How Does the Social Security Disability Process Work?

If anything is true about life, it is that we can expect that unexpected events will happen. Whether it be an injury or an illness, sometimes people lose their ability to work and provide for their families, either temporarily or permanently.

While some people purchase disability insurance in preparation for this possibility, most do not. In this case, United States citizens and lawful permanent residents (green card holders) can apply for government benefits, such as Social Security Disability Insurance (SSDI). Learn how to apply for SSDI and how we may help make the process easier for you.

Determining Eligibility for SSDI Benefits

Those wishing to apply for Social Security benefits will often go through a state agency to do so. In Pennsylvania, the Bureau of Disability Determination is the state agency that assists the Social Security Administration in determining whether Pennsylvania residents are eligible for federal assistance.

In order for an adult to be considered to have a disability, the Social Security Administration requires that:

• You must be unable to do any substantial work because of your medical condition; and
• Your medical condition must have lasted, or be expected to last, at least one year, or be expected to result in your death.

In order for a child to be considered to have a disability, the requirements are as follows:

• The child must have a physical or mental condition that very seriously limits their activities; and
• The condition must have lasted, or be expected to, last at least one year or result in death.

If you meet are determined to have an eligible disability, you must also meet the following requirements to receive assistance:

• You must have worked and paid Social Security taxes for a sufficient amount of time; some of the taxes must have been paid in recent years; and
• You must be the insured worker or the worker’s adult child or widow(er); and
• You are not performing any substantial work as defined by the Social Security Administration.

Applying for SSDI Benefits

Once you are determined to be eligible, you may begin the application process with the assistance of Pennsylvania’s Bureau of Disability Determination. The Bureau processes approximately 145,000 Pennsylvania disability claims every year, so it is important to begin your application as soon as possible.

While your application is being processed, the Social Security Administration and/or the Bureau of Disability Determination may request additional information, including:

• What medical treatments you have received
• What any medical tests have shown about your condition
• Your doctors’ input on your ability to work

If additional information is needed, examinations will be scheduled at no additional cost to you.

Why Might an Application Get Denied?

There are several reasons an SSDI application may get denied, including the following:

• You earn too much money. If you work above the limit that is considered “substantial gainful activity” (SGA), it means you earn too much money to be considered disabled. In order to receive benefits, you may earn no more than $1,310 per month in 2021 (for non-blind people). Only work income counts toward this amount, not income from investments or anything similar.
• Your disability isn’t severe enough. In order to receive assistance, your disability must last at least one year and prevent you from working enough to earn an income. Common denied claims involve broken bones. Even though they often prevent workers from earning an income, they almost always heal within 12 months. However, each case is evaluated on an individual basis, so do not self-eliminate before going through this process.
• You will not follow prescribed treatments. If you do not follow your doctor’s orders in regard to your injury or illness, your benefits may be denied or terminated. However, there are some exceptions to this rule, including having a mental illness that prevents you from complying with prescribed treatments, you have an intense fear of surgery, you cannot physically follow treatment without assistance, your religious beliefs prevent you from participating in the therapy, and more.
• Your disability is based on drug or alcohol addiction. The Social Security Administration determines that drug or alcohol addiction will prevent an applicant from receiving benefits if the addiction is “a contributing factor material to the determination of disability.”

If you disagree with the decision made on your claim, you have the right to appeal the decision. Your appeal must be in writing and delivered to any Social Security office within 60 days of the date you receive the decision from the Administration. It is important to note, however, that the final acceptance rate for claims between 2006 and 2015 averaged out to 34%.

However, with the help of an experienced attorney, you may not have to go through the appeals process at all. Our team at Robert Peirce & Associates, P.C. is here to help you build a strong claim and get the benefits you deserve. We know exactly the type of evidence the Social Security Administration is looking for, and we can put everything together while you focus on recovering from your injury or illness. We are dedicated to keeping you informed on the progress of your claim and will answer any questions you may have.

Call Robert Peirce & Associates, P.C. at (844) 383-0565 to schedule an appointment!