SSDI Denial Appeal Guide – Pennsylvania, PA

Introduction: Why This Guide Matters to Pennsylvanians

Pennsylvania workers who paid FICA taxes have already invested in their right to Social Security Disability Insurance (SSDI). Yet the Social Security Administration (SSA) initially denies roughly two-thirds of first-time SSDI applications statewide, according to the SSA’s own Annual Statistical Report. If you live in Philadelphia, Pittsburgh, Erie, Allentown, or any of the Commonwealth’s 67 counties, a denial letter is not the end of the road. This 2,500-plus-word guide explains your rights, the federal and state rules that protect you, and the practical steps to overturn an unfavorable decision. Although slightly claimant-focused, every statement is grounded in authoritative sources such as the Code of Federal Regulations (CFR), the Social Security Act, and published SSA data.

Primary SEO Phrase

ssdi denial appeal pennsylvania pa

Understanding Your SSDI Rights

SSDI is a federal program administered locally through SSA field offices such as:

• Philadelphia SSA – 2 Penn Center, 20th Floor, 1500 JFK Blvd.
• Pittsburgh SSA – 921 Penn Avenue.

Because SSDI is federally funded, the core eligibility rules do not change across state lines. To qualify you must:

• Have insured status (usually 20 of the last 40 quarters worked per 20 CFR 404.130).
• Show a severe medically determinable impairment lasting or expected to last at least 12 months or result in death (20 CFR 404.1509).
• Prove you cannot perform past relevant work or adjust to other work in the national economy (20 CFR 404.1520).

You also have the right under Section 205(b) of the Social Security Act to a hearing before an Administrative Law Judge (ALJ) after reconsideration.

Common Reasons SSA Denies SSDI Claims

The SSA lists its technical and medical denial codes in Program Operations Manual System (POMS) DI 11010. Denials most frequently issued to Pennsylvania applicants include:

• Insufficient work credits – common for part-time school district employees or gig-economy drivers in Philadelphia.
• Earnings above Substantial Gainful Activity (SGA) – 2024 amount is $1,550/mo for non-blind claimants (20 CFR 404.1574).
• Lack of objective medical evidence – e.g., chronic pain cases followed only by family physicians without MRI or EMG reports.
• Non-compliance with treatment – refusal of a cardiologist-prescribed procedure without documented medical cause.
• Failure to respond to SSA requests – missed consultative examinations at local providers such as Allegheny Health Network.

Federal Legal Protections & Regulations

Pennsylvania claimants benefit from the same federal framework that protects every American worker:

• 20 CFR 404.909 – Establishes your 60-day right to file a Request for Reconsideration after a notice of initial determination.
• 20 CFR 404.933 – Describes hearing procedures before an ALJ, including your right to representation.
• 20 CFR 404.970 – Outlines Appeals Council review standards.
• 42 U.S.C. §405(g) – Grants the right to file a federal district court lawsuit (for Pennsylvania, the Eastern, Middle, or Western District).

Pennsylvania attorneys are governed by the Pennsylvania Rules of Professional Conduct and must also comply with 20 CFR 404.1740 (Rules of Conduct and Standards of Responsibility for Representatives).

Steps to Take After an SSDI Denial

1. Calendar Your 60-Day Deadline

You have 60 days plus five mailing days to appeal (20 CFR 404.909(a)(1)). Missing this window usually forces you to start a new application, losing back-pay months.

2. File a Timely Request for Reconsideration

Use form SSA-561 or the online portal SSA.gov. In Pennsylvania, reconsiderations are processed by Disability Determination Services (DDS) in Harrisburg.”### 3. Strengthen the Medical Record

Work with specialists at UPMC, Penn Medicine, Geisinger, or Lehigh Valley Health Network to gather:

• Imaging reports
• Functional capacity evaluations
• Mental status exams (if mental impairments)

4. Prepare for the ALJ Hearing

If reconsideration fails, request a hearing. Pennsylvania hearings are held via the SSA’s Office of Hearings Operations (OHO) in Philadelphia, Pittsburgh, and Seven Fields, or by video from your local field office.

5. Consider an Attorney or Non-Attorney Representative

Fee-capped at 25% of past-due benefits, not exceeding $7,200 in 2024 (20 CFR 404.1728).

When to Seek Legal Help for SSDI Appeals

Claimants should strongly consider counsel when:

• The file exceeds 500 pages of medical evidence.
• Vocational issues (age 50-54 “closely approaching advanced age”) may trigger Grid Rules (20 CFR Pt. 404, Subpt. P, App. 2).
• Past work is skilled (e.g., union electrician in Scranton) and transferable-skill arguments are likely at hearing.

A Pennsylvania disability attorney can subpoena records from providers who are unresponsive, cross-examine vocational experts, and draft legal briefs citing Third Circuit precedents such as Chandler v. Comm’r, 667 F.3d 356 (3d Cir. 2011).

Local Resources & Next Steps

Key SSA Offices

• Philadelphia OHO – 300 Spring Garden St., 6th Floor.
• Pittsburgh OHO – 1000 Liberty Ave., Suite 1012.
• Harrisburg DDS – 1523 North Sixth St.

Community & Medical Resources

• Legal Aid of Southeastern PA – Free representation for very low-income individuals.
• UPMC Disability Evaluation Center – Functional capacity testing.
• PA Office of Vocational Rehabilitation (OVR) – Post-approval return-to-work supports.

Further Reading

SSA Appeals Process Overview SSA Listing of Impairments (Blue Book) SSA POMS DI Series## Disclaimer

This article is for informational purposes only and does not constitute legal advice. Consult a licensed Pennsylvania attorney regarding your individual circumstances.

If your SSDI claim was denied, call Louis Law Group at 833-657-4812 for a free case evaluation and claim review.