SSDI Attorney Guide for Massachusetts, Massachusetts

Massachusetts SSDI Denial & Appeal Guide: What Claimants Need to Know

If you live in Massachusetts and your Social Security Disability Insurance (SSDI) application was denied, you are not alone—and you are not out of options. Many first-time SSDI claims are denied nationwide, but federal law provides a structured multi-level appeals process that gives Massachusetts residents several opportunities to submit new evidence, correct misunderstandings, and obtain a fair decision. Because Massachusetts is part of the Social Security Administration’s (SSA) Boston Region (Region 1), your case proceeds under the same federal rules and procedures as other states, with local processing through Massachusetts SSA field offices and, if needed, hearings before Administrative Law Judges (ALJs) assigned to the Boston Region.

This guide takes you step-by-step through your rights, why claims are commonly denied, and how the federal appeals process works, with practical, claimant-focused tips to help you marshal medical evidence, meet strict federal deadlines, and avoid avoidable mistakes. We also cover local SSA office information for Massachusetts, how to find your nearest field office, and when it may be beneficial to work with an experienced representative. While this guide is tailored to Massachusetts, all references to rules and deadlines come from federal law, including the Social Security Act and the Code of Federal Regulations (CFR), which control SSDI nationwide.

Key takeaways for Massachusetts claimants include: you generally have 60 days from the date you receive a denial to appeal at each level; you have the right to representation; you can and should submit all relevant medical evidence; and you should be prepared to explain your past work and functional limitations in detail. If you’re searching for support on an SSDI denial appeal massachusetts massachusetts matter, the information below provides a roadmap grounded in federal authority, with local context for Massachusetts residents.

Understanding Your SSDI Rights

What SSDI Is—and What It Is Not

SSDI is a federal insurance program for workers who have paid Social Security taxes and can no longer engage in substantial gainful activity due to a medically determinable impairment that has lasted or is expected to last at least 12 consecutive months or result in death. The statutory definition of disability is set by Congress at 42 U.S.C. § 423(d), which requires both a severe medical impairment and inability to perform substantial gainful activity (SGA).

Unlike needs-based Supplemental Security Income (SSI), SSDI entitlement depends on your work history and “insured status,” not household resources. The insured status requirement comes from federal regulations at 20 C.F.R. § 404.130, which describes how quarters of coverage are earned and how “date last insured” is determined for disability claims.

Your Core Rights Under Federal Law

• The right to a fair, multi-step evaluation. SSA must evaluate your claim under the five-step sequential evaluation process outlined at 20 C.F.R. § 404.1520. This process considers whether you are working at SGA, whether you have severe impairment(s), whether you meet or equal a Listing, whether you can perform past relevant work, and whether you can adjust to other work given your residual functional capacity (RFC), age, education, and experience.
• The right to appeal. If denied, you have a right to appeal through reconsideration, ALJ hearing, and Appeals Council review, per 20 C.F.R. § 404.900 and §§ 404.909, 404.929, 404.967. If the Appeals Council denies or dismisses your request, you may seek federal court review under 42 U.S.C. § 405(g).
• The right to representation. You may appoint an attorney or qualified representative to assist you, as set forth in 20 C.F.R. § 404.1705. Representation is optional but often helpful in building a complete medical and vocational record.
• The right (and duty) to submit evidence. Claimants must inform SSA about or submit all known medical evidence relating to disability (20 C.F.R. § 404.1512). At the ALJ level, SSA’s “five-day rule” (20 C.F.R. § 404.935) requires you to submit or inform SSA about written evidence at least five business days before the hearing, with limited exceptions for good cause.
• The right to a written decision with reasons. SSA must issue written determinations that explain the basis for the decision, with specific findings, so you can understand and challenge the result.

Who Is Eligible in Massachusetts

Massachusetts claimants must meet the same federal criteria as any other state. In short, you must: (1) have sufficient work credits and insured status as of the alleged onset date; (2) have a severe, medically determinable impairment expected to last 12 months or result in death (20 C.F.R. § 404.1509); and (3) be unable to engage in SGA due to that impairment. SSA publishes medical Listings—often called the “Blue Book”—describing impairments that can qualify at Step 3 if medical criteria are met or equaled. Even if you do not meet a Listing, you may still qualify at Steps 4–5 based on your RFC and vocational factors.

Massachusetts residents often receive care through large health systems such as Massachusetts General Hospital, Brigham and Women’s, UMass Memorial, Baystate Health, and others. Records from your treating sources—physicians, psychologists, and advanced practice providers—are critical to your claim. Keep in mind that SSA evaluates the persuasiveness of medical opinions under 20 C.F.R. § 404.1520c (for claims filed on or after March 27, 2017), focusing on supportability and consistency with the record.

Common Reasons SSA Denies SSDI Claims

Understanding why claims are denied can help you fix the problem on appeal. Common, regulation-driven reasons include:

• Working above SGA. If you are earning above SGA levels, SSA generally finds you not disabled under Step 1. SGA thresholds are defined in 20 C.F.R. §§ 404.1571–404.1574. If your work includes special conditions, subsidies, or unsuccessful work attempts, clarify that in your evidence.
• Insufficient medical evidence. SSA may deny if there is no objective medical evidence from acceptable medical sources establishing a medically determinable impairment (20 C.F.R. § 404.1521). Ensure diagnostic testing, exam findings, and longitudinal treatment records are in the file.
• Impairment not severe or not of required duration. A non-severe impairment or one expected to improve within 12 months can lead to denial under 20 C.F.R. §§ 404.1522 and 404.1509.
• Does not meet or equal a Listing. Many claims fail at Step 3 because the record does not include the precise medical findings required by a Listing. Consider whether additional testing or specialist input is warranted and consistent with your medical care.
• Can perform past work or other work. At Steps 4–5, SSA evaluates your RFC, age, education, and past work. If the decision finds you can return to past relevant work or adjust to other work, it may deny the claim. Vocational evidence, functional assessments, and detailed work histories can be decisive.
• Non-compliance with treatment without good cause. Under 20 C.F.R. § 404.1530, failure to follow prescribed treatment that could restore the ability to work can be a basis for denial. If you could not follow treatment due to access barriers, side effects, or other valid reasons, explain this clearly.
• Substance use deemed material. If drug or alcohol use is a contributing factor material to disability, SSA must deny (20 C.F.R. § 404.1535). The key is whether you would still be disabled if you stopped using substances.
• Failure to cooperate or missed exams. Not responding to requests for information or failing to attend a consultative examination can lead to denial. Notify SSA promptly of address changes and good-cause reasons for any missed appointments (see 20 C.F.R. § 404.911 on good cause for late filing, which provides a helpful framework for excusable noncompliance in some contexts).

Most of these reasons can be addressed with targeted evidence on appeal. For example, if SSA questioned your functional limitations, seek detailed functional capacity evaluations, symptom-specific testing, or specialist opinions that are consistent and well-supported.

Federal Legal Protections & Regulations That Govern Your Case

The Sequential Evaluation and Evidence Rules

SSA’s five-step sequential evaluation in 20 C.F.R. § 404.1520 is the backbone of every SSDI claim. Understanding how each step works helps you fill gaps in your record. Complementing this framework are the evidence rules:

• Claimant’s duty to submit evidence. 20 C.F.R. § 404.1512 requires claimants to submit or inform SSA about all evidence known to them that relates to disability.
• Evaluation of medical opinions. For modern claims, 20 C.F.R. § 404.1520c guides how SSA evaluates medical opinions and prior administrative medical findings, emphasizing supportability and consistency.
• Symptom evaluation. SSA evaluates the intensity and persistence of your symptoms (e.g., pain, fatigue) against the evidence as a whole, consistent with regulations and subregulatory rulings such as SSR 16-3p.

Appeal Deadlines—Your Federal “Statute of Limitations” to Act

Appeal deadlines are strict but manageable if you act promptly. For most SSDI appeals, the deadline is 60 days from the date you receive the notice (20 C.F.R. § 404.909(a)(1) for reconsideration; § 404.933(b) for ALJ hearing; § 404.968(a) for Appeals Council). SSA presumes you receive the notice 5 days after the date on the notice unless you can show otherwise (20 C.F.R. § 404.901). If you miss a deadline, you can still ask SSA to accept a late appeal for “good cause” (20 C.F.R. § 404.911), but do not rely on this—file on time whenever possible.

Your Right to Representation and Fee Safeguards

You may appoint a representative—attorney or qualified non-attorney—under 20 C.F.R. § 404.1705. Representation fees must be approved by SSA and are governed by the Social Security Act and regulations, including 42 U.S.C. § 406 and 20 C.F.R. § 404.1725. Under the “fee agreement” process, SSA will approve a fee that is subject to a maximum amount set by SSA, payable from past-due benefits if you win. Representatives may also seek reimbursement for reasonable out-of-pocket costs (for example, medical record copying fees), which are separate from fees and may be billed regardless of outcome if agreed in writing.

From Massachusetts Field Office to Federal Court

Massachusetts SSDI claims are processed by local SSA field offices and Disability Determination Services (DDS) before any hearing is scheduled with an ALJ assigned within the Boston Region. If you exhaust administrative remedies, you may file a federal court action under 42 U.S.C. § 405(g), asking a U.S. District Court judge to review SSA’s final decision. The court reviews the administrative record; it does not hear new witnesses or retry the case. Relief can include a remand for a new hearing or, in rare cases, an award of benefits if the record compels it.

Steps to Take After an SSDI Denial

1) Read Your Denial Letter Carefully

Your notice explains why SSA denied your claim and how to appeal. Note the date on the letter and calculate your deadline: appeal within 60 days of receipt, with a 5-day mail presumption unless you can prove a later date (20 C.F.R. § 404.901). Mark your calendar with a “file-by” date that is earlier than the 60-day limit to prevent last-minute problems.

2) File Your Appeal Promptly

Do not start a new application unless advised for a strategic reason. Instead, keep your protective filing date alive by appealing on time. File your reconsideration or request for hearing online or at your local SSA office. The SSA appeals portal is the fastest way to confirm submission:

SSA: Appeal a Decision Keep copies of everything you submit. If filing by mail, use a trackable method. If hand-delivering to a Massachusetts field office, request a date-stamped receipt.

3) Strengthen the Medical Record

SSA bases decisions on objective medical evidence and functional limitations. Work with your treating providers to ensure your records are complete and up-to-date:

• Update records from all sources. Hospitals, specialists, primary care, mental health providers, physical therapy, and pain clinics. Massachusetts residents often receive care through major systems like Massachusetts General Hospital, Brigham and Women’s, UMass Memorial, Tufts Medicine, Baystate Health, and others—make sure each provider’s records are requested.
• Seek testing that documents limitations. Imaging, EMG/NCS, pulmonary function tests, neuropsychological testing, or standardized functional assessments if clinically appropriate.
• Ask for detailed medical opinions. Target your providers’ opinions to your functional abilities and limitations (sitting, standing, lifting, persistence, pace, attendance). Under 20 C.F.R. § 404.1520c, opinions supported by objective findings and consistent with the rest of the record are most persuasive.
• Explain symptom variability. If your symptoms flare or you have good and bad days, describe frequency, duration, and triggers. This helps ALJs evaluate the intensity and persistence of symptoms in line with federal standards.

4) Document Your Work History and Daily Activities

SSA needs precise descriptions of your past work and current limitations:

• Work history. Provide job titles, dates, duties, skills, exertional levels, and how your jobs were typically performed in the national economy. This helps vocational analysis at Steps 4–5.
• Functional limits. Keep a symptom diary and share examples: how long you can sit/stand/walk, lift/carry limits, need to lie down, off-task time, and missed days per month.
• Third-party statements. Statements from family or former coworkers can corroborate your limitations. While not medical evidence, they may help paint a fuller picture.

5) Prepare for Reconsideration and Hearing

Reconsideration is a fresh review by DDS. If you are denied again, request a hearing with an ALJ. Before the hearing:

• Meet the “five-day rule.” Submit or identify evidence at least five business days before the hearing (20 C.F.R. § 404.935), unless good cause applies.
• Pre-hearing brief. A concise brief can guide the ALJ to key evidence and applicable Listings or vocational issues.
• Witnesses. Consider whether a spouse, friend, or caregiver can provide helpful, consistent testimony about your limitations.
• Consistency matters. Ensure your testimony aligns with your medical records, function reports, and work history.

6) Appeals Council and Federal Court

If the ALJ denies your claim, you can request Appeals Council review within 60 days (20 C.F.R. § 404.968(a)). The Appeals Council may deny review, remand for a new hearing, or issue a decision. If the Appeals Council denies or dismisses your request, you can seek judicial review in federal court under 42 U.S.C. § 405(g). A federal court case is based on the administrative record; no new evidence is considered except under limited circumstances.

When to Seek Legal Help for SSDI Appeals

Although you can represent yourself, many Massachusetts claimants find that experienced representatives improve organization, evidence development, and hearing preparation. Consider help if:

• Your condition is complex (e.g., overlapping physical and mental impairments) or involves rare disorders or nuanced Listings.
• You have significant past work that raises difficult Step 4 issues, or you are near an age category change affecting the medical-vocational rules.
• Prior decisions flagged credibility or inconsistency concerns that now require careful, well-supported clarification.
• You are overwhelmed by medical evidence gathering, deadlines, and hearing preparation.

Representation rules and fees. Under 20 C.F.R. § 404.1705, you can appoint an attorney or qualified non-attorney representative. All fees must be approved by SSA pursuant to the Social Security Act and regulations (see 42 U.S.C. § 406; 20 C.F.R. § 404.1725). Under the fee agreement process, approved fees are typically paid from past-due benefits and are subject to a maximum set by SSA. Representatives may also seek reimbursement for out-of-pocket costs if authorized in your agreement.

Massachusetts-specific note. If you want legal advice about Massachusetts law beyond federal SSDI issues, consult an attorney licensed to practice in Massachusetts. Representation before SSA is a federal practice; however, only attorneys licensed in Massachusetts can provide Massachusetts-specific legal advice unrelated to federal SSDI rules.

Local Resources & Next Steps for Massachusetts Claimants

Finding and Using Your Local SSA Office

Massachusetts SSDI applications, appeals, and hearings are part of the SSA’s Boston Region. You can locate your nearest Massachusetts field office (e.g., in cities such as Boston, Worcester, Springfield, Lowell, and others) using the SSA Office Locator. This tool provides addresses, hours, and contact information so you can plan in-person visits or confirm where to mail documents:

SSA Office Locator (Find Your Local Massachusetts Office)SSA Regional Offices (Boston Region Overview) Before you go, check current office hours and whether appointments are recommended or required. Many appeal steps can be completed online, and online filing is strongly encouraged to preserve deadlines and reduce processing delays.

Key Federal Links for Massachusetts SSDI Appeals

SSA: Appeal a Decision – File reconsideration, request an ALJ hearing, or request Appeals Council review online.eCFR: 20 C.F.R. Part 404 (Disability Insurance) – Governing regulations, including appeals process, evidence rules, and sequential evaluation.SSA Blue Book: Disability Listings – Medical criteria for specific impairments.

Building a Massachusetts-Centered Evidence Plan

To give your case the best chance on appeal, create a plan focused on the evidence SSA requires:

• Identify all Massachusetts providers. List every clinician and facility that treated you. Request full records, including imaging, labs, operative reports, therapy notes, and mental health treatment summaries.
• Ask treating sources for specific, supported opinions. A detailed functional assessment tied to objective findings can be highly persuasive under 20 C.F.R. § 404.1520c.
• Track deadlines. Set reminders for the 60-day appeal deadline and the ALJ “five-day rule” (20 C.F.R. § 404.935).
• Prepare for vocational questions. Write out your past job duties and the heaviest physical and mental demands for each job.

What to Expect If You Win

If you win on appeal, SSA will issue a decision establishing an onset date and calculating any past-due benefits owed. SSDI beneficiaries in Massachusetts receive the same federal benefits as claimants in other states. If you are awarded benefits, review your Notice of Award carefully, confirm the onset date is correct, and ensure dependents’ benefits (if applicable) are considered. If you disagree with the onset date or another aspect of the award, consult your representative promptly about next steps within the applicable deadlines.

Detailed Overview of the SSA Appeals Path for Massachusetts Residents

Reconsideration (20 C.F.R. § 404.909)

Reconsideration is a complete review by someone who did not take part in the initial decision. You may submit new evidence and clarifications. In Massachusetts, Disability Determination Services will reassess medical and vocational evidence. Provide all new treatment records and explain how any new diagnoses or test results affect your ability to work. If you miss the 60-day deadline, file as soon as possible and include a detailed “good cause” statement (20 C.F.R. § 404.911).

ALJ Hearing (20 C.F.R. § 404.929)

If reconsideration is denied, request a hearing by an Administrative Law Judge within 60 days of receipt. Hearings may be in person, by video, or by telephone. Before the hearing, you will receive a Notice of Hearing. To comply with the five-day rule (20 C.F.R. § 404.935):

• Submit or identify all evidence at least five business days before the hearing.
• If you cannot obtain certain records in time, notify the hearing office promptly and explain the efforts you made to get them. The ALJ may find good cause to accept late evidence.

At hearing, the ALJ may call a vocational expert (VE) or medical expert (ME). Prepare to testify about your symptoms, treatment, side effects, daily activities, and past work demands. Consistency with your medical records enhances credibility.

Appeals Council Review (20 C.F.R. § 404.967 and § 404.968)

To request Appeals Council review, file within 60 days of receiving the ALJ decision. The Appeals Council may deny review, remand your case for a new hearing, or issue a fully favorable, partially favorable, or unfavorable decision. If you have new and material evidence that relates to the period on or before the ALJ decision and there is a reasonable probability it would change the outcome, submit it with your request and explain why it was not previously available.

Federal Court (42 U.S.C. § 405(g))

If the Appeals Council denies review or issues an unfavorable decision, you may file a civil action in federal court within 60 days. The court reviews the administrative record to determine if SSA’s decision is supported by substantial evidence and free of legal error. Possible outcomes include a remand for further proceedings or, rarely, reversal and award of benefits when the record overwhelmingly supports disability.

Smart Evidence Strategies for Massachusetts Claimants

Medical Evidence That Carries Weight

• Longitudinal treatment records. Regular, consistent treatment records that document objective findings and functional impact over time often carry more weight than sporadic visits.
• Treating source opinions with support. Detailed medical opinions that cite clinical findings, imaging, and examination results are more persuasive under 20 C.F.R. § 404.1520c.
• Functional testing where appropriate. Timed walk tests, grip strength, range of motion, neurocognitive testing, and other objective measures can substantiate limitations.
• Adherence and side effects. Document attempts to follow treatment, side effects that limit functioning, and any barriers to care.

Vocational Evidence That Can Tip the Balance

• Accurate job descriptions. The more precisely you describe past work, the better SSA and the VE can assess whether you can still perform it.
• RFC-consistent examples. Provide concrete examples of limitations (e.g., needing to lie down, off-task percentage, unscheduled breaks) that align with your medical evidence.
• Age and education considerations. The medical-vocational guidelines (“grids”) may favor claimants of certain ages when combined with restrictive RFCs. Be prepared to address transferable skills and realistic job adjustments.

Massachusetts-Specific Practical Tips

• Use SSA’s Office Locator. Find your Massachusetts field office for in-person assistance and document drop-off using the Office Locator. Always request a receipt for submissions.
• Coordinate with major medical systems. Large Massachusetts providers often have patient portals—use them to obtain visit summaries and test results quickly for SSA.
• Mind the five-day rule. Massachusetts ALJ hearing offices apply the same federal five-day rule—get your evidence in early and notify the hearing office of any delays.

Frequently Asked Questions for Massachusetts SSDI Appeals

How long do I have to appeal?

Generally 60 days from the date you receive the denial notice (with a 5-day mailing presumption), as set by 20 C.F.R. §§ 404.909(a)(1), 404.933(b), and 404.968(a). File as early as possible.

Do I have to stop all work to qualify?

No, but your earnings must be below SGA and your work must not show you can sustain full-time competitive employment. See 20 C.F.R. §§ 404.1571–404.1574 for SGA rules.

Can non-attorneys represent me?

Yes, if they meet SSA’s qualifications and you appoint them under 20 C.F.R. § 404.1705. All fees require SSA approval (42 U.S.C. § 406; 20 C.F.R. § 404.1725).

What if I missed my deadline?

File immediately and explain “good cause” under 20 C.F.R. § 404.911. Provide documentation for mail delays, hospitalization, or other circumstances beyond your control.

What if my condition worsens after the ALJ decision?

Submit any new and material evidence to the Appeals Council if it relates to the period on or before the ALJ decision and could change the outcome. Otherwise, ask a representative about the pros and cons of a new application versus continuing appeal.

How to Start Today—A Checklist for Massachusetts Claimants

• Mark your deadline. Count 60 days from the notice date plus 5 days for mailing unless you can prove later receipt (20 C.F.R. § 404.901). File your appeal online. Use the SSA appeals portal for faster confirmation and fewer mailing risks. Start Your SSDI Appeal
• Gather medical records. Request complete records from all Massachusetts providers and ensure test results are included.
• Ask for treating opinions. Request function-focused medical opinions that cite objective findings and track symptoms over time in line with 20 C.F.R. § 404.1520c.
• Prepare a work history summary. Include job titles, dates, physical/mental demands, and any accommodations.
• Consider representation. If you want help navigating rules, deadlines, and hearings, you may appoint a representative per 20 C.F.R. § 404.1705.

Local SSA Office Information for Massachusetts

SSA serves Massachusetts residents through multiple field offices across the Commonwealth and hearing operations managed within the Boston Region. To find the correct office for your ZIP code, confirm contact details, and check hours, use these official SSA resources:

Find Your Local SSA Office in MassachusettsSSA Regions: Boston Region (Region 1)eCFR: SSDI Regulations (20 C.F.R. Part 404) If you plan to visit an office, bring a government-issued ID and any documents you plan to file. For mailed submissions, use trackable delivery and keep copies. You can complete most appeal actions online, which is recommended to protect deadlines.

Your Rights, Protected: A Massachusetts Claimant’s Perspective

SSDI law is meant to ensure that workers who become medically unable to work have a path to benefits they paid for through payroll taxes. The federal framework—20 C.F.R. Part 404 and the Social Security Act—creates structured opportunities to challenge errors, fill evidentiary gaps, and obtain impartial review. Massachusetts claimants should lean on these protections by appealing on time, documenting functional limitations thoroughly, and invoking their right to representation when helpful.

Above all, remember that an initial denial is not the end. Many cases are approved on reconsideration or at the hearing level after the record is fully developed and the medical and vocational issues are clearly presented. Stay organized, meet every deadline, and use the authoritative SSA tools linked in this guide.

Legal Disclaimer

This guide provides general information for Massachusetts residents and is not legal advice. SSDI cases turn on specific facts and medical evidence. For advice about your situation, consult a licensed Massachusetts attorney or qualified representative.

Get Help

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