Requirements for Obtaining Disability Benefits (SSDI) in Pennsylvania
Statistics estimate that about 13.4% of Pennsylvanians have a disability. For some, their health conditions are easy to manage — but others have impairments that are so severe that employment becomes completely impossible. If that is the case for you, you may qualify for disability benefits.
When a medical condition negatively impacts your ability to earn income, the financial consequences can be devastating. Fortunately, you may be able to qualify for social security disability benefits through the Social Security Administration (SSA). Unfortunately, it can often be extremely difficult to qualify without the assistance of an experienced disability benefits attorney. Statistically speaking, well over half of all Pennsylvania claimants are denied after making their initial application, and the denial rate skyrockets to about 90% during the Reconsideration stage of appeals. While it may be difficult to get a claim approved, it isn’t impossible — but you do need a basic understanding of the eligibility criteria and application process.
To learn more about the requirements for getting SSDI in Pennsylvania, speak with our Pennsylvania disability lawyers at Young, Marr, Mallis & Deane by calling (215) 701-6519.
What Are SSDI Benefits in Pennsylvania?
Social Security Disability Insurance (SSDI) benefits are a form of assistance provided by the Social Security Administration. SSDI is funded from Social Security taxes that you will have paid into by working. People who have never had to pay taxes for Social Security, or people who have never had an income for whatever reason, may not be eligible for this kind of program and could instead apply for a different form of need-based disability benefits.
Your disability benefits are calculated based on your total income during the years you were able to work. You must have actually spent a certain number of years gainfully employed to be eligible in the first place. Many people may have never held a job and may not receive SSDI benefits. People who may not have worked because they stayed home while their partner worked or people who were too young to work when their disability began may need to find a different form of assistance.
If you were previously able to work, have a history of working for at least several years, and suffered a disability that now prevents you from working, you might be eligible to receive SSDI.
Do You Qualify for Disability Benefits?
Disability benefits are contingent upon disability. This may sound too obvious to be worth mentioning, but actually, the SSA uses very strict guidelines to define disability, and the majority of denials are attributed to medical rather than technical reasons. While you may feel positive that you are impaired, the SSA may come to a different conclusion based on its own set of stringent standards. Therefore, you can prepare a much stronger claim if you understand SSA evaluation.
To be approved for disability by the SSA, your impairment must meet certain criteria. First, your condition must be severe enough to prevent you from being able to work, meaning it cannot be easily suppressed or worked around. Ideally, your condition should be listed in the SSA’s “Blue Book” and match the severity standards listed for your specific impairment. However, even if your condition does not meet these standards or is not listed in the Blue Book, you may still be eligible for disability through other channels such as Compassionate Allowances or medical-vocational allowances. Lastly, your condition must be so severe that you cannot perform your previous job duties or find an alternative position.
Proving Your Disability in Pennsylvania
Proving you are indeed disabled requires more than just filling out some paperwork. You will need to provide evidence and documentation of your disability in order to be approved for SSDI benefits. For some, this may be easy if their disability is included in the SSA’s Listing of Impairments. For others, we might have to go the extra mile when demonstrating your disability.
First, we absolutely need hospital and doctor’s records regarding your disability and any treatments you received. These records should be thorough enough to indicate when your disability started and how it has impaired your life. Your primary care doctor should submit a report about your disability, their experience treating you, and their opinion on the level of impairment you suffer. If you have seen any other doctors, like specialists or surgeons, we should get records from them as well.
The evidence should not only indicate that you have a disability but that your disability prevents you from working or at least prevents you from earning a significant income. The point of applying for SSDI benefits is that you are unable to earn enough income to support yourself due to your disability. If the SSA and BDD find that you are capable of gainful employment, your application may be denied.
Your Ability to Work and SSDI Benefits in Pennsylvania
Not all disabled individuals are completely unable to work. Some disabled people can perform more limited kinds of work, but their income would be insufficient to support them fully. You do not have to be completely incapacitated in order to be approved for SSDI benefits in Pennsylvania. Perhaps you can work a part-time job with more limited job duties.
SSDI is calculated based on the average income of your working years. For people who had a lower income, their SSDI benefits may not be enough. In such cases, speak to an attorney before trying to supplement your SSDI benefits with a small income from working. If you are able to work, your benefits may be reduced.
Your Work History and SSDI Benefits in Pennsylvania
Getting approved for SSDI requires more than just being disabled. SSDI is based on Social Security and will only be available to people who have a history of employment during which they paid Social Security taxes. A person who has never worked or never paid Social Security taxes might be ineligible for SSDI unless they can use their spouse or parent’s record to get SSDI. If you have no eligible spouse or parents, there are other forms of public assistance for which you may qualify. Contact our Philadelphia SSDI lawyers to discuss your situation.
Generally, the age at which you became disabled will dictate how many years of work you must have in order to be approved for SSDI. The younger you are, the fewer years of work experience you need. However, if your disability did not manifest until a later age, you will need a long work history in order to be approved.
Your work history is also important because it is used to determine the number of your benefit payments if you are approved. Benefits will be based on your average lifetime income. The more you earned when you were able to work, the greater your benefits will be. This can put people who earned low incomes and had shorter work histories at a disadvantage.
Eligibility for Children and Spouses of a Disabled Person in Pennsylvania
SSDI benefits are mainly intended for people who are unable to work due to a disability or medical condition. However, under limited circumstances, family members of disabled individuals may be eligible to receive SSDI benefits.
For the most part, family members who can receive SSDI benefits from your working history are limited to spouses and children. Eligible children include adopted children and can sometimes include stepchildren and grandchildren, depending on your situation. If you are the spouse or child of an injured worker, you may be able to use your spouse or parent’s working record to obtain benefits for your support in addition to theirs.
Elderly spouses over the age of 62 may be eligible, but spouses of any age could also be eligible if they are taking care of your child and are dependent on your income. The eligibility of children is primarily based on their age, marital status, and disability status.
How to Apply for Disability in Pennsylvania
The SSA is a federal organization. However, in order to more rapidly process the sheer volume of applications, the SSA works with smaller organizations in each state. In Pennsylvania, the SSA works with the Bureau of Disability Determination (BDD), which is part of the Pennsylvania Department of Labor and Industry.
The BDD reports evaluating about 145,000 claims every year, or approximately 400 claims every day. These claims, which are sent to the BDD after receiving a basic review by the SSA, represent both Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). While these two programs have different eligibility standards, with SSI based on financial need and SSDI based on earning work credits, both grant assistance to Pennsylvanians who cannot work because they are impaired.
There are five BDD offices spread throughout the state to serve different counties. For residents of Eastern Pennsylvania, there are two offices that might be appropriate:
If you are a resident of Bucks County, Chester County, Dauphin County, Montgomery County, or Philadelphia County, call or visit the BDD office at:
1171 S. Cameron Street
Harrisburg, PA 17104-2594
If you are a resident of Berks County, Lehigh County, or Northampton County, call or visit the BDD office at:
264 Highland Park Blvd.
Wilkes-Barre, PA 18703
There are three primary methods to apply for benefits in Pennsylvania. Firstly, you can easily apply online through the official website of the SSA. Secondly, you can visit any of the numerous field offices situated across the state to apply in person. To locate the nearest and most accessible office, you can utilize the SSA’s field office locator. Lastly, you have the option to apply over the phone by contacting the SSA at (215) 701-6519.
How Long Does it Take to Get SSDI Benefits in Pennsylvania?
Once you apply for SSDI benefits in Pennsylvania, it may be some time before you start receiving benefits. Pennsylvania applicants should expect to wait several months before they get their first check from the Social Security Administration, if not longer.
Generally, it takes a few months for the SSA to review and approve SSDI applications. If your claim is approved, you will automatically enter into a five-month waiting period before you start receiving benefits, depending on your medical condition. For example, Pennsylvania applicants with ALS don’t have to wait and can receive benefits immediately after their claim is approved. To clarify whether or not you’re eligible for immediate benefits or must face the five-month waiting period, ask your Pennsylvania disability lawyer.
The five-month waiting period after SSDI claim acceptance is so that the SSA can be sure you are eligible for benefits. If your condition improves or changes during that time, inform the SSA right away.
Once the five-month waiting period is over, you’ll start receiving your monthly SSDI checks. The amount you receive each month will be exclusively based on your work history. Ask a Pennsylvania disability lawyer for insight to get a better idea of what your monthly payments may look like.
The date you receive your monthly SSDI benefit is determined by your birthdate. As a Pennsylvania SSDI recipient, you can expect payments on the following schedule: If your birthday falls between the 1st and 10th of the month, your payment will arrive on the second Wednesday of the month. If you were born between the 11th and 20th of the month, your payment will arrive on the third Wednesday. And if your birthday falls between the 21st and 31st, your payment will arrive on the fourth Wednesday of the month. If you get SSDI benefits through a parent’s earning record, you will receive your monthly checks according to your parent’s birthday.
What Are the Requirements for Maintaining Access to Disability Benefits in Pennsylvania?
Once you’re approved for SSDI payments, there is no guarantee that you will receive them forever. While SSDI benefits are designed to support Pennsylvania residents with permanent disabilities for the rest of their lives, certain things can threaten a recipient’s access to benefits. Understanding the requirements for maintaining access to disability benefits is crucial so that you don’t unknowingly put yourself and your family at risk.
Substantial Gainful Activity
In order to remain eligible for SSDI benefits, Pennsylvania residents can’t earn over a certain amount in additional income each month. After all, being unable to engage in substantial gainful activity (SGA) is a prerequisite for getting SSDI benefits. In 2022, the SGA threshold is $1,350 monthly for non-blind recipients and $2,260 for blind recipients. If you earn over the SGA limit in a month, you may become ineligible for SSDI benefits.
Unfortunately, many SSDI recipients are unaware of this restriction or the fact that they have to report additional earnings to the SSA. Your Pennsylvania disability lawyer can help you keep track of your income so that you don’t unknowingly earn over the SGA limit and lose your access to SSDI payments.
Trial Work Periods
Sometimes, SSDI recipients think they might be able to return to work but are unsure. In order to accommodate these recipients, the SSA allows for trial work periods (TWPs). Pennsylvania recipients can attempt to reenter the workforce during a TWP while still getting benefits. Unfortunately, these trial work periods are automatically triggered when SSDI recipients earn over $970 monthly over nine months. That means you can enter into a TWP without knowing it, ultimately risking your access to benefits.
The good news is your checks won’t go away immediately. Once aware of a TWP, your Pennsylvania disability lawyer can contact the SSA, explain the situation, and get them to reconsider repealing your benefits. Quickly addressing an unintentional trial work period is important, so you don’t lose access to the monthly SSDI payments you and your family rely on.
SSDI benefits are reserved for individuals with severe medical conditions and disabilities that prevent them from earning sufficient income. In order to remain eligible for SSDI benefits in Pennsylvania, your condition cannot improve significantly. If it does, and you can again engage in substantial gainful activity, the SSA may revoke your monthly benefit.
SSDI recipients must inform the SSA of any changes or improvements to their medical condition. Depending on your initial prognosis, the SSA may subject you to regular evaluations over the years to ensure you are still eligible for SSDI benefits based on your disability.
What Can I Do If My SSDI Claim Is Denied?
Do not worry if your SSDI claim is denied at first. There are several chances for you to fix any issues that led to the denial. But it is important to act quickly to ensure your appeal is accepted for review. Your first step is to request your claim to be reconsidered by the SSA. If that does not work, you can request a hearing in front of an administrative law judge. If you are still unsuccessful, you can take your claim to the SSA Appeals Council and even file a lawsuit in federal court to review your claim.
Submit a Request for Reconsideration
In order to initiate the appeal process, it is necessary to submit a request for reviewing the initial denial of your benefits. Upon being denied, you will receive a notice outlining your right to request reconsideration. The Disability Determination Services (DDS) will have your review conducted by an examiner and medical consultant who were not involved in the previous decision-making process. This way, your claim will be seen with a fresh perspective to ensure the claim is not denied out of bias.
If your claim is not approved upon reconsideration, you will receive a notification of denial along with an explanation for the decision. However, this does not mean the end of your claim. You have the option to request a hearing before an administrative law judge if your claim is denied after reconsideration.
Request a Hearing Before an Administrative Law Judge
SSA’s Office of Hearings Operations will be the next place your claim will be reviewed. This will typically be done in a hearing before an administrative law judge (ALJ). Their main responsibility is to review decisions that deny initial claims or terminate disability benefits. Fortunately, there is a good chance that denied claims will be approved during this stage of the appeal process. Nevertheless, it is absolutely vital to request a hearing before an administrative law judge within 60 days of being denied reconsideration. Failing to do so will forfeit your right to further appeal your claim.
Request a Review by the SSA Appeals Council
If your appeal before an ALJ does not go in your favor, the next step is to request a review of your claim by the SSA Appeals Council. However, the Appeals Council does not hear every case appealed and randomly selects cases to review. They have the discretion to deny a claim without review unless certain circumstances are clearly established.
The Appeals Council will typically review a claim to check if the ALJ made any errors. To overturn the ALJ’s decision, it must be proven that there was an abuse of discretion on their part that violated your right to a fair hearing. An ALJ can also be overturned if they made an error of law or procedure, like denying you the chance to submit additional relevant evidence that supports your claim. In case the ALJ has rejected your claim because you missed important deadlines or failed to file it within the designated time, the Appeals Council may deny your claim without any review.
Keep in mind that the probability of succeeding at this stage is relatively low. Typically, claim appeals are sent back to the ALJ for additional scrutiny but are rarely overturned. If this approach does not yield the desired outcome, you will be given one final opportunity to appeal your claim by filing a lawsuit in federal court.
Filing a Lawsuit in Federal Court
If all appeal options have been exhausted, filing a lawsuit in U.S. District Court is the next necessary step. The federal judge will conduct a “bench trial” without a jury to review the case. It is crucial to understand that federal judges are typically hesitant to overturn decisions made by the ALJ or Appeals Council. Nevertheless, some cases result in the judge sending the claim back to the SSA for further review. This occurs when the judge wants the SSA to re-examine the medical opinion of a treating physician or the symptoms of the claimant. While winning a federal appeal is possible, it is important to note that the process is often prolonged and expensive, potentially taking several years to conclude.
Time Limit to File Your Appeal for SSI and SSDI Benefits
When filing an appeal for benefits, it is critical to keep track of the timeframes involved. You will usually have 60 days from the day you receive the SSA’s notice of claim denial to appeal the decision. However, the SSA considers all notices received within five days of the letter date, unless you can provide evidence that you received it later.
If you fail to file an appeal within 60 days, you may lose your right to appeal, and the previous ruling will be considered final. If an Administrative Law Judge (ALJ) ruled against you and you did not contest their decision within 60 days, your claim will not receive another hearing without an important excuse. The SSA could grant you an extension if you provide a valid reason in writing, but even then there is no guarantee. It is important to clearly state the reasons for the delay in your written request, as it will likely be denied if not stated explicitly.
For a fast and easy way to challenge a denied claim, consider requesting an appeal online. This option is available for most stages of the process, except for the lawsuit stage. If you prefer to mail in your appeal forms, you can also download them online. Alternatively, if you would rather speak with someone directly, you can contact the SSA toll-free at 1-800-772-1213 to obtain information. It is important to keep in mind that a written request for an appeal hearing will be necessary at some stage.
Is It Better to File a New Claim or Appeal a Claim that Has Already Been Submitted?
When a claim is denied, many people believe that filing another claim is the best option. However, it is more effective to appeal the denied claim by providing supplementary evidence instead of starting the process all over again. Filing a new claim may result in the same outcome as before. By appealing, you demonstrate to the SSA examiner that you are putting in the effort to have your initial claim approved by providing new evidence and explanations.
Why Should I Talk to a Pennsylvania SSDI Attorney?
If you plan on applying for SSDI benefits in Pennsylvania, hiring an attorney is important. The application process can be complicated, and just one mistake might result in a rejection. An experienced Pennsylvania disability lawyer can help you gather the necessary information to succeed in your initial application for SSDI benefits.
Applying for SSDI benefits can be a complex process. Pennsylvania applicants must compile proof of their work history and disability or medical condition, which can be laborious. In addition to proving your eligibility, you may also have to answer questions regarding your family, dependents, and other personal details.
If you are denied SSDI benefits, an attorney can help you file an appeal. Unfortunately, the SSDI claim appeals process can take months or even years. By that time, you may face serious financial difficulties if you still cannot work because of your disability. An experienced Pennsylvania disability lawyer can help you properly apply for SSDI benefits and answer any questions you may have about the process so that you can start receiving monthly payments as soon as possible.
Get in Touch with Our Pennsylvania SSDI Attorneys for Help
For a free case review with our Doylestown SSDI benefits attorneys, contact Young, Marr, Mallis & Deane today at (215) 701-6519.