There are certain medical conditions that may automatically qualify you for Social Security disability benefits in Pennsylvania. The Social Security Administration (SSA) maintains a list of disabling conditions that are severe enough to prevent an individual from working. If you have one of these conditions, the SSA will expedite the disability application process.
What are the medical requirements for disability in PA?
To qualify for disability benefits in Pennsylvania, you must have a physical or mental condition that:
- Prevents you from performing substantial gainful activity (SGA)
- Is expected to last at least 12 months or result in death
Substantial gainful activity refers to the ability to earn a certain monthly income from working. For 2023, the monthly SGA amount is $1,470 for non-blind individuals and $2,460 for blind individuals.
Your condition must also be considered severe enough to meet the requirements in the SSA’s Blue Book listing of impairments. The Blue Book contains criteria for hundreds of disabling conditions organized by body system.
What conditions are included in the Blue Book?
Some of the body systems and conditions covered in the Blue Book include:
- Musculoskeletal system: arthritis, back disorders, fractures
- Special senses: loss of vision, loss of hearing
- Respiratory system: COPD, cystic fibrosis, asthma
- Cardiovascular system: chronic heart failure, aneurysms
- Digestive system: liver disease, inflammatory bowel disease
- Genitourinary system: chronic kidney disease, nephrotic syndrome
- Hematological disorders: sickle cell disease, hemophilia
- Skin disorders: burns, skin infections, dermatitis
- Endocrine system: diabetes, thyroid disorders, adrenal gland disorders
- Congenital disorders: Down syndrome, spina bifida
- Neurological disorders: stroke, Parkinson’s, epilepsy, TBI
- Mental disorders: schizophrenia, bipolar, depression, anxiety
- Cancer
- Immune system disorders: HIV/AIDS, lupus
What conditions automatically qualify you for disability?
There are some conditions that automatically qualify you for disability benefits in Pennsylvania if your medical records show that your condition meets the Blue Book listing. These include:
- End stage renal disease (ESRD) requiring dialysis
- Amputation of two limbs
- Total blindness
- Total deafness – unaided hearing threshold of 90dB or greater in the better ear
- Non-healing fractures and soft tissue injuries
- Brain tumors
- Intellectual disability – IQ below 70 along with deficits in adaptive functioning
- Certain cancers – e.g. small cell cancer, pancreatic cancer, etc.
- Amyotrophic Lateral Sclerosis (ALS)
- Coma lasting at least 1 month
- Heart transplant recipients
In addition, if you are a worker over the age of 50 who can no longer perform your previous occupations due to disability, you may also qualify under the SSA’s Medical-Vocational guidelines, which consider age, education, work experience, and transferable skills.
How do I prove I qualify for disability benefits in PA?
To prove you qualify for disability in Pennsylvania, you will need to provide medical evidence from your doctor, including:
- Office visit notes documenting examinations, reported symptoms, test results, diagnoses, treatment, etc.
- Hospital discharge summaries
- Imaging study results (x-rays, MRIs)
- Lab test results
- Psychological evaluations
- Information about medications you have been prescribed
This evidence should show that your condition meets or equals the criteria in the Blue Book listing for your impairment. The more detailed documentation you can provide about your limitations, the better.
How long does it take to get approved for disability in PA?
Getting approved for disability benefits in Pennsylvania can take anywhere from 3 to 6 months on average. However, if you have a condition that is included in the list of compassionate allowances conditions, you could get an approval in as little as a few weeks to a couple months.
The timeline involves these steps:
- Initial application – 1 to 2 months for initial decision
- Reconsideration request – 1 to 2 months for reconsideration decision
- Administrative law judge hearing – 1 to 2 months for hearing; 1 to 2 months for decision
- Appeals Council review – 1 to 2 months for review; 1 to 2 months for decision
- Federal Court review – 1 to 2 months for review; 1 to 2 months for decision
At each stage, your case could be approved. If denied, you would move on to the next level of appeal. Having an experienced Social Security disability lawyer can help speed up the process and increase your chances of approval.
When do disability benefits start in Pennsylvania?
If approved for disability, your disability benefits will start 5 months after your determined date of disability onset. So if the SSA decides your disability began on January 15, 2022, your benefits would start on June 15, 2022.
Exceptions include:
- Disabilities that require 6+ months to determine – benefits start 12 months before application month
- Concurrent SSDI/SSI claims – SSDI starts 5 months after onset; SSI starts in application month
You also must complete a 5-month waiting period before benefits kick in. You become eligible for Medicare benefits 24 months after your disability benefits start.
How much will I receive in disability benefits in Pennsylvania?
Your disability benefit amount will depend on your average lifetime earnings. Social Security disability insurance (SSDI) pays a monthly percentage of what you earned and paid taxes into the system on.
The maximum SSDI benefit in 2023 is $3,345 per month. However, the average benefit amount in Pennsylvania is around $1,400 per month. SSI disability pays a flat monthly amount up to $914, but this may be supplemented if you have little income or assets.
Are my family members eligible for benefits in PA?
If you qualify for SSDI in Pennsylvania, certain family members may also be eligible for additional monthly dependent benefits. These include:
- Spouse age 62 or older – up to 50% of your benefit amount
- Spouse with a child under age 16 – up to 50% of your benefit amount
- Children under age 18 – up to 50% per child
- Children age 18-19 still in high school – up to 50% per child
- Disabled adult children – up to 50% per child
These benefits are paid out of your SSDI amount and do not decrease your benefit. Family members may also qualify if you receive SSI disability.
What medical conditions are likely to be denied?
Some of the conditions that are commonly denied disability benefits in Pennsylvania include:
- Minor arthritis
- High blood pressure
- Obesity, unless causing major limitations
- Anxiety or depression that is mild to moderate
- Addiction disorders
- ADHD
- Digestive disorders like IBS, Crohn’s disease
- Fibromyalgia
- Sleep apnea
- Diabetes that is well controlled
- Carpal tunnel syndrome
- Asthma that is mild to moderate
For these conditions to be approved, symptoms and limitations must be very severe with supporting documentation.
Should I get a disability lawyer in Pennsylvania?
Getting help from a disability lawyer in Pennsylvania can significantly increase your chances of approval. Statistics show approval rates are much higher at the hearing level when represented by an attorney.
An experienced lawyer will:
- Help you understand qualifications and required medical proof
- Obtain your medical records
- Communicate with your doctors if needed
- File appeals if you are denied
- Represent you at hearings
- Address any legal issues
Most disability attorneys work on a contingency fee basis, meaning they only collect a fee if you are awarded benefits. The fee is capped at 25% of your retroactive benefits or $6,000 maximum, whichever is less.
Key Takeaways
- You must prove your disability prevents substantial gainful work activity for at least a year.
- Certain conditions like ESRD, amputation, blindness, etc. automatically qualify if fully documented.
- It can take 3 to 6 months or longer to qualify for benefits.
- Average SSDI payments are around $1,400 per month.
- Having a disability lawyer represent you can significantly improve your chances of approval.
Conclusion
Qualifying for disability benefits in Pennsylvania involves having severe disability, detailed medical evidence, and often patience with the application process. Seeking help from an attorney and understanding which conditions are likely to be approved or denied can help speed up the process. If you suffer from a serious medical condition, don’t assume you will not qualify – it’s worth exploring your options.