How Does the Disability Appeals Process Work in Pennsylvania?

Disability benefits are there to help people who are seriously ill or injured pay for their medical bills and other expenses while their health keeps them out of work.  At the end of 2012, the SSA (Social Security Administration) reported over 10 million Americans were receiving some form of disability with an average monthly benefit of $1,134.86.  However, successfully qualifying is known for being a difficult process which often requires the applicant to appeal.  In this post, we’ll take a closer look at how the appeals process works, and what to do if your social security disability claim was denied.

How Many Disability Applicants Are Rejected in Pennsylvania?

Unfortunately, being approved for disability is no easy feat.  While submitting a claim may seem like a simple task, once applications are received by the SSA, they undergo an extremely stringent review process which, more often than not, ends in a rejection notice.

Statistically speaking, you are far more likely to be denied than approved.  The national average rejection rate is about 65%, meaning only 35% of applicants — barely one third — will be approved.  In Pennsylvania, the rejection rate is estimated to range somewhere between 63% and 69%, making it roughly equal to the national rate.

Why Was My Disability Claim Denied?

If you’re like most disability claimants, your application for monthly benefits will be denied — at least initially.  The good news is, that denial isn’t necessarily final.  There are additional steps you can take to get approved, even if you’ve already been rejected by the SSA.

But before you begin the appeals process, you should make sure you understand why your claim was rejected by the SSA.  This will give you a better chance of being approved on your next attempt.

Rejections are divided into two basic categories: technical denials, which are less common, and medical denials, which are more common.

Some typical reasons for a technical denial might include missing a deadline, or earning too much money (more than $1,070 per month, or more than $1,800 per month for blind claimants).

Medical denials generally occur when a claimant’s disability fails to match or equal the severity standards in the “Blue Book,” or Listing of Impairments, or when a medical condition doesn’t meet the SSA’s 12-month duration requirement.  (However, there are some exceptions for advanced and very severe illnesses, known as Compassionate Allowances.)

When your claim is rejected, the SSA should send you a written notification which explains the reasoning behind the decision.  If you disagree with this explanation, it may be time to appeal.

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How Do I Start the Disability Appeals Process?

The appeals process unfolds in a series of steps.  Exactly how many of these steps you’ll have to go through depends on how your claim is assessed at each stage.

Step 1: Request for Reconsideration

If your claim was denied, the first step is to submit a formal Request for Reconsideration. The reason for your denial affects which forms you’ll need to submit:

  • Technical Denials:
    • Form SSA-561 (Request for Reconsideration)
  • Medical Denials:
    • Form SSA-3441 (Disability Report – Appeal)
    • Form SSA-827 (Authorization to Disclose Information to the SSA)

Reconsideration traditionally has the worst chance winning approval out of any stage of the process, including the initial application, so don’t be discouraged if you’re rejected again.  Applicants statistically fare far better at the next stage.

Step 2: ALJ Hearing

About 90% of applicants are denied at the Reconsideration stage, meaning the vast majority of claimants must request something called an ALJ hearing.  It is very important that you make this request within 60 days of your original denial.  If you miss this deadline, you will have to submit Form HHS-727 to the U.S. Department of Health and Human Services, so it’s best to simply be on time and avoid unwanted delays.

The ALJ hearing is named for the ALJ, or Administrative Law Judge, who presides over the meeting.  However, the hearing does not always take place in person, and may be conducted over video teleconference (VTC) or even via phone.

Nonetheless, it is very important that you take this meeting seriously, because it represents your best statistical chance of being approved.  After the discouraging approval rates associated with Reconsideration, it may come as a pleasant surprise that you actually have a very good chance at qualifying during this stage: about 62% to 66%.

After the hearing concludes, you can generally expect a wait of several weeks to several months before receiving notification of the ALJ’s decision.  While claims are more often than not approved at this juncture, rejected applicants still have the option to proceed to the Appeals Council Review (which must be requested within 60 days of the ALJ hearing), and if need be, to federal court.

Pennsylvania Disability Lawyers Offering Free Consultations

If you or your child has had a claim rejected by the SSA, an experienced disability attorney can help guide and represent you throughout the appeals process.  To set up a free, confidential legal consultation, call the law offices of Young, Marr & Associates at (215) 701-6519 in Pennsylvania, or contact us online.

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13 Convenient Office Locations

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Quakertown

328 W Broad St
Quakertown, PA 18951
Tel: (215) 515-6876
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Plymouth Meeting

600 West Germantown Pike #400
Plymouth Meeting, PA 19462
Tel: (215) 515-6876
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Doylestown

44 E Court Street #100
Doylestown, PA 18901
Tel: (215) 515-6876
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Marlton

10000 Lincoln Drive E, Suite 201
One Greentree Centre
Marlton, NJ 08053
Tel: (856) 213-2805
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Philadelphia

7909 Bustleton Ave, First Floor
Philadelphia, PA 19152
Tel: (215) 607-2715
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Bensalem

3554 Hulmeville Rd, #102
Bensalem, PA 19020
Tel: (215) 515-6389
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Bala Cynwyd

2 Bala Plaza, Suite 300
Bala Cynwyd, PA 19004
Tel: (610) 557-3209
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Cinnaminson

909 Route 130 South, Suite 202
Cinnaminson, NJ 08077
Tel: (609) 796-4344
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Jenkintown

135 Old York Road
Jenkintown, PA 19046
Tel: (215) 544-3347
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Allentown

137 N 5th St, Suite A
Allentown, PA 18102
Tel: (215) 240-4082
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Easton

101 Larry Holmes Dr, #212
Easton, PA 18042
Tel: (215) 515-7077
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Hamilton Twp.

3525 Quakerbridge Rd, #903
Hamilton Township, NJ 08619
Tel: (609) 236-8649
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Piscataway

371 Hoes Lane, Suite 200
Piscataway Township, NJ 08854
Tel: (908) 367-7256
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