What to Do When Your SSDI Claim is Denied: Complete Appeal Process Guide

Why SSDI Claims Get Denied

Receiving a denial letter for your Social Security Disability Insurance (SSDI) claim can be discouraging, but you're not alone. Approximately 65-70% of initial SSDI applications are denied. Understanding why claims are denied helps you address these issues during the appeal process.

Common Reasons for SSDI Denial

• Insufficient Medical Evidence: Lack of detailed medical documentation supporting your disability
• Failure to Follow Treatment: Not complying with prescribed medical treatments without valid reason
• Short-Term Disability: Condition expected to improve within 12 months
• Technical Denials: Missing work credits or earning above substantial gainful activity limits ($1,550/month in 2025)
• Incomplete Application: Missing information or documentation
• Ability to Perform Other Work: SSA determines you can perform some type of work despite limitations

The Four Levels of SSDI Appeals

If your SSDI claim is denied, you have the right to appeal through four distinct levels. You must complete each level in order before moving to the next.

Level 1: Reconsideration (3-5 Months)

The first step in the appeal process is reconsideration, where a different disability examiner reviews your entire claim from scratch.

What to do:

• File Form SSA-561 (Request for Reconsideration) within 60 days of receiving your denial letter
• Submit new medical evidence and records from recent doctor visits
• Correct any deficiencies identified in the denial letter
• Provide detailed statements from treating physicians about your limitations

Level 2: Administrative Law Judge Hearing (12-18 Months)

If reconsideration is denied, you can request a hearing before an Administrative Law Judge (ALJ). This is where most successful appeals occur, with approval rates around 50%.

What to do:

• File Form HA-501 (Request for Hearing) within 60 days of the reconsideration denial
• Consider hiring a disability attorney (they work on contingency)
• Gather updated medical records and functional capacity evaluations
• Prepare testimony explaining how your disability affects daily activities
• Attend your hearing in person or via video conference

At the Hearing:

• The ALJ will ask questions about your medical conditions, work history, and daily activities
• Medical and vocational experts may testify
• You can present witness testimony from family, friends, or former employers
• Your attorney can cross-examine experts and make legal arguments

Level 3: Appeals Council Review (12-24 Months)

If the ALJ denies your claim, you can request review by the Social Security Appeals Council.

What to do:

• File Form HA-520 within 60 days of the ALJ decision
• Explain why the ALJ decision was incorrect or unfair
• Submit any new and material evidence
• The Council may grant review, deny review, or remand to the ALJ

Level 4: Federal Court (12+ Months)

As a last resort, you can file a lawsuit in federal district court challenging the Appeals Council's decision.

What to do:

• File within 60 days of the Appeals Council decision
• Legal representation is strongly recommended at this level
• The court reviews whether the SSA decision was supported by substantial evidence
• The court can affirm, reverse, or remand the case back to SSA

Critical Deadlines: The 60-Day Rule

Important: You have only 60 days from the date you receive a denial notice to file an appeal. The SSA assumes you received the letter 5 days after the date on the notice, giving you effectively 65 days total. Missing this deadline means starting over with a new application.

If you miss the deadline, you can request an extension, but you must show "good cause" such as:

• Serious illness preventing you from filing
• Death or serious illness in the immediate family
• Important records were destroyed
• You didn't receive the notice due to SSA error

Strengthening Your Appeal

To improve your chances of success, take these proactive steps:

1. Obtain Updated Medical Evidence

Medical evidence is the foundation of your claim. Ensure you have:

• Recent medical records (within the last 90 days)
• Detailed treatment notes from all doctors
• Results from diagnostic tests, imaging, and lab work
• Functional capacity evaluations
• Mental health treatment records if applicable

2. Get Residual Functional Capacity (RFC) Assessments

Ask your treating physicians to complete RFC forms that detail your specific physical and mental limitations, such as:

• How long you can sit, stand, or walk
• Weight lifting limitations
• Frequency of breaks needed
• Concentration and memory issues
• Ability to interact with others

3. Document Your Daily Limitations

Keep a disability journal describing:

• Daily symptoms and pain levels
• Activities you can no longer perform
• How your condition affects daily tasks (cooking, cleaning, personal care)
• Side effects from medications
• Good days vs. bad days

4. Follow All Medical Treatment

Continue following your prescribed treatment plan. If you stop treatment or miss appointments, the SSA may conclude your condition isn't as severe as claimed.

5. Be Honest and Consistent

Provide truthful, detailed information. Inconsistencies between your testimony, medical records, and daily activities can harm your credibility.

Should You Hire a Disability Attorney?

While not required, hiring an experienced disability attorney significantly improves your chances, especially at the hearing level. Benefits include:

Advantages of Legal Representation

• Higher approval rates (statistics show represented claimants win more often)
• Knowledge of SSA rules and medical-vocational guidelines
• Help gathering and presenting medical evidence
• Preparation for hearing testimony
• Cross-examination of vocational and medical experts

Attorney Fees

Disability attorneys work on contingency, meaning:

• No upfront costs or consultation fees
• Fee is 25% of back pay, capped at $7,200 (as of 2025)
• Fees are only paid if you win your case
• Fees are deducted from your back pay automatically by SSA

What to Expect After Winning Your Appeal

Once your appeal is approved:

• Back Pay: You'll receive retroactive benefits from your disability onset date (minus the 5-month waiting period)
• Monthly Benefits: Ongoing monthly payments begin
• Medicare Eligibility: After 24 months of receiving SSDI, you qualify for Medicare
• Continuing Disability Reviews: SSA will periodically review your case to ensure you still qualify

Filing a New Application vs. Appealing

Generally, appealing is better than filing a new application because:

• Your established onset date (EOD) is preserved, protecting your back pay
• Appeals are faster than new applications when you're at the hearing level
• You keep your place in line at the hearing office

However, filing a new application while appealing may make sense if:

• Your condition has significantly worsened since your original application
• You've developed new disabling conditions
• You're past the 60-day appeal deadline

Don't Give Up

An initial denial doesn't mean you don't deserve benefits. The appeal process is designed to catch errors and give you multiple opportunities to present your case. Many people who are eventually approved are denied initially.

Take action quickly, gather strong medical evidence, and consider professional representation. Your persistence can pay off with the disability benefits you've earned through years of work and that you need to support yourself and your family.