Disability Lawyers Near Me: SSDI Guide for New York, Florida

Introduction: SSDI Denials in New York, Florida

Every year thousands of New York, Florida residents apply for Social Security Disability Insurance (SSDI) only to receive a Notice of Disapproved Claim. According to the Social Security Administration (SSA), the national initial approval rate hovers near 35%, and New York’s District Office data show similar numbers. That leaves a majority of local claimants facing stressful decisions about appeals, medical evidence, and financial survival. This guide is written for you—workers who paid into the system, now unable to work, and who need clear, authoritative information to challenge an unjust denial. While the SSA’s regulations are federal and uniform, every state has its own medical networks, SSA field offices, hearing locations, and legal communities. New York claimants often file at field offices such as Manhattan (123 William St., 4th Fl., New York, NY 10038) or Brooklyn (154 Pierrepont St., 6th Fl., Brooklyn, NY 11201). Appeals hearings for downstate residents are usually heard at the New York Office of Hearings Operations, 26 Federal Plaza, Room 2900. Floridians working on your case—including attorneys at Louis Law Group—must be licensed by The Florida Bar, Rule 4-1.1, ensuring minimum competency and ethical standards.

This 2,500-plus-word handbook slightly favors the claimant’s perspective but remains strictly rooted in federal law—mainly the Social Security Act and Title 20 of the Code of Federal Regulations (CFR). You will learn why claims are denied, which statutes protect you, how the four-level appeal works, and when to hire experienced counsel. Bookmark this page, gather your denial letter, and let’s begin protecting your rights.

Understanding Your SSDI Rights

Your Entitlement Under the Social Security Act

SSDI is not a public assistance program; it is an earned benefit funded through Federal Insurance Contributions Act (FICA) payroll taxes. Section 223 of the Social Security Act (42 U.S.C. § 423) gives insured workers the right to a monthly disability benefit when:

• You have the required number of work credits based on age and recent work; and

• You suffer from a “medically determinable impairment” expected to last at least 12 months or result in death, and that prevents “substantial gainful activity” (SGA).

SSA measures SGA annually ($1,470 per month in 2023 for non-blind claimants). If earnings exceed that threshold, SSA must deny, even if your health problem is genuine.

Key Procedural Rights

• Written Notice and Reasons: 20 CFR § 404.904 requires SSA to explain the rationale for every unfavorable decision.

• Right to Representation: 20 CFR § 404.1705 lets you appoint an attorney or qualified non-attorney advocate. Representative fees are capped and must be approved by SSA.

• 60-Day Appeal Window: Under 20 CFR § 404.909 and § 404.933, you generally have 60 days from the date you receive the decision (SSA presumes five days after mailing) to request the next appeal level.

• Right to a De Novo Hearing: At the Administrative Law Judge (ALJ) level, your case is reviewed afresh, and you may present new evidence, call medical/vocational experts, and testify.

These protections apply equally in New York and Florida. The federal venue only changes where your hearing is held, not the legal standard applied.

Common Reasons SSA Denies SSDI Claims

Medical Insufficiency

The most cited reason in SSA statistical reports is “insufficient medical evidence.” SSA’s Listing of Impairments (20 CFR Part 404, Subpart P, Appendix 1) contains strict criteria. Primary care notes alone rarely satisfy these listings. In New York City, claimants with conditions like fibromyalgia or chronic fatigue syndrome often lack longitudinal rheumatology records, leading to DDS (Disability Determination Services) denials.

Work Credit Deficiency

If you moved to Florida and took gig-economy jobs without paying FICA, you may fall short of the “20/40” test—20 work credits earned in the 40 quarters before disability onset. SSA computer systems (MEF and SEQY records) flag such gaps automatically.

Engaging in Substantial Gainful Activity

Many New Yorkers try part-time work while waiting for a decision. If gross earnings average above monthly SGA, DDS must deny by regulation—regardless of your physician’s opinion.

Failure to Follow Prescribed Treatment

Under 20 CFR § 404.1530, claimants who refuse recommended treatment without a ‘justifiable cause’ risk denial. An ALJ in the Manhattan hearing office cited this rule to deny a claimant who would not undergo spinal fusion surgery.

Non-Severe Impairment or Duration

Impairments expected to improve within 12 months do not meet the Act’s definition of disability. Post-operative recovery cases illustrate this. DDS routinely denies orthopedic injuries anticipated to heal in under a year.

Procedural Missteps

Missing deadlines, failing to return SSA-3373 Function Reports, or not attending consultative exams are all processed as denials due to “insufficient evidence.”

Federal Legal Protections & Regulations

The Five-Step Sequential Evaluation

Regulations at 20 CFR § 404.1520 define a mandatory five-step review:

• SGA test – Are you working above SGA?

• Severity test – Is your impairment severe?

• Listings test – Does it meet or equal a Listing?

• Past relevant work (PRW) – Can you do your former jobs? (20 CFR § 404.1565)

• Other work – Considering age, education, and Residual Functional Capacity (RFC), are there other jobs in significant numbers you can perform? (20 CFR § 404.1560)

The burden of proof shifts at Step 5 to SSA, a critical advantage claimants should embrace at the ALJ stage.

Judicial Precedent Benefiting Claimants

• Schauer v. Schweiker, 675 F.2d 55 (2d Cir. 1982) – The Second Circuit, whose jurisdiction covers New York, held that subjective pain testimony cannot be dismissed solely because objective evidence is lacking.

• McRoberts v. Bowen, 841 F.2d 1077 (11th Cir. 1988) – Binding in Florida, this case requires ALJs to articulate “good cause” before discounting a treating physician’s opinion.

Together these cases underscore your right to a fair credibility assessment and proper weight for treating doctors—particularly powerful when paired with 20 CFR § 404.1520c (new medical opinion rules).

Statute of Limitations on Appeals

You must proceed through the appeals chain in this order, each within 60-days:

• Reconsideration – 20 CFR § 404.907 (except prototype states; New York reinstated reconsideration in 2019).

• Administrative Law Judge Hearing – 20 CFR § 404.933.

• Appeals Council Review – 20 CFR § 404.968.

• Federal District Court – 42 U.S.C. § 405(g) (60 days from Appeals Council denial).

Missing a deadline usually ends your claim unless you show “good cause” under 20 CFR § 404.911, such as hospitalization or mental impairment.

Steps to Take After an SSDI Denial

1. Review the Denial Letter Carefully

The letter lists “technical” or “medical” reasons. For medical denials, note the date of onset the adjudicator used and which evidence was considered.

2. File a Timely Reconsideration

Use SSA-561 Request for Reconsideration and SSA-3441 Disability Report-Appeal. In New York, you can file online through SSA’s iAppeals portal. Keep the electronic receipt.

3. Update Medical Evidence

Secure imaging, lab results, and specialist notes dated after the initial decision. In New York City, facilities like NYU Langone or Mount Sinai can furnish rapid electronic record transfers. If you have moved to Florida, ensure Tampa General Hospital or the Mayo Clinic Jacksonville submits records directly to SSA’s Electronic Records Express (ERE) fax.

4. Track Deadlines and Confirm Receipt

Mail appeals certified or upload online. Call the local field office (SSA Brooklyn: 866-331-6399) within 10 days to confirm scanning.

5. Prepare for the ALJ Hearing

Average wait times in New York are about 11 months; in Miami, roughly 9 months. Use this period to:

• Undergo objective tests (e.g., MRI, EMG) that match Listing criteria.

• Ask treating specialists to complete SSA-form “Medical Source Statements.”

• Maintain a symptom diary, crucial for pain-related claims under Schauer.

• Consider vocational assessments showing you cannot perform past work.

6. Consider On-the-Record (OTR) Requests

If evidence is overwhelming, your representative may file an OTR brief, potentially securing a favorable decision without a hearing, saving months.

When to Seek Legal Help for SSDI Appeals

SSA allows self-representation, but statistics published in the SSA’s Office of Retirement and Disability Policy show higher allowance rates when claimants are represented. Here are practical benchmarks for retaining counsel:

• Complex Medical Profiles: Multiple impairments or rare diseases such as systemic lupus often demand precise legal argument linking medical findings to specific Listing criteria.

• Adverse Vocational Factors: If you are under 50 and denied at Step 5 because SSA believes you can perform sedentary work, a legal brief citing Medical-Vocational Rule 201.00(h) could be pivotal.

• Prior Unfavorable ALJ Decision: Appeals Council and federal court review focus on legal errors. An attorney must draft arguments referencing the record and precedent like McRoberts.

• Evidentiary Gaps: Representatives can subpoena records or request consultative exams better tailored to your impairment.

Fees are contingency-based and capped at 25% of past-due benefits or $7,200 (2024 cap) per 20 CFR § 404.1730. No upfront payment is required.

Local Resources & Next Steps

Key SSA Offices Serving New York Claimants

• Manhattan Field Office: 123 William Street, 4th Floor, New York, NY 10038. Phone: 866-331-5283.

• Office of Hearings Operations (OHO): 26 Federal Plaza, Room 2900, New York, NY 10278.

Medical Facilities Experienced with SSA Forms

• NYU Langone Disability Documentation Unit – Coordinates RFC forms.

• Mount Sinai Hospital Social Work Dept. – Assists patients with SSA paperwork.

Legal Aid & Community Support

Legal Services NYC – Free representation for low-income claimants. Empire Justice Center – Publishes New York-specific disability manuals.

Florida-Based Support for Transplants

Many New Yorkers relocate to Florida after disability onset. If you become a Florida resident, your case will be transferred to the appropriate DDS in Tallahassee, but your prior evidence remains valid. You can seek help from:

Florida Legal Services.

• Local Social Security field offices such as the Miami SSA Office, 11401 SW 40th St., Miami, FL 33165.

Checklist Before Calling an Attorney

• Collect your denial letters and any SSA-827 authorization forms.

• Create a timeline of medical treatment with provider contacts.

• Note appeal deadlines on a calendar.

• Prepare questions about attorney fees and strategy.

Conclusion

A denial is not the end; it is the beginning of a federally protected appeals process designed to correct errors. By understanding 20 CFR § 404.1520, key court rulings like Schauer and McRoberts, and leveraging local resources in New York and Florida, you dramatically improve your odds of ultimately receiving the benefits you earned.

Legal Disclaimer: This guide is for informational purposes only and does not constitute legal advice. Laws and regulations change. Consult a licensed Florida attorney regarding your specific situation.

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