 straight months or be expected to cause the applicant’s death.
Components of a Social Security Disability Benefits Application in Philadelphia
When you review SSDI application requirements, the amount of medical information requested is typically overwhelming. A qualified attorney can guide you through this process effectively. The landmark Supreme Court decision Sullivan v. Zabel (1990) enunciated the legal standard for evaluating Social Security disability claims. Accordingly, your Social Security disability application typically goes through a detailed review that must meet the following five conditions:
“Substantial Gainful Activity”
Usually, you cannot be employed, and your income cannot exceed certain guidelines. Your application should provide your current sources of income, bank statements, and other financial information explaining how you have supported yourself since the onset of the disability. As of 2021, if your monthly income exceeds $1,310, your application may be unsuccessful. An exception occurs if the person applying for disability benefits is blind. In this case, the blind person is permitted to have a monthly income not exceeding $2,190 per month and still qualify for SSDI. Your attorney can explain this requirement in greater detail.
Having an Impairment that Disables You from Working
The symptoms of your impairment are such that it’s clear you cannot hold a job. A qualified attorney can go through your medical information to help you determine if you meet the requirements of a disabling condition based on the symptoms you experience.
Impairment Level Matches Social Security Regulations
Your condition doesn’t have to meet the requirements of an automatic disability. However, your impairment must be listed under Social Security laws and regulations. Your medical documentation must also provide strong support for the existence of that impairment. With the assistance of an experienced bucks county social security disability attorney, you can provide the information needed for this aspect of your claim.
Inability to Perform Previous Work Duties
At this juncture, the nature of your disability is reviewed to determine if you can come back to your previous job with reasonable accommodations and if you have “transferrable skills” based on that job. Your prior job history is needed for this analysis.
Impairment, Age, and Education Precluding You from Doing Any Work
This analysis in disability law terms is known as the “residual functioning capacity.” The basis for this analysis is known as “grids.” The grids consist of a pre-established set of federal medical-vocational guidelines used in the review of Social Security disability applications. An attorney is best qualified to answer whether or not grids can impact your application.
Aside from these five main components, there are also other issues to consider, including the following:
“Trial Work Periods”
A trial work period occurs when you are receiving SSDI but are also working on the side. If you make more than a certain amount of money during that month, the month will count as a trial work period in Philadelphia. For 2021, earning any amount exceeding $940 per month will count as a trial work period. You are only permitted to use nine months toward a trial work period before your benefits may be endangered. These months do not need to be consecutive if they are in the same 60-month period.
Special Medical Examination Needed for SSDI Approval
Sometimes, the SSA will require you to undergo a special medical examination before they approve you for SSDI payments. This typically occurs when you have not seen a doctor in some time or do not have enough medical records for the SSA to determine whether or not you have a severe disability.
The exam will be conducted by an independent physician who has contracted with the SSA to perform such examinations. If the SSA schedules such an exam for you, you must attend and fully comply with the examining doctor so they can make an accurate report. Failure to fully comply or to show up for your appointment could result in your claim being denied.
Types of Conditions that Have Been Granted SSDI Benefits in Philadelphia
Your work experience comes into play as the examiners analyze whether you have what is known as “residual functional capacity” or “RFC,” meaning that you have transferrable skills based on your previous experience. To be considered disabled in Philadelphia, your symptoms must interfere with your ability even to use your lowest level of RFC. Some of our successful SSDI applications include multiple ailments, including the following conditions:
- Degenerative disc disease
- Disorders of the spine
- Debilitating hand pain
- Peripheral neuropathies
- Mitral regurgitation
- Ventricular hypertrophy
- Coronary artery disease
- Hypertrophic cardiomyopathy
- Traumatic brain injury
- Recurring migraine headaches
- Seizure disorder
- Personality disorders
- Panic disorders and anxiety
- Borderline intellectual functioning
- Depressive disorders
- Bipolar disorders
- Rheumatoid arthritis
- Multiple sclerosis
- Miller Fisher variant of Guillain Barre
Other Serious Conditions
- Restrictive lung disease
- Bowel incontinence
Using the Blue Book to Your Advantage in Philadelphia
The SSA evaluates every SSDI claim using a comprehensive list of medical impairments and conditions. Commonly referred to as the “Blue Book,” the Disability Evaluation Under Social Security features fourteen categories of medical conditions along with their related symptoms, diagnoses, and treatments. Using this comprehensive guide, the SSA can quickly locate a medical condition and its listed requirements to determine if an applicant’s impairment qualifies for benefits.
While the Blue Book serves as a guide for SSA case examiners, it also provides a helpful framework for people applying for benefits. The listings included in the Blue Book will help you determine what medical evidence and documentation will help strengthen your case. If your impairment is listed in the Blue Book, you will be able to see what criteria are necessary to support your claim.
In some cases, your condition might not be listed in the Blue Book. In these cases, you will want to have your doctor complete a residual functional capacity form (RFC). The RFC will determine what tasks and duties you are capable of doing, given the limitations of your medical condition. Because your treating physician is tasked with completing the RFC, you can be assured that it is based on your medical history.
When your condition is not listed in the Blue Book, the RFC allows you to present information regarding your personal situation. It is possible that your condition might encompass listing requirements of several conditions in the Blue Book without satisfying one particular impairment. Your doctor should thoroughly list your limitations based upon the available medical evidence.
SSDI for Spouse and Other Dependents in Philadelphia
If you are on SSDI in Philadelphia and have a spouse, children, or even grandchildren who depend on your income, they may qualify for additional auxiliary benefits under the program. Each dependent can receive SSDI benefits up to 50% of your own payment, but the total that all your dependents receive cannot exceed 180% of your own SSDI payment. The following sections explain the requirements for spouses and other dependents to qualify for auxiliary benefits.
A spouse can qualify for additional SSDI benefits in Philadelphia if one of the following is true:
- The spouse is 62 years old or older
- The spouse is the primary caregiver for at least one child under 16 years old
- The spouse is the primary caregiver for a disabled child of any age
A divorced spouse can qualify for additional SSDI benefits if all the following are true:
- The two of you were married for 10 years or more
- The ex-spouse is at least 62 years old
- The ex-spouse is not remarried
- The ex-spouse is not eligible under their own or someone else’s Social Security account for benefits greater than or equal to yours
Children can qualify for additional SSDI benefits if one of the following is true:
- The child is 18 years old or younger and is not married
- The child is 19 and still in high school and is not married
- The child is 18 or older, unmarried, and has a disability, the onset of which occurred before their 22nd birthday
Grandchildren and Stepchildren
Grandchildren and stepchildren can be eligible for additional SSDI benefits if all the following are true:
- The child is 18 years old or younger
- The child resides with you
- The child’s parents are dead or disabled
- You were responsible for half or more of the child’s financial needs in the year before you started on disability, or the child is under one year old and you have been responsible for at least half of their financial needs since the child’s birth
If you are on SSDI in Philadelphia and you pass away, those who survive you may be eligible for survivor’s benefits in certain situations. A widow or widower would be eligible if they fulfill one of the requirements listed under the “Spouses” section above or if they themselves are disabled. If they have reached full retirement age, they are eligible for 100% of the deceased’s benefits. If they are between sixty-two and full retirement age, they are eligible for 71% of the deceased’s benefits.
Children, grandchildren, and stepchildren will be eligible for survivor’s benefits in Philadelphia if they meet the requirements laid out in the sections above.
How Long It Takes for SSDI Applications to be Approved in Philadelphia
Generally, it takes time and effort to receive approval of Social Security Disability benefits. Do not be surprised if your application is denied initially; SSDI claims are frequently rejected at first. With the help of an experienced attorney, you can navigate through the process successfully and avoid lengthy questioning about your medical documentation. Depending on your condition, there are results and medical tests that carry more weight than others. When you fail to provide the types of documentation needed, your application may be rejected.
Unlike most government applications, the SSDI application process has multiple levels of reconsideration and appellate review. Since every case is decided based on the specific circumstances of the individual, you can’t make conclusions based on what you hear from other people. An experienced attorney can give you a more definite sense of your case.
Your attorney can also advocate for what is known as a “compassionate allowance condition” and request a fast-track review of your application. People eligible for this exception must have a serious condition warranting this exception.
Myths About SSDI Benefits in Philadelphia
The Social Security disability application process is frustrating. Our skilled Philadelphia disability attorneys are available to lend their expertise, experience, and knowledge. However, there are many misconceptions and myths associated with the SSDI benefits.
The Social Security System is Straightforward and Provides an Applicant All the Information They Need
If you are applying for SSDI benefits, you should take responsibility for your claim. For example, if the SSA provides a deadline for submitting any documentation, it should be sent certified mail with a return receipt requested. When deadlines are in place, you need to ensure that you not only meet them but have proof that you did. Do not let your claim fall through the cracks by trusting that the regular mail will deliver your documents on time.
Additionally, the SSDI benefits process is complicated. While it is often not intended, sometimes employees for the Social Security Administration provide inaccurate information. You should verify any instructions or information that you receive. You could avoid many of these issues by having our Philadelphia disability lawyers handle your claim.
You Have to Be a Certain Age to Get SSDI Benefits
There’s no age requirement for Social Security Disability. According to the Social Security Administration, the average age for Americans receiving SSDI benefits is 48 years old, well below the retirement age of 65. The age group with the largest recipients of benefits is between 55 and 59 years old. The average monthly benefit for men is about $1,200 whereas the average benefit for women is slightly lower at $1,000 per month. If you’re pain limits how you live your life and your ability to work, there’s absolutely no reason why you should not apply for disability benefits today.
Twelve percent of citizens in the United States are disabled, according to the Social Security Administration. If you’re one of them, you may have rights to compensation for your pain so you can pay your bills and continue to live as healthy a life as humanly possible. If you’d like to submit an application to the federal government for help, contact our law firm today.
You Only Need a Medical Opinion
While it has been stated several times already, it needs to be stressed – medical evidence and documentation are vital when applying for SSDI benefits. A statement from your doctor saying “my patient is suffering from a disability” is not enough to satisfy the SSA. Your doctor’s opinion is critically important. However, it must be detailed and supported by medical evidence.
More importantly, your doctor must describe your disability and medical treatment in terms of how it impairs your ability to complete ordinary tasks. For example, if your doctor states that you suffer from osteoarthritis or degenerative disc disorder and explains the diagnostic tests and treatments you have undergone, it might not be enough for the SSA. The medical opinion should support your condition while indicating how your impairment impacts your ability to stand, sit, walk, or lift.
You Must Wait Twelve Months Before Filing a Claim
To qualify for SSDI benefits, your impairment or medical condition must be expected to last at least twelve months or result in your death. This does not mean you are required to wait twelve months before filing for benefits. While SSDI benefits are not intended for someone who has a temporary disability, such as a broken arm, a person suffering from a qualifying condition does not have to wait until their condition has lasted twelve months.
To compensate individuals who have waited, the SSA will provide back payments for up to one year prior to your application date. Nonetheless, the application process takes time and you should consider when it is appropriate to file a claim. You want to ensure you have gathered enough medical documentation to support your claim. In many situations, this could take four to five months. If you file too soon, your claim could be denied for lack of medical evidence.
Your Claim is Not Different From Others That Have Been Denied
Approximately 70% of initial claims for SSDI benefits are denied. Only around 60% of denied claims are approved upon reconsideration or after a hearing before an administrative law judge. Receiving a denial letter is not out of the ordinary. Case examiners for the SSA are not invested in your case and they do not know you.
You should not assume that because you have a disability and some medical evidence that your claim will be approved. It is crucial to make your application as strong as possible. These means including extensive and accurate medical records that relate to your condition and your ability to perform ordinary tasks. Irrelevant information only makes an examiner’s job more difficult. You should also remember that denials are part of the process. When our office gathers information, we are looking to have your initial claim approved while already preparing to appeal a denial.
Hiring an Attorney to Help with Your SSDI Application is Expensive
The SSDI benefits process is complicated, frustrating, and aggravating. Denials are more common than approvals. Attempting to navigate the process without experienced legal assistance increases your chances of receiving a denial. While an attorney is not a guarantee that your claim will be approved, it does make it more likely. Fortunately, most disability attorneys work on a contingency basis. This means that you will only have to pay your attorney if your claim is approved.
Furthermore, the fee our Philadelphia disability lawyers charge must be approved by the Social Security Administration. More specifically, Social Security laws govern what an attorney is permitted to charge. Under the law, an attorney is permitted to charge 25% of your disability back pay benefits. This amount is further capped at $6,000 in the majority of cases.
It is important to note that the above relates to attorney fees. You still might be required to pay for some costs involved in the application process, such as the expense of obtaining medical records, postage, and copying.
Dealing with Rejection of Your SSDI Disability Application
Many SSDI applications fail because the file contains medical information without clear explanations of how the condition renders you disabled. Our disability lawyers will work closely with you and make sure that your application contains the necessary materials to tell your full story, such as all the help you need to get through your days and how your career has been affected by the disability.
Some medical conditions are not well understood because not everyone with the same condition becomes automatically disabled. For example, there are conditions such as multiple sclerosis, fibromyalgia, and rheumatoid arthritis that cause flairs where the person is unable to work and will likely need custodial assistance. Every medical condition has a unique impact on every person, and other complications can cause a mild medical condition to turn into a disability. An experienced attorney understands these variations and will work with seasoned medical experts, if necessary, to show that what you experience is part of your condition.
While many people with these diagnoses can continue to work, there are others who eventually have constant flairs and develop complications that impede their ability to hold on to a job. Many applicants fail to provide the necessary evidence that can substantiate the reality of how their medical condition impacts their life.
The Blue Book is not the ultimate basis for determining your disability. With the assistance of your attorney, you can provide the types of information about your chronic condition or a combination of medical ailments that cause impediments in your systems.
Below are common reasons SSDI benefits are denied in Philadelphia and what you can do if you were denied for this reason.
Lack of Medical Evidence
The primary reason many Social Security Disability benefits claims are denied is due to insufficient medical evidence. If you want to receive SSDI benefits, you must prove that you are unable to work because of your medical condition or impairment.
To prove this, you must have extensive medical documentation and records that show how your disability impairs your ability to perform the duties associated with your job. For instance, many people apply for benefits because of back pain. However, if your medical records only indicate that you suffer from a herniated disc but do not describe how the condition adversely impacts your ability to work, your claim will be denied.
In some cases, the SSA will request that you undergo an examination with an approved Social Security doctor. You should not assume that this examination will provide enough evidence to support your claim. Your treating physician has a much more intimate relationship with you and your medical health.
Your doctor should provide detailed information regarding your diagnosis, prognosis, treatment, and tests. More importantly, your doctor needs to describe how your medical condition impairs your ability to work. For example, a collection of doctor’s notes excusing you from your work duties are compelling pieces of evidence. It is crucial to discuss your condition with your doctor, so it is understood that you are applying for disability benefits.
More SSDI claims are denied than are approved. Therefore, a majority of claimants are faced with the decision of what to do after their initial claim was denied. It is not uncommon for someone to file a new disability claim instead of filing an appeal. This is not a good idea. In many cases, an SSA case examiner will deny your claim when they see that your previous claim was denied. Therefore, if your claim is denied, you should follow the appellate process. If you filed your initial claim by yourself, now would be the time to seek the help of our Philadelphia disability lawyers.
Substantial Gainful Activity
You are applying for SSDI because you are unable to work. Therefore, if you have the ability to earn a living, your claim will be denied. The Social Security Administration defines the ability to earn a living as “substantial gainful activity.” As of 2021, a person who earns $1,310 or more is engaging in substantial gainful activity and is not eligible for SSDI benefits.
Not Following Medical Treatment
To qualify for SSDI benefits, your medical condition must persist for at least twelve months or result in your death. Additionally, it must impair your ability to perform your work duties. If you fail to follow your doctor’s prescribed treatment, the SSA will be unable to assess whether your condition prevents you from working or if you are unwilling to take the steps necessary to improve. If you fail to follow your doctor’s instructions, such as taking medication or participating in physical therapy, the SSA will deny your claim. If there is a valid reason for not complying with your medical treatment, our Philadelphia disability lawyers will address it during the appellate process.
There are a substantial number of hoops you will be required to jump through during the SSDI benefits application process. Sometimes, certain requests might feel like a burden or unnecessary. No matter how you feel about the process, you need to fully cooperate with the Social Security Administration if you hope to receive an approval.
If the SSA requests documents, it is crucial that you send them promptly. Additionally, you should never miss an appointment or scheduled medical examination. The SSA will deny your claim if you are uncooperative.
Not Enough Work Credits
SSDI benefits function as insurance for people who have paid into the Social Security system. One way to think about SSDI benefits is an early withdrawal of your retirement benefits. To qualify for benefits, you must have worked long enough and have paid FICA taxes. Typically, a claimant must have earned 20 to 40 work credits. The total amount depends on the age of the claimant. You are only able to earn four credits per year, so you must have been working for at least five or ten years.
If you do not have enough work credits, you are not eligible for SSDI benefits. This is sometimes a problem for individuals who were self-employed or worked as independent contractors.
Technical Denials of Applications
A “technical” denial means there’s a glitch in the paperwork of an application or a violation of the rules for receiving SSD benefits. According to the Social Security Administration, reviewers deny 31 percent of all benefit applications for technical reasons:
- Income exceeds the “Substantial Gainful Activity” limit set by the SSA.
- Application is missing medical records.
- Failure to prove a relationship to the person the claimant is applying for (relative, spouse, power of attorney, etc.)
- No detailed information or substantial errors throughout the documentation.
- Claimant hasn’t paid into Social Security enough to qualify for benefits.
Hiring experienced SSD attorneys can greatly improve your chances of first-time application approval and eliminate all the headaches that come with trying to go it alone. Simple mistakes on your application can lead to month-long delays in securing regular disability payments. Don’t take that chance.
What to Do if Your Disability Application Was Denied in Philadelphia, PA
SSDI applications are known for initial denials. Yet, about 48 percent of the more than 700,000 who the SSA rejects, fail to submit an appeal. The law allows up to four different levels of appeal for disability benefits, though many choose not to take advantage of their rights because they lack the right help. Even if the SSA Appeals Council refuses to hear a claimant’s case, they still have the right to appeal directly to federal court where 81 percent of those who do have a ruling in their favor. What makes the difference for these claimants? A dedicated attorney behind them.
With an attorney at your side, you can have someone proactively communicating and advocating on your behalf. In that case, there are multiple opportunities to ask for further review, including:
As of April 2019, denied Philadelphia, PA SSDI applications must go through reconsideration by another claims examiner at the local office. At this point, you may receive requests for additional information that your attorney can help you follow through on.
Administrative Law Hearing
Your application is reviewed by an administrative law judge (ALJ) who determines whether the claims examiner analyzed the information consistent with rules and regulations. Your attorney can take this opportunity to provide adequate testimony and present your situation in the most favorable light.
There are instances when the ALJ will ask for a vocational expert to testify about their findings regarding your ability to work. Also, medical experts often testify as to their conclusions about your disability. Having an attorney representing you at this stage is crucial because sometimes, these experts draw incorrect conclusions. At this point, your attorney can ask them questions during what is known as “cross-examination” and test the witnesses’ credibility.
Appeals Council Review
You can ask for a review by the SSA’s policy panel. They don’t take all cases. Your attorney can help you determine if this option is viable or if it is better to skip this review.
U.S. Federal District Court
A denied application is typically subject to an appeal. An appeal is the part of the process where no more evidence is allowed. The judge looks at your existing medical evidence to determine whether previous reviews were adequate. At this juncture, your attorney presents an argument about the unjust review of your case.
At this point, your lawyer must demonstrate how your record met all SSA rules and regulations. These legal proceedings can get complicated because you have to prove that your application meets the legal standard known as “preponderance of the evidence.” An experienced disability attorney can explain this at greater length.
Our Philadelphia Disability Attorneys Can Help
Your medical condition does not have a schedule and is not predictable. Nothing could be harder than facing an expensive and debilitating medical condition after reaching adulthood. Most people have a financial advisor to prepare for retirement but don’t consider the possibility of encountering a disability before retiring.
Moreover, being unable to meet the financial needs of a disabled child is difficult. Your Philadelphia Disability Lawyer can guide you when applying under these circumstances. When you apply for SSDI in Philadelphia, you have to be prepared to wait for a significant period of time for your application decision. However, with the assistance of a qualified attorney, you can stand ready to put forth a strong application.
Call for a Free Consultation
At the law offices of Young, Marr, Mallis & Associates, you will find a knowledgeable, compassionate, and diligent team of attorneys who understand there is a lot at stake on your SSDI application. They proudly serve Philadelphia residents who need disability law services. To schedule a prompt, free, and private consultation, call our law offices at (215) 515-2954.