Social Security Lawyers Near Me: SSDI – Massachusetts, MA

SSDI Denials and Appeals in Massachusetts, Massachusetts: What Social Security Lawyers Near Me Want You to Know

Receiving a Social Security Disability Insurance (SSDI) denial is frustrating—especially when your medical condition clearly limits your ability to work. If you live anywhere in Massachusetts, Massachusetts, you still have strong rights and multiple opportunities to appeal that decision under federal law. This comprehensive guide explains how the Social Security Administration (SSA) evaluates disability claims, common reasons denials occur, what deadlines apply, how to pursue each level of appeal, and where to find local resources serving Massachusetts residents. It also highlights how a Massachusetts disability attorney may help you strengthen your case.

Massachusetts claimants are served locally by SSA field offices and the SSA’s Boston Region, and hearings for Massachusetts residents are generally assigned by the Office of Hearings Operations serving the Commonwealth. While many steps occur online, it can be reassuring to know your appeals are administered within the Boston Region and that in-person services are available at your nearest SSA field office if you choose. Because federal SSDI rules apply uniformly nationwide, this guide focuses on the federal statutes and regulations that control your claim and appeal—always tailored to practical steps you can take from within Massachusetts.

One reminder at the outset: SSDI appeals are time-sensitive. Most appeal stages require action within 60 days of the date you receive SSA’s notice (with an assumed 5 additional days for mailing in most cases). Missing a deadline can jeopardize your benefits unless you establish “good cause” for late filing, so being prompt and organized is critical.

Understanding Your SSDI Rights

What SSDI Is—and Is Not

SSDI is a federal insurance program for workers who paid Social Security taxes and can no longer perform substantial gainful activity due to a medically determinable impairment expected to last at least 12 months or result in death. The core definition of disability is set out in federal regulations, including 20 CFR 404.1505 (basic disability standard) and the five-step evaluation in 20 CFR 404.1520 (sequential evaluation process). SSDI differs from Supplemental Security Income (SSI), which is a needs-based program. This guide focuses on SSDI, though many legal rules overlap.

Your Right to Apply and to a Full and Fair Review

As a Massachusetts worker or former worker, you have the right to file an SSDI application and to have SSA evaluate your claim under the federal five-step process. You also have the right to:

• Be represented by an attorney or qualified non-attorney representative at any stage (20 CFR 404.1700–404.1717).
• Review your file and submit evidence, including medical records and function reports (20 CFR 404.1512 and 404.1513).
• Receive written decisions and notices explaining determinations.
• Appeal denials through reconsideration, a hearing before an administrative law judge (ALJ), review by the Appeals Council, and federal court (20 CFR 404.909, 404.933, 404.968; judicial review under 42 U.S.C. § 405(g)).

Insured Status and Work Credits

To qualify for SSDI, you generally must be “insured” by having worked and paid Social Security taxes for a sufficient period relative to your age and the date you became disabled. This is governed by 20 CFR 404.130 (insured status). If your “date last insured” (DLI) has passed, you must show you were disabled on or before that date. If your claim was denied for lack of insured status, a Massachusetts disability attorney can help you analyze your earnings history to confirm its accuracy.

Medical Evidence and Your Treating Sources

SSA requires objective medical evidence from acceptable medical sources to establish a medically determinable impairment (20 CFR 404.1513). Evidence includes clinical findings, imaging, laboratory results, diagnoses, and functional assessments. Massachusetts residents often receive care from large health systems and clinics statewide; comprehensive records from all treating providers are crucial. If SSA needs more information, it may arrange a consultative examination (20 CFR 404.1519).

Common Reasons SSA Denies SSDI Claims

While every case is unique, denials tend to fall into a few recurring categories. Understanding these helps you fix issues before you appeal.

1) Working Above Substantial Gainful Activity (SGA)

If SSA decides your earnings show you can perform substantial gainful activity, it will deny at Step 1 of the sequential evaluation. SGA is defined in 20 CFR 404.1572 and related sections. Earnings thresholds change over time; SSA evaluates both income and work activity. If you tried to return to work but couldn’t sustain it, explain whether it was an unsuccessful work attempt.

2) Not Severely Impaired for 12 Months

To be disabled under 20 CFR 404.1505, your impairment must be severe and expected to last at least 12 months or result in death. Claims may be denied if SSA thinks your condition improved too quickly or lacks longitudinal documentation. Massachusetts claimants can address this by submitting updated treatment notes, specialist evaluations, and objective testing results that demonstrate persistent limitations.

3) Insufficient Objective Medical Evidence

Under 20 CFR 404.1513, SSA needs medical signs, laboratory findings, and clinical observations. Many initial denials cite gaps in care, missing tests, or records that don’t address functional impact. Submitting a detailed residual functional capacity (RFC) opinion from your treating provider that describes your ability to sit, stand, walk, lift, concentrate, and meet attendance requirements can be persuasive, especially when supported by objective findings (see 20 CFR 404.1545 on RFC).

4) Ability to Perform Past Work or Other Work

Even if you can’t do your past relevant work, SSA may deny your claim if it believes you can do other work available in the national economy (20 CFR 404.1560–404.1569). The Medical-Vocational Guidelines (commonly called the “Grid Rules”) in 20 CFR Part 404, Subpart P, Appendix 2, may direct a finding of “disabled” or “not disabled” based on your age, education, work history, and RFC. Disputes often center on how the RFC is formulated and how vocational evidence is applied.

5) Noncooperation or Missed Appointments

Failing to respond to SSA requests, missing consultative examinations, or not completing forms can lead to denial. Keeping your contact information current and responding promptly is essential.

6) Treatment Noncompliance

SSA may deny claims if it concludes you failed to follow prescribed treatment that could restore your ability to work, without good reason (see 20 CFR 404.1530). If you have legitimate reasons (e.g., severe side effects, inability to afford treatment, or conflicting medical advice), document them clearly.

Federal Legal Protections and Regulations That Shape Your Case

SSDI appeals do not depend on state-specific benefit laws. Instead, they are governed by federal statutes and regulations that apply equally to Massachusetts claimants. Key authorities include:

• 20 CFR 404.1520: The five-step sequential evaluation. SSA determines whether you are working at SGA, whether you have severe impairments, whether you meet a Listing, whether you can do your past work, and whether you can do other work.
• 20 CFR 404.1505: Defines disability for SSDI purposes.
• 20 CFR 404.1512 and 404.1513: Your responsibilities to submit evidence and what counts as acceptable medical evidence.
• 20 CFR 404.1545: Residual functional capacity (RFC) assessment.
• 20 CFR 404.1560–404.1569 and Appendix 2: Vocational factors and the Medical-Vocational Guidelines.
• 20 CFR 404.909, 404.933, 404.968: Deadlines and procedures for reconsideration, ALJ hearing, and Appeals Council review.
• 20 CFR 404.935: Five-business-day rule for submitting or informing SSA about evidence before an ALJ hearing.
• 20 CFR 422.210 and 42 U.S.C. § 405(g): Judicial review in federal court after the Appeals Council.
• 20 CFR 404.1700–404.1717 and 42 U.S.C. § 406: Representation and fee approval. SSA must approve your representative’s fee; most are contingent on past-due benefits.

These authorities protect your right to a full and fair review. They also establish the time limits and evidentiary rules you must follow for a successful appeal.

Steps to Take After an SSDI Denial

Massachusetts residents who receive a Notice of Disapproved Claim should take the following steps promptly. Timeliness and documentation are key.

1) Calendar Your Deadline Immediately

You typically have 60 days from receipt of the denial notice to appeal to the next level (SSA assumes you received it 5 days after the date on the notice unless you show otherwise). See 20 CFR 404.909(a)(1) for reconsideration deadlines; similar timelines apply for hearings (20 CFR 404.933) and Appeals Council review (20 CFR 404.968). If you miss a deadline, you may request an extension by showing “good cause” (20 CFR 404.911).

2) File for Reconsideration (First Appeal Level)

Most initial denials are reconsidered by a different examiner. You can file online or through your local SSA office. At this stage, submit updated medical records, correct any errors, and provide detailed statements about your functional limitations and work history. If you are in Massachusetts, your reconsideration is handled within the SSA’s Boston Region processes.

3) Request a Hearing Before an Administrative Law Judge (ALJ)

If reconsideration is denied, request an ALJ hearing within 60 days (20 CFR 404.933). Hearings can be held by video or in-person and provide the best chance to present your case directly to a judge. Prepare by:

• Organizing medical evidence and obtaining opinion letters or RFC forms from treating specialists.
• Preparing testimony about your symptoms, daily activities, and work history.
• Addressing the five-step analysis with a focus on why you cannot sustain full-time work.
• Anticipating vocational expert testimony and whether hypothetical questions reflect your true limitations.

Under 20 CFR 404.935, submit or identify all evidence at least five business days before the hearing. If new evidence becomes available late, explain why it could not be submitted earlier.

4) Seek Appeals Council Review

If the ALJ denies your claim, you can request review by the Appeals Council within 60 days (20 CFR 404.968). The Appeals Council may grant review, deny review (making the ALJ decision final), remand your case to the ALJ for further proceedings, or issue its own decision. Provide arguments identifying legal errors, evidentiary oversights, or new and material evidence that relates to the period at issue.

5) File a Federal Court Action

After the Appeals Council denies review or issues an unfavorable decision, you have 60 days to file a civil action in the United States District Court with jurisdiction over your residence—in Massachusetts, that is the U.S. District Court for the District of Massachusetts—under 42 U.S.C. § 405(g) and 20 CFR 422.210. The court reviews the administrative record for legal error and whether the decision is supported by substantial evidence. Federal court practice is formal litigation; many claimants choose to retain counsel for this stage.

How a Massachusetts Disability Attorney Can Help

While you may represent yourself, many Massachusetts claimants choose to work with an experienced representative at some point in the process. A representative can help you:

• Identify missing or persuasive evidence, request records, and coordinate detailed RFC opinions from treating specialists.
• Develop the vocational theory of your case, including challenges to transferable skills and job numbers based on your limitations.
• Prepare you to testify effectively about the frequency, duration, and impact of symptoms, side effects, and functional limits.
• Observe and brief legal issues at the ALJ hearing and on appeal (e.g., application of the Medical-Vocational Guidelines, consideration of combined impairments, evaluation of medical opinions under current regulations).

Under 42 U.S.C. § 406 and 20 CFR 404.1700–404.1717, SSA must approve any fee for representation. Most representatives use a contingency fee approved by SSA, typically a percentage of past-due benefits and subject to a cap set by SSA. You do not pay fees unless you obtain past-due benefits, although you may be responsible for out-of-pocket costs like obtaining medical records. Fee terms should be provided in writing.

Attorney Licensing in Massachusetts

In Massachusetts, attorneys are admitted by the Supreme Judicial Court and are subject to regulation and discipline overseen in part by the Board of Bar Overseers. For Social Security administrative proceedings, attorneys licensed and in good standing in any U.S. jurisdiction may represent claimants before the SSA (20 CFR 404.1705). If you seek court representation in the U.S. District Court for the District of Massachusetts, counsel must be admitted to that federal court’s bar or appear pro hac vice in accordance with the court’s rules.

Key Federal Rules to Leverage in Your Appeal

The Five-Step Sequential Evaluation (20 CFR 404.1520)

• SGA: Are you working at substantial gainful activity levels? If yes, not disabled.
• Severe Impairment: Do you have a severe, medically determinable impairment (or combination) that significantly limits basic work activities for at least 12 months?
• Listings: Does your condition meet or equal a listing in 20 CFR Part 404, Subpart P, Appendix 1? If yes, disabled.
• Past Work: Can you perform your past relevant work given your RFC?
• Other Work: Can you adjust to other work existing in significant numbers given your RFC, age, education, and work experience?

Make sure your evidence and arguments specifically address each step.

Evidence Duties and Acceptable Sources (20 CFR 404.1512–404.1513)

You are responsible for providing evidence and telling SSA about your medical sources. Acceptable medical sources include licensed physicians and certain other qualified practitioners. Functional assessments, imaging, labs, and treatment histories are all relevant. If SSA lacks sufficient evidence, it may order a consultative exam (20 CFR 404.1519).

RFC and Vocational Issues (20 CFR 404.1545; 404.1560–404.1569; Appendix 2)

Residual functional capacity determines what you can do on a sustained basis. Consider limitations in sitting, standing, lifting, use of hands, postural activities, pain, concentration, pace, persistence, attendance, and need for breaks. Vocational experts may testify about jobs and transferable skills; your representative can challenge assumptions and job-incidence evidence where appropriate.

Practical Tips After an SSDI Denial in Massachusetts

• Do not file a new application unless advised. Filing a fresh claim can sacrifice your protective filing date. Appeal on time to keep your claim alive.
• Request your file. Review the SSA exhibit list, medical assessments, and vocational findings that supported the denial.
• Build the record. From specialists to primary care, ensure all providers submit complete, updated records. Ask for detailed RFC opinions tied to objective findings.
• Document daily limitations. Keep a symptom and activity log that tracks pain, fatigue, mental health symptoms, side effects, and bad days.
• Address gaps in treatment. If cost, transportation, or other barriers exist, document them. If medication causes side effects, tell your provider and ensure it’s charted.
• Meet every deadline. Use certified mail or online submission receipts to verify timely filing.
• Prepare for the hearing. Practice answering questions about your past work, transferrable skills, and why you cannot sustain full-time work. Identify witnesses if helpful.

Local Resources and SSA Contacts for Massachusetts

Massachusetts residents are served by SSA field offices throughout the Commonwealth and by the SSA’s Boston Region. To confirm your nearest field office and available services, use SSA’s official locator:

Find Your Local SSA Office (Office Locator) Appeals and hearings for Massachusetts claimants are administered within the Boston Region. For a regional overview, including general contacts and program information, consult SSA’s regional resources:

SSA Regional Offices (Boston Region) If you need federal court review after the Appeals Council, Massachusetts residents typically file in the U.S. District Court for the District of Massachusetts under 42 U.S.C. § 405(g). Federal court procedures are formal and governed by strict rules and deadlines; consider consulting counsel admitted to that court.

Massachusetts Medical and Support Context

Your medical records are the backbone of your SSDI case. Massachusetts is home to numerous hospitals, clinics, and specialists. Ensure that all treating sources—primary care, specialists, mental health providers, imaging centers, and physical or occupational therapists—submit complete and timely records. Vocational rehabilitation and independent living services in Massachusetts may also provide documentation of functional limitations relevant to work capacity. Keep copies of everything you submit.

Deadlines and Statutes of Limitations for SSDI Appeals

• Reconsideration: Request within 60 days after receipt of the denial (20 CFR 404.909(a)(1)).
• ALJ Hearing: Request within 60 days after receipt of the reconsideration denial (20 CFR 404.933(b)).
• Appeals Council Review: Request within 60 days after receipt of the ALJ decision (20 CFR 404.968(a)).
• Federal Court: File a civil action within 60 days after receipt of the Appeals Council’s denial or decision (42 U.S.C. § 405(g); 20 CFR 422.210).

SSA presumes you received each notice five days after the date on the notice unless you can show otherwise. If you miss a deadline, you can request more time by showing good cause (20 CFR 404.911). Always keep your contact information current with SSA to avoid missing critical notices.

Strengthening Your Massachusetts SSDI Appeal: Evidence Checklist

• Treating source statements: Detailed RFC assessments addressing sitting/standing tolerance, lifting/carrying limits, postural and manipulative limitations, cognitive/mental health limitations, attendance, off-task time, and need for rest breaks.
• Objective testing: Imaging, lab results, pulmonary function tests, cardiac studies, neurocognitive testing, EMGs, sleep studies, or other diagnostics relevant to your conditions.
• Longitudinal records: Office visits, specialist referrals, therapy notes, and medication history documenting persistence, side effects, and treatment response.
• Activities of daily living (ADL) evidence: Statements from you and third parties that describe real-world limitations with reliability, pace, and endurance.
• Work history and vocational details: Accurate job titles, exertional levels, skill levels, and the heaviest demands of past jobs to address Step 4 and Step 5.

Frequently Asked Questions for Massachusetts SSDI Appeals

Do I have to live in Massachusetts to use my representative?

No. SSDI is a federal program. Representatives can assist Massachusetts residents regardless of where the representative is based, as long as they meet SSA’s requirements (20 CFR 404.1705). If you want court representation in Massachusetts, your attorney must be admitted to the U.S. District Court for the District of Massachusetts or comply with that court’s admission rules.

Will I have to attend my hearing in person?

Hearings may be conducted in person or by video, depending on SSA scheduling and your preferences. Massachusetts claimants can request the format that works best for them, subject to SSA’s procedures.

How long will my SSDI appeal take?

Timelines vary based on SSA workload and the complexity of your case. Because specific timeframes can change, focus on meeting your deadlines and building a complete evidentiary record.

Can I work part-time while I appeal?

Earnings and work activity can affect eligibility, particularly at Step 1 (SGA) and in evaluating your functional capacity. Review 20 CFR 404.1571–404.1576 regarding work activity and discuss potential risks with your representative.

Authoritative Guidance and Further Reading

SSA: How to Appeal a DecisioneCFR: 20 CFR Part 404 (Disability Insurance Benefits)42 U.S.C. § 405 (Judicial Review and Procedures)SSA Office Locator for Massachusetts Field Offices

Putting It All Together: A Massachusetts-Focused Strategy

For a strong SSDI denial appeal Massachusetts Massachusetts approach, think in terms of the five-step framework and timelines:

• At reconsideration: Focus on filling evidence gaps. Add objective tests and detailed treating-source opinions tailored to the functional demands of work.
• Before the hearing: Organize your exhibits and update medical evidence by the five-business-day mark (20 CFR 404.935). Prepare to explain symptom severity, frequency, and functional effects.
• At the hearing: Present consistent, fact-based testimony and challenge vocational assumptions that don’t reflect your limitations.
• On Appeals Council and in court: Identify legal errors and whether the decision is supported by substantial evidence under 42 U.S.C. § 405(g).

While the process can feel daunting, many Massachusetts claimants ultimately succeed on appeal—especially when they meet deadlines, build the medical record, and clearly connect impairments to work-related limitations.

Legal Disclaimer

This guide is for informational purposes only and does not constitute legal advice. Laws and regulations change, and application to your specific facts may vary. You should consult a licensed Massachusetts attorney about your particular situation.

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