Who Decides if You Get Disability Benefits in Pennsylvania?

In Pennsylvania, if you want to receive Social Security Disability Insurance (SSDI) benefits, you have to apply to the U.S. Social Security Administration (SSA). However, in Pennsylvania, the Bureau of Disability Determination (BDD) assists the SSA in determining if a disabled Pennsylvania citizen is eligible for SSDI benefits. While Pennsylvania’s approval average is slightly more than the national average, only 39% of initial applications are approved. At Young, Marr, Mallis & Associates, our Philadelphia Social Security Disability lawyers help our clients file for benefits or appeal a denied claim. Below, we look at what the BDD is looking for when it reviews a benefits application.

SSDI Benefits for Pennsylvania Residents

SSDI is a federal program that is administered by the SSA that provides benefits to disabled or blind Pennsylvanians who are covered through workers’ contributions under the Federal Insurance Contributions Act (FICA). These contributions are a tax paid through the earnings of the beneficiary or their spouse or parents.

To be eligible for SSDI, a person must have worked and paid Social Security taxes for a sufficient amount of time. A portion of the taxes must have been paid over the last few years prior to claiming benefits. The medical condition the applicant is suffering from must meet SSA disability criteria. Meaning it must persist for at least 12 months or is anticipated to end in death. The condition must also prohibit the claimant from being able to perform substantial work.

The Role of the BDD in Pennsylvania Social Security Disability Claims

During the course of an average year, the BDD processes over 145,000 disability claims. The Bureau utilizes case examiners, doctors, psychologists, and other medical professionals to review applications for SSDI benefits.

Once you finish and file your application with your local Social Security office, it will be reviewed to see if it meets the minimum requirements for SSDI as set forth by the SSA. If your application meets these basic requirements, it will be forwarded to Pennsylvania’s Bureau of Disability Determination. The BDD’s role is to decide whether the documentation and medical evidence you presented meets the threshold for a disability under Social Security law.

The BDD will assign a team to your case consisting of a disability examiner and a physician or psychologist. This team will cooperatively review your application, including all the evidence presented, to determine if your medical condition qualifies as an eligible disability. With the assistance of our Pennsylvania Social Security lawyers, your application should include medical documentation from your doctors, hospitals, clinics, or any other health facility where you received treatment for your condition. One of the primary reasons why claims are denied is a lack of convincing medical evidence. Part of our job is to ensure your medical condition is documented and the evidence is forwarded to the BDD with your application.

It is also possible that the BDD will request permission to request to speak with your treating physicians or additional evidence to support your claim. While our office will work to ensure all the necessary documentation was sent, it is still a good idea to grant permission to the BDD. The two concurrent roles of the medical evidence are to provide clear documentation of your condition and supporting evidence to demonstrate how the condition adversely affects and restricts your ability to engage in work-related activities, including lifting, standing, sitting, concentrating, or communicating. The evidence provided by your doctor should be more than just a statement of belief. It needs to show a concrete connection between the medical condition and your inability to gainfully work.

It is also possible that the BDD will request additional medical examinations or tests to corroborate the evidence provided. In many cases, this examination will be performed by your doctor or at the healthcare facility where you were already receiving treatment. The BDD will pay for any requested examinations or additional tests. These expenses also include travel costs to and from the healthcare facility.

Disability as Defined by the SSA and the Pennsylvania Bureau of Disability Determination

The definition of what constitutes a disability according to the Social Security Administration is extremely strict. Two specific factors must be present.

  • You must not be able to do any substantial gainful activity (SGA) because of the limitation imposed by your medical condition. To qualify as SGA as 2021, an individual must be making more than $1,310 a month and $2190 a month if you are blind. Anything under these thresholds could be eligible for SSDI.
  • Your medical condition or disability must be expected to last at least 12 months or be expected to end in your death.

The BDD will use the provided medical evidence to determine if your medical condition meets the SSA threshold. If your application is approved, the BDD will send a letter outlining your benefit amount and the date when the payments will begin. If your application is denied, then a letter will be sent that details the reasons why. Our experienced Northeast Philly Social Security Disability attorney could also assist you in appealing the Bureau of Disability Determination’s decision.

Our Pennsylvania Social Security Disability Benefits Attorney is Available for a Free Consultation

Applying for Social Security Disability benefits can appear intimidating. In Pennsylvania, you are dealing with both the Social Security Administration and Pennsylvania’s Bureau of Disability Determination. If you are struggling with a medical condition that is keeping you out of work, gathering the correct documentation and completing the application might seem impossible. At Young, Marr, Mallis & Associates, our Springfield, PA Social Security attorneys are dedicated to helping our clients navigate the process – whether it is the initial claim or appealing an unfavorable decision. Call (215) 701-6519 to schedule a free consultation.

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