Home » Who Decides if You Get Disability Benefits in Pennsylvania?

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. However, you stand the best chance of getting the benefits you deserve by working with our skilled Social Security Disability benefits attorneys.

For a free case consultation with our Social Security Disability benefits lawyers, call Young, Marr, Mallis & Associates at (215) 701-6519.

Social Security Disability Insurance 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 Bureau of Disability Determination 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.

Disability as Defined by the Social Security Administration 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 $1,470 per month, and $2,460 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.

Understanding the Pennsylvania Social Security Disability Insurance Process

The process of recovering benefits from Social Security Disability Insurance can be notoriously challenging and often confusing. However, the process is similar for most applicants and can be broken down into a few important parts. The following is the general process for receiving SSDI benefits in Pennsylvania:

Applying for Social Security Disability Benefits

Applying for SSDI benefits is arguably the most crucial stage of the SSDI process in Pennsylvania. To ensure that your application has the best chance of getting approved on the first attempt, knowing exactly what information the BDD will need is important. With the right evidence, your SSDI benefits claim will likely process much faster and avoid a lengthy and stressful appeals process.

To demonstrate your disability and qualify for benefits, you will need to provide certain information and medical evidence. This includes your Social Security number and proof of age for all individuals applying for benefits, including spouses and children. You should also provide the names, addresses, and phone numbers of any medical facilities or professionals who have treated you, along with dates of treatment.

Additionally, it is important to list all medications you are currently taking and their prescribed dosages and provide any medical records, x-rays, or test results related to your condition. A summary of your work history from the past 15 years, including company names, addresses, and supervisor contact information, is also required. If you are self-employed, you must also provide a copy of your W-2 form or federal tax return.

If you have a bank account, bring documentation from your bank to facilitate direct deposit of your benefits. If applying for SSI, you may need to provide additional information about your home, income, and assets. Proof of U.S. citizenship or non-citizen status is also required.

Getting Approved for Social Security Disability Benefits

After applying for Social Security disability benefits, the initial step involves the Social Security Administration reviewing your application to ensure that you meet the eligibility criteria. If you meet these criteria, your application is then forwarded to the BDD for a medical review to determine your qualification for disability benefits under Social Security law. However, your application will generally take about three to five months to be processed.

During this process, the BDD requests and reviews medical evidence from various sources, such as your doctors, hospitals, and other medical treatment providers. The BDD evaluates this evidence to determine the severity of your condition and whether it meets the requirements for Social Security disability benefits.

Your doctor may be asked to provide various pieces of information when evaluating your eligibility for disability benefits. This information may include details about your medical condition, such as what it is and when it began. Additionally, your doctor may be asked to explain how your medical condition limits your ability to perform daily activities.

Medical evidence, such as test results, might also be requested from your doctor. Finally, your doctor might be asked to provide information about what treatments you have received for your medical condition. This can help determine your condition’s severity and eligibility for benefits.

The BDD may also request information from your doctors regarding your ability to perform work-related activities, such as walking, sitting, lifting, carrying, and following instructions. It is important to note that your doctors are not responsible for deciding your disability status.

In the case of children, information may be gathered from various sources, including medical providers, school officials, and other individuals familiar with the child’s condition. If more information is needed to evaluate your eligibility for benefits, the BDD could schedule special examinations at no cost to you. These exams are designed to provide additional information to determine your disability status.

When You Will Start Receiving Social Security Disability Benefits

Of course, the question you might be most concerned with is when you will receive your SSDI benefits. This will depend on whether your application is approved. If it is approved, you should receive your disability payments without delay. In practice, though, applicants might have to wait an unspecified amount of time before receiving benefits to allow the BDD to determine if they are still eligible for benefits at that point. However, if you have a qualifying disability, injury, or illness, you might receive your benefits immediately.

If you have entered into the waiting period, the BDD should notify you of the decision. From there, applicants must wait for five months before the final approval of their claim, during which they will receive no benefits. After getting final approval, it will take one more month before you get your benefits payment. As long as you remain eligible, you will receive benefits once a month through direct deposit to your bank account or by mailing you a check.

How Long You Can Receive Social Security Disability Benefits

The other question likely on your mind is how long you will receive benefits. This depends on your continued eligibility. Social Security Disability benefits are available to individuals that have worked for several years and have paid into Social Security through their taxes. If you have a qualifying injury, condition, or illness, you could receive benefits for the remainder of your life if you can no longer work. However, your payments will stop when your condition has improved, and you are prepared to return to work or if you are working again already. Keep in mind, though, that the SSA will review your case periodically to determine if your medical condition has improved. You are also required to report any developments in your condition, whether positive or negative.

Your SSDI benefits can also be stopped if you exceed the Social Security Administration’s income limit. This is also known as the “substantial gainful activity” (SGA) limit. As of 2023, non-blind recipients cannot exceed an income of $1,470 per month, and blind recipients must not make more than $2,460. You can work for a trial period if you earn over $1,050 a month but less than the SGA limit. However, your benefits might be cut off if your work period lasts more than nine months.