Applying for Disability in Pennsylvania
How to apply and qualify for SSD, SSI in Pennsylvania (PA)
Note: If you have already filed a claim and been denied for disability, or are wondering what to do in the event of a Social Security denial, proceed to the reconsideration and hearing appeal sections below.
Level I: Disability Application - In Pennsylvania, approximately 69 to 70 percent of all disability claims are denied in a typical year. For a majority of claimants, this will make When a denial on a disability application happens, it may be the result of a technical issue, such as having too much earned income at the time of filing, or having assets that exceed the allowable limit (note: the assets limit of $2000 only applies to SSI while the Social Security Disability program does not take assets into consideration and has no limit).
However, in most cases, the denial occurs because the claimant's case has failed to meet the medical requirements for disability under the guidelines used by SSA.
The medical requirements of a case have to do with the most basic issue, which is the determination of whether or not a person is disabled.
To arrive at that determination, Social Security uses the following definition of disability: A claimant must have a severe impairment that results in their inability to perform substantial and gainful work activity for a period of not less than one full year.
Meeting the requirements for disability
To satisfy this definition, a person applying for disability in Pennsylvania must prove, through their medical record documentation, that they have a medically determinable mental or physical impairment (in many cases, claimants have both physical and mental impairments) that affects their ability to engage in ADLs, or activities of daily living, and significantly interferes with their ability to perform basic work activities.
Furthermore, a claimant's condition must be severe enough that it rules out their ability to perform their past work (potentially any job they have done in the fifteen year period prior to becoming disabled), and further rules out their ability to use their skills and education to perform some type of other work.
How does the actual disability determination process work?
After a disability application is taken at a local Social Security office in Pennsylvania, it is transferred to the state disability agency. In most states, this agency is known as DDS, or disability determination services. At DDS, the case is assigned to a disability examiner.
The examiner's role is to render a disability determination on the case using both medical and vocational evidence, specifically medical records obtained from the claimant's treatment sources and information obtained from the claimant's work history. With regard to both types of information, the disability examiner will be entirely dependent on the information provided at the time of application.
For this reason, compiling a list of treatment sources prior to the appointment for the disability application interview, with dates of treatment, names of doctors, and addresses of facilities is usually a practical idea. This can minimize the opportunity for important information to be omitted and can allow for more accurate information to be provided.
For example, when the names of medical facilities are incorrectly listed, it can slow down the process of obtaining medical records. In certain instances, it can even make it impossible to obtain records.
By the same token, a claimant may wish to record their work history, complete with job titles and descriptions of jobs and the duties they entailed, prior to going in for the interview (or having the interview conducted over the phone, which is an option for someone filing for disability).
How is the evidence used on a disability case?
The information obtained from the claimant's medical records is used to gauge in what ways, and to what extent, the claimant is functionally limited, either mentally, physically, or both mentally and physically.
Physical limitations such as a reduced ability to stand, sit, walk, carry, reach, or grasp, and mental limitations such as a a reduced ability to remember, concentrate, or assimilate new information are used to render an assessment known as an RFC or residual functional capacity, rating. A person's RFC is a rating what they can still do despite their disabling condition.
When a disability claimant's RFC rating shows that they no longer have the ability to return to their past work, and that they do not possess the ability to perform some type of other work that their skills and education might ordinarily suit them for, they may qualify for disability benefits. This is known as a medical vocational allowance.
Some claims may be approved without regard to a claimant's vocational considerations. This occurs when a claimant has a medical condition that is listed in the Social Security Disability list of impairments, also referred to as the blue book (the blue book began as a desk reference source for disability examiners, judges, and disability attorneys and representatives).
However, not all conditions are listed in the blue book and for those that are the qualifications criteria is very specific and difficult to meet.
Qualifying for disability as a child
For children to qualify for disability, the process of qualifying for disability is esentially the same. Children may be approved for disability on the basis of satisfying the requirements of a listing.
When a listing cannot be met, however, the effect of the child's condition on ADLs (activities of daily living) must be such that it prevent them from engaging in activities that are specific to their age and peers.
For adults to qualify for disability, activities of daily living, of course, must be restricted to the extent that these functional limitations eliminate the ability of the claimant to work and earn a substantial and gainful living.
Level II: Request for Reconsideration - A claimant in Pennsylvania who has been denied on an application for disability may decide to file a brand new claim.
However, this is seldom a good idea. Beginning with a new claim will likely result in the case being denied again for the same reasons. Also, starting over can disadvantage a claimant by putting limitations on the amount of disability back pay they may eventually qualify to receive.
The best option after receiving a letter of denial will be to file an appeal. The first appeal is the request for reconsideration.
The reconsideration appeal is largely a repeat of the Social Security evaluation process used at the disability application level.
In fact, there is nothing different about the qualifications process at this level. Once again, the case will be handled by a disability examiner who will be assigned to the case after the Social Security office has received the necessary appeal paperwork from the claimant.
The reconsideration level examiner will be unlikely to effectively reverse the decision of the prior examiner unless a) the second examiner finds that the first examiner made a clear error or b) strong new evidence is brought into the case.
Reconsideration appeals have a high denial rate
In fact, in nearly every state, the rate of denial at the reconsideration step is substantially higher than the disability application level.
The primary advantage of going through the reconsideration stage is that if the claim is denied again, a claimant may file the second appeal, the request for a hearing.
At the hearing level, where the decision is made by a federal judge, the odds shift substantially in the claimant's favor provided the case is supported by solid evidence (including one or more statements obtained from the claimant's treating physician, or physicians) and that a logical theory of the case has been advanced to the judge.
A request for reconsideration is made by contacting the same Social Security office where the disability application was initiated. The appeal must be requested within 60 days of the date of the denial.
Claimants who are already represented by a disability lawyer or non-attorney disability representative should still contact their representative's office to ensure that both parties have received the notification of denial, so that the appeal will be submitted in a timely manner and the appeal period will not lapse.
Note: Reconsideration appeals are presently suspended in the state of Pennsylvania. Conjecture holds that the reconsideration appeal may return; however, currently, individuals who have been denied on a disability application may immediately file a request for a disability hearing.
Level III: Request for Hearing before an Administrative Law Judge - The disability hearing is the second Social Security appeal available to claimants in Pennsylvania and may be requested only after a reconsideration appeal has been denied.
A hearing must be requested within 60 days of the date of the prior denial, but, ideally, should be requested immediately after receiving notification of the denial of the reconsideration appeal to avoid unnecessary case processing delays, as well as the possibility of a missed appeal deadline.
Basic facts about disability hearings
1. Where are disability hearings held? - Disability hearings are held at ODAR, the office of disability adjudication and review, or, more simply, the hearing office.
In most states, there are multiple hearing office locations and it should be relatively easy for a claimant to get to the hearing site. However, even in larger states, such as the state of Pennsylvania, where there are several hearings offices, getting to a hearing office can sometimes mean a fairly long driving distance.
To accomodate this, Social Security will sometimes use alternate hearing locations, which may amount to nothing more than a conference room at a bank building or something equivalent to this.
2. What type of judge holds a disability hearing? - Hearings are conducted by ALJs, or administrative law judges. ALJs are federally appointed and are employees of the Social Security Administration. However, they are not part of the hierarchical structure and do not fall under the authority of the Social Security branch or regional offices. Judges are completely independent and autonomous, which is necessary to preserve their ability to make unbiased decisions on disability claims.
3. Is a judge more likely to approve a claim than an examiner? - Judges, in fact, have substantially higher rates of approval on SSD and SSI disability claims than do disability examiners, which is exactly why individuals who file for disability and are subsequently denied are usually advised to not give up on the claim, but, rather, to follow the appeal process to the hearing level where the chances of winning benefits increase markedly.
4. How are disability examiners and Social Security judges different? - In many respects judges perform the same functions as disability examiners, the individuals who make the disability application decision, and who also render the disability determination on the reconsideration appeal.
Disability judges, like disability examiners, review the medical evidence and vocational evidence (work history) of a case and then consider whether or not the claimant can be given a Social Security Disability award or SSI disability award on:
A) the basis of meeting the qualifications of a Social Security listing or
B) the basis of a medical vocational allowance, a type of approval in which it is determined that the claimant's condition, or conditions, make it impossible to return to work activity at a substantial and gainful earnings level.
However, unlike disability examiners, administrative law judges usually do not gather medical evidence. This is an important and critical distinction that claimants should be aware.
Essentially, the evidence that is in the case file at the time of the hearing is composed of:
A) whatever evidence was there when Social Security, via a disability examiner, last worked on the case, which is likely to have months in the past (meaning that the evidence is now out of date and cannot be used to make an approval on the claim) and
B) whatever evidence the claimant or their disability representative or Social Security attorney has obtained and updated the hearing office with.
This fact about evidence at disability hearings should serve as a cautionary note for claimants who choose to go to a disability hearing unrepresented while knowing little about what is needed to properly prepare the facts of the case, as well as assemble a legitimate rationale for approval under Social Security rules (e.g., the grid rules), regulations (title 20 of the code of the code of federal regulations), and rulings (various court rulings which to varying levels affect Social Security policy and procedure).
5. How long does it take to get a disability hearing? - The hearing appeal can be requested after the reconsideration has been denied. Since, in nearly every state, more than 80 percent of reconsiderations are denied, most claimants will find it necessary to file a request for a hearing.
Not all claimants do this, which is unfortunate because dropping a case at this point is probably the worst possible point for a claimant to give up on a disability claim: the majority of claimants do win their case at a hearing. Provided that a claimant has a legitimate medical disability and can provide the medical records to document their functional limitations, it is fairly likely that a judge will decide that their claim meets the necesssary requirements for receiving disability benefits. So, giving up is not wise.
The amount of time it takes to get to a hearing is chiefly dependent on backlogs which vary from state to state and are constantly shifting. A decade earlier, the rule of thumb was that it normally took 3 months to have a hearing scheduled after it was requested. Today, it is not unusual to wait six months to a year or longer before a Social Security hearing is scheduled.
Once a hearing is scheduled, though, both the claimant and their disability attorney or non-attorney disability representative will be notified of the time and place for the hearing. The representative will use their knowledge of the upcoming hearing date to ensure that all the needed medical evidence has been obtained and transmitted to the judge who has been assigned to the case.
6. Can I check the status of my hearing appeal? - Claimants who have submitted a request for a disability hearing in Pennsylvania can periodically check the status of their hearing request. This can be done by contacting the Social Security office where they first applied, or by contacting the hearing office itself. Generally, however, neither office will have anything to report other than that the hearing request is still pending.
In fact, it often takes months before the case that was transferred to the hearing office is even assigned to an administrative law judge. And even after that occurs, it may take months longer before the case is scheduled for a hearing date.
Having said this, though, it is a very good idea to contact the hearing office a few weeks after the hearing request has been submitted. This is to verify that the Social Security has actually transferred the case there. Errors and loose ends, unfortunately, are fairly common in the federal disability system.
7. What are the qualifications for disability at a hearing? - The criteria and qualifications at a Social Security hearing are no different than at the disability application level, or the reconsideration level.
Qualifying for disability will require proving that the claimant has one or more medically determinable (this simply means that the condition must be verifiable by medical evidence) impairments that last, or will eventually last, one full year, and which are severe enough to satisfy the requirements of a disability listing, or severe enough to rule out a return to substantial and gainful work activity, either in the performance of the claimant's past work, or performing some type of other work.
One factor that sets disability hearings apart, however, is the fact that judges are far more inclined to consideration and weight to the opinion of a claimant's own doctor, which SSA refers to as a treating physician.
This accounts for why disability lawyers routinely attempt to obtain supporting statements from doctors because such statements when they are supported by the remainder of the medical evidence can ensure that a person qualifies for disability and wins A) continuing monthly benefits and B) some amount of disability back pay.
Note: There are multiple hearing offices in Pennsylvania and the approval and denial rates listed here are averages for the state. Social Security Hearing offices in Pennsylvania deny more claims than they approve and for this reason claimants who have submitted requests for hearing should try to ensure that their claims are properly prepared prior to their hearing date.
The state-wide approval rate for Pennsylvania is lower than both the national average and also lower than the approval rate for SSA Region 3. (Disability award rates for the various hearing offices in Pennsylvania are listed near the bottom of the page).
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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Rates of Approval for Individual Social Security Hearing Offices in Pennsylvania
Elkins Park PA hearing office - disability award rate of 54.2 percent
Harrisburg PA hearing office - disability award rate of 47 percent
Johnstown PA hearing office - disability award rate of 46.3 percent
Philadelphia PA hearing office - disability award rate of 42.3 percent
Philadelphia East PA hearing office - disability award rate of 42.7 percent
Pittsburgh PA hearing office - disability award rate of 40.9 percent
Seven Fields PA hearing office - disability award rate of 42.6 percent
Wilkes Barre PA hearing office - disability award rate of 40.6 percent