What to Do if You Are Denied Disability Benefits in Pennsylvania

Disability Benefits Denial Statistics

The U.S. Census Bureau reports that as of 2010, approximately one in five Americans today live with a disability – that’s nearly 57 million people.  That total includes:

• 2 million people who are unable to see.
• 5.6 million people who use a hearing aid.
• 7 million people with anxiety or depression.
• 19.9 million people with difficulty lifting and holding items.
• 30.6 million people with difficulty walking or going upstairs.

The Census Bureau also reports that only 41% of Americans aged 21 to 64 years old are employed, versus 79% of non-disabled individuals.  For millions of people living with a disability, their condition physically prevents them from working and earning income.

70% of Disability Claims Are Denied

Unfortunately, life doesn’t pause.  While you may be unable to work, your utility bills, grocery expenses, housing expenses, and general costs of living continue to pile up.  To make the situation even more difficult, many people living with a disability must pay enormous medical costs in order to treat and manage their condition.  Between healthcare costs, day-to-day expenses, and a lack of income, the situation can rapidly become overwhelming.

At this point, millions of people decide to apply for monthly disability benefits through the Social Security Administration (SSA).  While some will be approved, the tough reality is that more than half of all applicants will be denied on their first attempt to qualify. Nationwide, the average denial rate is about 70%, meaning the approval rate is approximately 30% – fewer than one-third of all claims.

In Pennsylvania, the approval rate is only slightly better at around 32% (denial rate of 68%).

In New Jersey, applicants may have a somewhat easier time being approved.  The New Jersey approval rate is noticeably higher than the national (or Pennsylvania) average, at about 43.2% (denial rate of 56.8%).

While the statistics may be discouraging, you can take comfort in the fact that a denial isn’t the end of the story. Even if you are denied, a skilled and experienced disability benefits attorney can advocate for your application to be reconsidered.

Why Was My Disability Claim Denied?

Before you take any action, it is critically important to understand why you were denied, even if you feel the SSA’s logic is skewed, unfair, or downright incorrect.

If you are denied, the SSA will send you a denial notice which explains the rationale behind the rejection.  This notice should include a summary of your health condition, all of the documents which were reviewed (e.g. medical records), and the explanation itself.

While some claims are denied for a technical reason, most claims are denied on a medical basis.  When this happens, claimants understandably become frustrated, because they do not understand why the SSA has apparently disregarded their doctor’s professional medical opinion.  While the SSA does take consider your physician’s input and records, the SSA’s Bureau of Disability Determination (BDD) ultimately makes its own evaluation, which is based largely on the condition-specific guidelines contained within the SSA’s official Listing of Impairments.

Some common reasons for claim denials include:

• Your disability doesn’t (or won’t) meet the SSA’s 12-month duration requirement.
• You were convicted of a felony, or you were injured during commission of the felony or while you were in prison. This can prevent you from receiving disability benefits.
• You didn’t follow your doctor’s recommendation for treatment following a diagnosis.  (It should 8be noted that there are exceptions to this rule, e.g. not having enough money to complete the recommended treatment.)
• You failed to keep in touch with the SSA, and cannot be reached.
• Your disability is present, but it isn’t severe enough to prevent you from working.

The more thoroughly you understand why you were denied the first time around – even if you disagree with the reasoning – the less likely you will be to make the same application “mistakes” during your second attempt.

What Should I Do If My Disability Benefits Claim Was Denied?

If you are like most disability claimants, your initial application will, unfortunately, be denied.  If your claim is rejected by the SSA, what should you do?  What happens next?

Once you understand why your claim was denied, it’s time to do two things:

1. Contact an attorney.  A disability benefits lawyer will be able to review and strengthen your application, and will advocate on your behalf when you are going through the appeals process, which does include hearings, judges, and could even go to federal court.
2. Request a Reconsideration.  The official forms to request a Reconsideration from the SSA are available online here.  The “Request for Reconsideration” form is labeled Form SSA-561.

Our Experienced Pennsylvania Social Security Disability Lawyers Can Help

If your disability claim was denied, you don’t have to accept the denial as the final outcome.  At the law offices of Young, Marr, Mallis & Associates, our disability lawyers have more than 25 years of experience representing thousands of clients, and we have obtained millions in rightful compensation for the people of New Jersey and Pennsylvania.  To schedule your free and confidential case evaluation, call today at (609) 755-3115 in New Jersey or (215) 701-6519 in Pennsylvania, or contact us online today.