Pennsylvania Social Security Disability Attorneys

Have You Been Denied Social Security Benefits?

Disability is something must people don't like to think about. Unfortunately, for the vast majority of people, the chances of becoming disabled are greater than they realize. No one plans to become disabled, for some though, it is an unfortunate reality. It is very difficult for most hardworking, independent people to come to the realization that they can no longer work at a full time job due to physical or mental impairments. Many people resist applying for disability benefits, but the program was developed to act as a safety net, so that in the event you develop a disability, you have support for your and your family.

Who Can Qualify for Social Security Disability Benefits?

The two basic elements that you need to me to qualify for Social Security Disability ("SSDI") benefits are:

  • You must prove that you have been or will be unable to work for one year (12 consecutive months); or
  • Your medical condition must result in death

One of these must be in place to qualify for SSDI and you must provide medical proof of the disability. In addition, your work history must show that you have worked enough years to be eligible for benefits.

How The SSA Decides If You Have a Disability

To decide whether you have a disability and are able to receive SSDi benefits as a result of that condition, the SSA uses a 5 step process:

  • Are You Working?
  • If you are working and your earnings average is above a certain amount you generally cannot be considered disabled.
  • Is Your Condition Severe?
    • Your medical condition must be severe enough that it significantly interferes with basic work-related activities for your claim to be considered. 
  • Is Your Disability Found In The SSA Bluebook?
    • The SSA maintains a list of medical conditions that are so severe they automatically mean that you are disabled If your condition is not on the list, the SSA will have to make the determination of whether your condition is of equal severity to a medical condition that is listed.
  • Can You Do The Work You Did Previously?
    • If your condition is severe but not as severe as a medical condition on the list, then the SSA must determine if your condition interferes with your ability to do the work you did previously.
  • Are You Capable of Doing Any Other Type of Work?
    • If you cannot do the work you did in the past, the Social Security Administration will see if you are able to do a less physically and/or mentally demanding job.
    • If you can adjust to other work, and there is other work that fits within your restrictions and limitations, your claim will be denied.
Was Your SSDI Claim Denied?

Unfortunately, most SSDI claims are denied rather than accepted. Generally, 2 out of 3 claims are rejected on the on the initial application. Claims are denied for a variety of reasons. The most common reasons for denial are below:

  • You are Capable of Making too Much Money
    • The Social Security Administration ("SSA") uses a standard called "Substantial Gainful Activity" to determine whether you are able to support yourself. In 2021, the amount of monthly income the SSA considered to be SGA was $1,310.00. Meaning if the SSA thinks you are capable of earning more than this amount your claim will be rejected. 
    • If you are blind the threshold is higher. In 2021, it was $2190.00.
  • You Did Not Have Sufficient Treatment Records
    • This is usually a more common issue for people living with non-physical disabilities. 
  • You Have a Disability Because of a Criminal Conviction
    • Pursuant to the SSA any disabilities incurred in the commission of a crime are not eligible.
  • You Have a Disability Based on Drug and Alcohol Addiction
    • An SSDI applicant will not be approved for benefits if substance abuse (alcohol and or drugs) “substantially contributes to one's disabling condition.”
    • A case like this hinges on is whether the alcohol/drugs was a “contributing factor” to the impairment (either by causing it or making it worse). 
  • Your Disability is Not Expected to Last Long Enough
    • As mentioned earlier, to qualify for SSDI benefits, your disability must be expected to last 12 months or longer or result in death. 
    • In addition, your condition must make it impossible for you to work at your job, not just more difficult.
  • You Did Not Follow Reasonably Prescribed Treatment
    • If you do not follow the treatment recommended by your doctor, SSA will presume that you do not want to get better and deny your claim.
What Does The SSA Consider Substantial Gainful Activity?

SGA is the level of work a person without a disability can do. According to the SSA:

  • Substantial work activity means that you are doing significant physical or mental activities. Work can be substantial even if you can only work part-time, or even if you don't do as much or get paid as much as you did before you became disabled.
  • A gainful activity is one that you get paid to do. However, even if you don't get paid, the SSA may conclude that your work is gainful if it is an activity that people normally get paid to do.
What Types of SSDI Benefits Are There?

Depending on an individual's circumstances, certain family members of workers that are considered disabled can also receive money from Social Security.

How Much Money Will You Receive From SSDI?

The exact amount of money people get for SSDI each month is unique for every individual. This figure is based on your lifetime average earnings as well as the number of family members who qualify.

Can Immigrants Get SSDI Benefits?

Generally, SSDI benefits are available to both U.S. citizens and foreign-born workers. Permanent residents or workers with nonimmigrant visas are both eligible. To qualify for benefits, you must be here lawfully and have earned 40 work credits. As of 2020, you earn one work credit for every $1,410 you earn, and you can earn up to 4 credits per year. 

The Levels of Appeal For SSDI

As mentioned earlier, the vast majority of SSDI applications are initially denied. After your initial application is denied, you will need to follow the steps included in your notice of denial from the SSA.

  • Request for Reconsideration
    • To get the appeals process started, you first request that the initial denial be reviewed again.
    • A reconsideration is a complete review of your claim.
    • If your claim is denied again, you will receive a denial notice and an explanation similar to the one you received when your initial claim was denied. 
  • Administrative Law Judge Hearing
    • If your initial request for reconsideration was denied, and you want to continue to appeal, you must request a hearing before an administrative law judge (ALJ) within 60 days from receipt of your denial.
    • Generally speaking, ALJs grant almost half of the appeals that reach them.
  • Appeals Council
    • If you lose in front of the ALJ, you can request that the Appeals Council review your case. The Appeals Council randomly selects cases for review and has discretion to grant, deny, or dismiss your request for review. The Appeals Council can dismiss your case without review unless it finds one of the following:
      • an abuse of discretion;
      • the decision by the ALJ was not supported by substantial evidence; and
      • a procedural issue is raised
      • Usually, the only reason to file a request with the Appeals Council is to exhaust all of the SSA's administrative appeal avenues, which you must do before you sue Social Security in federal court.
  • Federal Court Review
    • The next step in the appeals process is filing suit in the United States District Court.
    • These appeals are bench trials, meaning the federal judges hear disability cases without juries. 
    • Even though you have a fair chance of winning an appeal after going to federal court, it is not an attractive option, as suing the SSA is expensive and time consuming. Even if you win, it might take years to reach that level of the appeals process.
Contact Us Today

If you or a loved one have been denied SSDI benefits, call Sklarosky Law today at (570) 283-1200 or use our online contact form and tell us about your potential case. SSDI claims can be complex and challenging.  Do not wait, call us today so that we can help you obtain the financial compensation you may be entitled to.

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