Will I Qualify For Disability Benefits in Pennsylvania?

If you are disabled and unable to work in Pennsylvania, you may qualify to get Social Security Disability and/or Supplemental Security Income (SSI) disability benefits. Receiving benefits will be based on the decision reached by the Pennsylvania BDD, the state-level agency that makes decisions on Social Security Disability and SSI claims for the Social Security Administration.

The approval rate for initial disability claims--disability applications--at the Pennsylvania Bureau of Disability Determination is 31.09 percent, approximately the same as the national initial claim approval rate--the national approval rate has remained fairly consistent at appromately 30 percent for more than two decades.

The high rate of denial for disability claims in Pennsylvania will mean that the majority of claimants will need to file at least one appeal before ultimately qualifying to receive disability benefits. In most instances, a cliamant must file two appeals, the first being a request for reconsideration and the second being a request for a disability hearing.

Filing a disability claim in Pennsylvania

To have your case evluated, you must first file a disability application with Social Security. There are two primary means of initiating a claim.

If you file your disability application by phone or in person through your local Social Security office, a claims representative, or CR, will complete all of your disability forms for you and you can file for both SSDI (Social Security Disability Insurance) and SSI, or SSDI or SSI separately. The determination of which program you are eligible to have a claim taken in--often, this is both--will be made by the Social Security office.

If you complete your disability application in person at your local Social Security office, they will have you sign your medical release form (form SSA-827) as part of the disability interview. However, if you file your disability claim by phone, the claims representative will send you a medical release to sign and return.

If you file online, you can only file a Social Security Disability application at this time and you are not able to apply for SSI disability at this time. This is problematic because many claims will, in fact, be concurrent, and will involve both programs. Claimants will have no way of knowing in advance if their claim will be for SSDI, SSI, or both programs; therefore, for this reason, it may be a more productive use of time to simply contact a local Social Security offcie to start the claim. This contact, as stated, can be done in person, or over the phone.

Individuals who are fairly sure that they will qualify for SSI only, and not SSDI, may choose to file for disability online. However, they should be careful to complete all the necessary disability forms. If this is not done, the claimant may receive a technical denial for failure to cooperate with the processing of the disability claim.

Additionally, if Social Security attempts to contact a person to resolve an issue on an internet claim and cannot reach the claimant, the claim may also potentially be closed. There are disadvantages and potential minefields involved in filing online versus contacting a Social Security office, or having one's disability representative or lawyer file the claim for them.

The processing of a disability claim in Pennsylvania

Once your disability application is completed, your claim is sent to the Bureau of Disability Determination for a decision. The Bureau of Disability Determination (BDD) processes about 145,000 disability cases every year.

The BDD, like other state disability agencies, uses disability examiners, physicians, and psychologists to review a claim and make a disability determination for Social Security.

The process basically works in this manner. After the claim is started at a local Social Security office, it is transferred to the state agency (Pennsylvania BDD) where it is assigned to a disability examiner. Typically, the examiner's first act will be gather medical records from all the sources listed by the claimant at the time of application.

This is usually where a disability case will encounter its first delay. The examiner will send out medical record request letters but his or her success will depend to some extent on the completeness of the information supplied by the claimant when they initially filed.

It is for this reason that claimants are cautioned to supply all known medical treatment sources, including full names of hospitals, clinics, and doctor's offices, along with the names of treating physicians, the dates of treatment, all diagnoses given, and the full addresses of each treatment source.

Doing so can potentially facilitate a faster decision on a claim. In most cases, the single largest amount of processing time on a disability case is consumer by whatever length of time the examiner must spend obtaining the medical records.

After the records have been received, the examiner will review them to determine if the claimant has a condition, mental or physical, that satisfies the requirements of a listing in the Social Security list of impairments.

This usually does not occur because listing requirements tend to be very specific. Also, most medical conditions are not included in the listings.

If it is apparent that a case cannot be approved through a listing, the examiner will check to see if the claimant's medical records and work history information indicate that the claimant's functional limitations are too great for them to either A) return to their past work, or B) perform some type of other work.

When a disability examiner (or a judge if the case is at the hearing level) decides that a claimant cannot go back to a past job or do some type of other work, based on their age, level of education, job skills, and current functional capabilities (their residual functional capacity), the claimant will qualify for disability benefits and the case will be approved.

When a claim for disability is denied in Pennsylvania

In the event your initial disability claim is denied, you can disagree with that decision by filing a reconsideration appeal. Reconsideration appeals are sent back to the same Pennsylvania state disability agency for a review of the initial disability decision.

Reconsideration appeal approval rates are lower than initial disability claim approval rates in all states.

However, if you are filing a reconsideration appeal in Pennsylvania, you have a slightly better chance of qualifying for disability at this level than in most other states.

The reconsideration appeal approval rate is 21.7 percent compared to the national reconsideration appeal approval rate of 11.2 percent. Still, while the reconsideration appeal approval rate is higher in Pennsylvania, the vast majority of reconsideration appeals--approximately 80 percent--are still denied.

Disability hearings in Pennsylania

Should you wish to continue your disability claim after a reconsideration appeal has also been denied, you will have to file a disability hearing request. This will require having to go before an administrative law judge who will make the final disability decision in your case.

Administrative law judges have more freedom than state disability examiners when making their disability determinations, which has allowed the approval rate for disability hearings in Pennsylvania and every other state to be higher than the initial disability claim or reconsideration appeal levels of the Social Security Disability process.

The disability hearing approval rate for Pennsylvania is 55.9 percent versus the national hearing approval rate of 58.5 percent. The odds of winning at the hearing level, of course, may increase when a case that is fully supported by objective medical evidence is presented to an ALJ (administrative law judge) in the form of a viable "theory of the case", meaning that it conforms to Social Security regulations, court rulings, and the medical vocational grid rules that direct decisional outcomes on cases.

Note: The request for reconsideration appeal step is currently suspended in the state of Pennsylania as Pennsylvania is one of 10 prototype states testing a system in which denied claims move immediately to the hearing level upon appeal. Reconsideration may be reinstated at some point and many consider this likely. In the meantime, a claimant who is denied on a disability application should request, and prepare, for a hearing before a federal administrative law judge.

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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