SSDI Attorney Appeal Guide – New York, New York

Introduction: Why SSDI Appeals Matter to New York, New York Claimants

More than 8.3 million Americans rely on Social Security Disability Insurance (SSDI) to replace wages lost to serious, long-term medical conditions. According to the Social Security Administration’s (SSA) Annual Statistical Report on the Social Security Disability Insurance Program, approximately 67% of initial SSDI applications are denied nationwide. New York City residents face the same odds despite living in one of the nation’s largest metropolitan areas with world-class medical facilities such as NYU Langone, Mount Sinai, and NewYork-Presbyterian.

If you reside in New York, New York (Manhattan) and recently received a denial letter—formally called a “Notice of Disapproved Claim”—you still have several opportunities to overturn that decision. This comprehensive guide explains your federal rights, the strict deadlines contained in 20 C.F.R. §404.909 and §404.933, and the practical steps for filing timely appeals from right here in the five boroughs. While we slightly favor protecting the claimant, every statement below is drawn from authoritative sources, including the SSA’s Program Operations Manual System (POMS), the Code of Federal Regulations (CFR), and binding federal case law.

Understanding Your SSDI Rights Under Federal Law

1. The Statutory Basis for SSDI

SSDI originates in Title II of the Social Security Act (42 U.S.C. §§401–434). To qualify, you must establish:

• Disability—an impairment expected to last at least 12 months or result in death (42 U.S.C. §423(d)(1)(A)).

• Insured Status—sufficient “quarters of coverage” earned through taxed employment (20 C.F.R. §404.130).

2. Due Process and the Right to Appeal

The U.S. Supreme Court has held that SSDI benefits are a statutorily created property interest protected by the Fifth Amendment’s Due Process Clause (Mathews v. Eldridge, 424 U.S. 319 (1976)). Consequently, the SSA must give you notice and the opportunity to be heard at multiple administrative stages before its decision becomes final.

3. Key Regulatory Protections

• 20 C.F.R. §404.900 – establishes the four-step administrative review process (Reconsideration, ALJ Hearing, Appeals Council, Federal Court).

• 20 C.F.R. §404.1520 – outlines the five-step disability evaluation sequence used at every stage of review.

Because these regulations carry the force of law, SSA adjudicators, Administrative Law Judges (ALJs), and federal courts must follow them when reviewing claims brought by New York City residents.

Common Reasons SSA Denies SSDI Claims

Understanding why the SSA said “no” is the first step toward turning that “no” into a “yes.” Below are the most frequently cited reasons for denial—each supported by SSA data and federal regulations:

Medical Insufficiency Medical records do not document objective findings, longitudinal treatment, or functional limitations severe enough to satisfy 20 C.F.R. §404.1521 (the severity standard). Ability to Perform Past Relevant Work (PRW) At Step 4 of the sequential evaluation (20 C.F.R. §404.1520(f)), the SSA concluded you can still perform any job held in the last 15 years. Vocational Adjustability Under Step 5, the SSA found you could transition to “other work” existing in significant numbers in the national economy, as defined in 20 C.F.R. §404.1560(c). Substantial Gainful Activity (SGA) If your earnings averaged more than the SGA threshold (e.g., $1,550/month in 2024 for non-blind individuals), the SSA must deny benefits under 20 C.F.R. §404.1571. Technical Non-Eligibility Failure to meet insured-status quarters or missing a critical deadline (such as the 60-day appeal window) will lead to a non-medical denial.

Fortunately, these issues can often be corrected with additional medical evidence, vocational expert testimony, or proof of reduced earnings. An experienced New York disability attorney can help fill these gaps.

Federal Legal Protections & Regulations You Should Know

1. The 60-Day Appeal Window

Under 20 C.F.R. §404.909(a)(1), you have 60 days from the date you receive your denial notice to request a Reconsideration, plus a presumptive five-day mailing period (20 C.F.R. §404.901). Missing this deadline generally forfeits your appeal rights, unless you can show “good cause” under 20 C.F.R. §404.911.

2. Subsequent Levels of Review

• Reconsideration – A different SSA examiner reviews your file (20 C.F.R. §404.907).

• Administrative Law Judge Hearing – Request within 60 days of a Reconsideration denial (20 C.F.R. §404.929). Hearings for Manhattan residents are typically held at the Office of Hearings Operations (OHO) at 26 Federal Plaza.

• Appeals Council Review – File within 60 days of an ALJ decision. The Appeals Council sits in Falls Church, Virginia but evaluates claims electronically.

• U.S. District Court – Suit must be filed within 60 days of an Appeals Council denial under 42 U.S.C. §405(g). New York City claimants file in the Southern District of New York (SDNY) at 500 Pearl Street.

3. One-Time Reopening Rights

Even if you missed the 60-day window, 20 C.F.R. §404.988 permits reopening a decision within 12 months for “any reason,” or up to four years for “good cause.”

4. Fee Regulation for Attorneys and Representatives

Attorney fees are capped at the lesser of 25% of past-due benefits or $7,200 (20 C.F.R. §404.1728). The SSA must approve all fee agreements, providing another layer of consumer protection.

Steps to Take After an SSDI Denial in New York City

Step 1 – Read the Notice Carefully

The denial notice lists the precise medical and non-medical reasons for denial and states the last date to appeal. Scan for:

• Date of the letter – Start counting your 60 days.

• Technical errors – Wrong onset date, missing employer wages, or incomplete earnings records.

• Medical rationale – Missing test results or doctor opinions the SSA never received.

Step 2 – Request Reconsideration (Form SSA-561)

You can file online via your my Social Security account, by mail, or in person at a local office. Manhattan claimants may visit the Social Security Field Office at 123 William Street, 4th Floor, New York, NY 10038. Bring a photo ID and any new medical evidence.

Step 3 – Strengthen the Medical Record

Collect:

• Diagnostic imaging (MRI, CT, X-ray) reports.

• Specialist treatment notes (neurology, orthopedics, psychiatry).

• Functionality assessments (RFC forms) from treating physicians detailing lifting, standing, and concentration limits.

Step 4 – Track Deadlines Using a New York-Specific Calendar

Mark appeal deadlines on your phone and set alerts; court closures for federal holidays such as Juneteenth or Indigenous Peoples’ Day can affect filing dates in the SDNY.

Step 5 – Prepare for an ALJ Hearing

Many Manhattan hearings are now held by secure video from the OHO at 26 Federal Plaza. Submit pre-hearing briefs citing medical listings (e.g., 20 C.F.R. Pt 404, Subpt P, App 1 §1.04 for spine disorders) no later than five business days before the hearing (20 C.F.R. §404.935).

When to Seek Legal Help for SSDI Appeals

1. Complexity of the Record

Cases involving multiple impairments—such as a combination of degenerative disc disease and major depressive disorder—often require vocational expert cross-examination. Federal courts routinely overturn ALJ decisions that fail to consider combined impairments (Burgos v. Berryhill, 2018 WL 701992 (S.D.N.Y. 2018)).

2. Adverse Vocational Expert (VE) Testimony

Experienced SSDI attorneys know how to impeach VE testimony using the Dictionary of Occupational Titles, Selected Characteristics of Occupations (SCO), and cross-examination techniques approved in Biestek v. Berryhill, 139 S. Ct. 1148 (2019).

3. Federal Court Litigation

Once your claim reaches the SDNY, the Federal Rules of Civil Procedure and local court rules apply. Drafting a complaint, filing a Rule 12(c) motion for judgment on the pleadings, or negotiating a remand under 42 U.S.C. §405(g) Sentence Four are tasks best handled by counsel admitted to the SDNY bar.

4. Contingency Fee Advantage

Because attorney fees are contingency-based and capped by federal law, you pay nothing up-front. The representative is compensated only if you win and only from past-due benefits—never future monthly payments.

Local Resources & Next Steps for New York, New York Claimants

1. Key SSA Offices

Field Office – 123 William Street, New York, NY 10038 Phone: 800-772-1213 | Hours: 9 a.m.–4 p.m., Mon–Fri

• Hearing Office (OHO) – 26 Federal Plaza, Room 29-112, New York, NY 10278

2. Free or Low-Cost Medical Clinics

• NYC Health + Hospitals/Gotham Health Gouverneur – 227 Madison St., New York, NY 10002

• Community Healthcare Network – Multiple Manhattan locations offering sliding-scale fees.

3. Legal Aid Organizations

• Legal Aid Society Disability Advocacy Project – Provides free representation for qualifying low-income SSDI claimants.

• New York Legal Assistance Group (NYLAG) – Offers pro bono help with ALJ hearings and federal appeals.

4. Statute of Limitations for Federal Court

Remember, you must file your civil action within 60 days of an Appeals Council denial (42 U.S.C. §405(g)). Missing this deadline usually ends your claim unless equitable tolling applies under Harvey v. Timberland Fed. Credit Union, 873 F. 3d 733 (9th Cir. 2017).

5. Track Your Claim Online

Create or log in to my Social Security to monitor appeal status, upload documents, and receive real-time messages from SSA staff.

External Authoritative References

SSA Official Appeals Process Overview 20 C.F.R. §404.909 – Time and Place for Filing Requests for Reconsideration SSA Regulations & Guidance (CFR & POMS) Southern District of New York – Filing Information SSA Office of Hearings Operations (OHO) Locator

Conclusion

A denial is often just the first chapter in a longer SSDI journey. By understanding federal regulations, meeting strict deadlines, and leveraging local resources in New York City, you can maximize your chances of securing the disability benefits you earned through years of work. Most importantly, do not wait—the SSA’s clock starts ticking the moment your denial notice is dated.

Disclaimer: This information is for educational purposes only and does not constitute legal advice. Consult a licensed New York 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.