From 2013-2017, 9.6 percent of all Pennsylvanians under 65 were living with some form of disability. If that statistic isn’t troubling, consider this: 25% of today’s 20-year old population will become disabled before they retire. For many who seek short term disability in PA, however, the application process may seem as troubling as the extensive qualifications process.
The lawyers at Krasno, Krasno & Onwudinjo would like to give potential short term disability applicants an overview of qualifications and eligibility. We will cover how applying affects individuals and employers, and look at how chronic pain diagnoses may play into the short term disability process.
So you understand the distinction between both benefit types, we will discuss employer-sponsored short term disability and Social Security Disability provided by the government.
For Injuries Expected to Last Less Than 12 Months
Pennsylvania short term disability benefits may be awarded to incapacitated or sick employees who cannot work, yet expect their ailments to last less than one year.
Before submitting your application for benefits, there is a waiting period of 0 to 14 days. Once the waiting period has expired, you are free to file for benefits with your employer. Once accepted, you will receive short term disability compensation for no more than twenty-four (24) consecutive months.
In order to increase your chances of approval, the following conditions must exist:
- The company must employ 50 or more full-time workers.
- You must have 12 months or more at your current employer, with at least 1,250 work-hours logged.
- By Pennsylvania Short Term Disability law, you must be considered a key employee. A key employee is a salaried FMLA-eligible wage earner ranking in the top 10 percentile of all highest paid workers residing within 75 miles of the employer’s main facility.
If you find yourself in a situation where you cannot work for a few months, you should familiarize yourself with the application process for short term disability in Pennsylvania. Note that Pennsylvania does not offer short term disability benefits directly.
Applying for Short-Term Disability from Employer
You will basically be applying for workers’ compensation which provides the same relief as short term disability.
Deadlines you should be aware of:
- Employees are given 21 days to tell their employer that they intend to apply for benefits; after 120 days, the claim is time-barred according to Pennsylvania law;
- On or after the 7th day after sustaining your accident, employee and employer may agree on compensation to avoid hearing; and
- Employees have three years to file a claim petition seeking benefits for their work-related injury.
Applicants who are denied should immediately petition for rehearing with an attorney. As these hearings are complex and require comprehensive medical evidence to substantiate your benefits request, you should have an attorney do all work.
If Your Injury Is Expected to Last More Than 12 Months
Injuries that will prevent work for an extended period will qualify for Social Security Disability (SSD) benefits.
In order to qualify for disability benefits in Pennsylvania, you must be able to meet specific criteria as determined by the Social Security Administration (SSA). That criteria includes:
- Having a verifiable medical condition that is expected to last longer than twelve (12) months;
- If you sustained an injury at work, the condition must meet Workers’ Compensation eligibility criteria;
- You must have enough work credits accumulated to qualify for benefits.
The Social Security Administration’s (SSA) method of determining eligibility changes frequently as new illnesses are discovered. With millions of Pennsylvanians submitting applications for benefits annually, the SSA is notorious for denying first-time applicants with legitimate illnesses; one may believe benefits are more difficult to acquire today than in years past.
Those suffering from chronic pain may find maintaining, or securing, gainful employment is difficult at best. Before submitting your application, there are many stipulations regarding chronic pain and your Social Security application that you should understand.
Understanding SSA Guidelines
SSA guidelines require persons to have medically determinable mental or physical ailments expected to last longer than one year. Once that test is passed, one meets age requirements (except for paralysis or blindness). Finally, once lab tests and physician reviews determine that conditions exist that are expected to impede future employment, benefits may begin.
Chronic pain does not qualify unless the applicant can produce evidence their ailment could last for at least 12 months. In other words, experiencing pain that debilitates you would qualify you, provided the condition negatively impacts your ability to maintain employment for the foreseeable future.
Credibility plays an integral role in determining chronic pain – which often goes undetected – and whether you are capable of experiencing, or are currently enduring, the level of pain you claim. An administrative law judge or examiner will normally perform tests such as the Residual Functional Capacity Assessment to gauge your level of pain tolerance.
Assessing Your Residual Functional Capacity
In accordance with the Code of Federal Regulations, Section 416.945, the Social Security Administration will evaluate your highest effective work capacity to be able to ascertain what jobs you may be able to perform. Remember, it is not the Administration’s job to disqualify persons who genuinely need help, but weed out those attempting to defraud the system by investigating them for disability fraud.
Persons with leg issues may not perform standing work duties, but would qualify for sedentary jobs; individuals who cannot recall information due to mental conditions, but read well enough can also find employment. When – and only when – the SSA determines no possible jobs exist that individuals can perform given their condition will benefits be awardable. The Dictionary of Occupational Titles is the standard used by examiners to match work with one’s capabilities.
Disabled persons experiencing chronic pain may be able to qualify by showing an inability to work. Through testing and review, SSA will consider the intensity, frequency, and limitations of your chronic pains to determine if benefits are payable.
Pain Disorders That Might be Eligible for Benefits
Despite the myths about SSDI and short term disability in PA floating around the web, many physical conditions could qualify for benefits in Pennsylvania. Some of those include:
- Somatoform disorders, which are mental conditions so severe they induce physical pain;
- Many neurological syndromes;
- Inflammatory arthritis.
Additionally, certain injuries may cause chronic pain, which impairs one’s ability to work:
- Back, neck, and spine injuries;
- Inflammatory bowel disorder (IBD).
It is difficult to obtain benefits for chronic pain unless you can prove it is caused by a physical or mental impairment that is recognized by the SSA. As the blue book used by SSA does not define chronic pain as a standalone disorder, other injuries or maladies that force chronic pain to exist will qualify.
Enhance Your Credibility with the SSA
A significant portion of chronic pain is unverifiable through traditional medical examinations, meaning that the only way SSA can determine how extreme, or debilitating, your chronic pain may actually be will depend on your ability to come across as ‘believable’ to examiners and administrative judges.
To increase odds of approval, make sure to:
- Let SSA examiners, attorney, and judge know about your strong work ethic and history;
- Ask your doctor to document your exertional and non-exertional limitations, especially if dealing with inflammatory arthritis;
- Give an honest account of how your pain comes and goes; if you can go shopping one day, SSA assumes you can shop every day.
- Be honest when asked to rate pain level. You may be inclined to say 10, but that would likely mean you are unable to move.
- Do not skimp on medical treatment. Get the best care possible as often as possible to prove you are proactive and committed to controlling chronic pain.
How Do I Apply For Short Term Disability In PA?
Social Security Disability (SSD) has many benefits that make going through the application process worth the hassle; in fact, you have no shortage of options when you are ready to apply. You can either hire an experienced lawyer, or start the application process either online at SSA.gov, or in person.
You will be asked questions about your ailment, what you have done to mitigate further damage to your body, where you work and the activities you perform. Most initial applications are denied by default unless you are paralyzed, blind or over 65.
Denied applications will go through an appeals process that could take one or several years. If accepted, you will receive back pay based on when you applied, and when you were granted benefits. With an attorney working on your case, you are likelier to get approved much quicker than if you re-applied without one.
Denied Short-Term Disability? Our Firm Can Help.
Both employers and the government makes their short term disability applications and the eligibility of benefits unnecessarily brutal, which can intimidate applicants who choose to carry on without counsel.
Since Workers’ Compensation only pays if the incapacitating sickness or accident took place at work and a good portion of American workers have less than $1,000 saved, the stakes are high for applicants. Even worse, most American workers have less than $1,000 in their savings at any given time. An unexpected accident at work could be catastrophic, in other words, yet not knowing how to apply for short term disability in PA could be equally devastating.
With your short term disability lawyer handling the formalities of the application process, this habitually nerve-wracking process can go much smoother. Call The Law Offices of Krasno Krasno & Onwudinjo today at 1-888-897-3591 for an initial consultation at no cost to you.