SSDI Denial Appeal Guide – California, CA

Introduction: Why This Guide Matters to California Claimants

More than 4.3 million Californians live with a disability, yet fewer than 740,000 receive Social Security Disability Insurance (SSDI) benefits.1 When the Social Security Administration (SSA) denies a claim, the decision can feel final—especially in a high-cost state like California, where lost income can quickly threaten housing and medical stability. This comprehensive guide is written with a slight bias toward protecting claimants’ rights while remaining strictly factual and anchored in federal law. You will learn why SSDI applications are denied, which federal regulations protect your appeal, how long you have to act, and where to get localized help in California.

Quick Look: Key Facts for California Residents

• Appeal deadline: 60 days plus 5 mail days from the date you receive the denial notice (20 CFR §404.909, §404.933).
• Four-level federal appeals process: Reconsideration, Administrative Law Judge (ALJ) hearing, Appeals Council review, and federal district court.
• California’s average ALJ approval rate (2023): 55%—slightly above the national average of 54%.2
• Largest SSA Hearing Offices (OHO/OHO) in California: Los Angeles, San Francisco, Oakland, San Diego, and Pasadena.

Understanding Your SSDI Rights

What the Social Security Act Guarantees

Title II of the Social Security Act establishes disability insurance for workers who have paid into the system. Section 223 (42 U.S.C. §423) defines “disability” as an inability to engage in substantial gainful activity (SGA) for at least 12 consecutive months due to medically determinable impairments.

Key Federal Regulations

• 20 CFR §404.1505: Sets out the basic definition of disability used by SSA adjudicators.
• 20 CFR §404.1520: Establishes the five-step sequential evaluation used to decide every claim.

These regulations apply nationwide—including every SSA field office, state Disability Determination Service (DDS) unit in Sacramento, Los Angeles, and Stockton, and all hearing offices across California.

Common Reasons SSA Denies SSDI Claims

• Insufficient Medical Evidence. DDS examiners must see objective findings—imaging, lab results, specialist notes—or they may rule that your impairment is not “severe.”
• Failure to Follow Prescribed Treatment. Under 20 CFR §404.1530, failure to comply with reasonable medical advice can result in denial unless you prove a good-cause exception.
• Earnings Above SGA. In 2024, earning more than $1,550 per month ($2,590 if blind) usually triggers an SGA denial.
• Durational Requirement. Conditions expected to improve within 12 months, such as some fractures, do not qualify.
• Prior Denial Not Appealed. SSA may treat a new application within 12 months as a “duplicate claim” and issue a technical denial.

California DDS denies roughly 70% of initial claims.3 Understanding why helps you build a stronger appeal.

Federal Legal Protections & Regulations

Due-Process Rights

The Fifth Amendment’s due-process clause and Richardson v. Perales, 402 U.S. 389 (1971), confirm that disability claimants are entitled to a full and fair hearing before benefits are permanently denied. SSA must:

• Provide written notice of evidence used.
• Allow you to review and submit additional evidence.
• Issue a written decision citing specific regulations and facts.

Key Timelines Set by Federal Law

The same deadlines apply in California as anywhere else:

• Reconsideration: Request within 60 days of the initial denial (20 CFR §404.909).
• ALJ Hearing: File form HA-501 within 60 days of reconsideration denial (20 CFR §404.933).
• Appeals Council Review: 60 days from the ALJ decision (20 CFR §404.968).
• Federal Court: 60 days from Appeals Council denial or dismissal (42 U.S.C. §405(g)).

Miss a deadline and you may need to prove “good cause” (20 CFR §404.911) such as hospitalization or mental incapacity.

Steps to Take After an SSDI Denial

1. Read the Denial Letter Carefully

The notice will specify whether the denial is medical or technical. Identify the cited regulation—e.g., “Step 4 of the sequential evaluation” or “insufficient quarters of coverage.”

2. Request Reconsideration (California DDS)

Use SSA-561 (Request for Reconsideration). Attach medical evidence your initial file lacked—specialist opinions from UCLA Medical Center, UCSF Health, or Stanford Health Care, for example.

3. Schedule Consultative Exams Strategically

You may be sent to a contracted California physician. Bring imaging discs, medication lists, and assistive devices to the appointment.

4. Prepare for the ALJ Hearing

• Submit evidence 5 business days in advance (20 CFR §405.331).
• Ask your treating doctor for a Medical Source Statement using SSA’s preferred RFC format.
• Request witnesses—vocational experts can be cross-examined on transferable job skills in California’s labor market.

5. Appeals Council & Federal Court

The Appeals Council in Falls Church, VA, reviews whether the ALJ erred procedurally or misapplied law. If denied, you can file a civil action in the U.S. District Court for the Northern, Eastern, Central, or Southern District of California. You typically need an attorney admitted in that federal district.

When to Seek Legal Help for SSDI Appeals

Contingency Representation

Under 42 U.S.C. §406(b) and 20 CFR §404.1728, attorney fees are capped at 25% of past-due benefits or $7,200 (2024 cap), whichever is less. No upfront retainer is required.

Advantages of Hiring a California Disability Attorney

• Knowledge of local ALJ approval statistics in Los Angeles vs. Oakland.
• Relationships with California specialist physicians willing to draft persuasive medical opinions.
• Experience questioning vocational experts on California labor-market trends—e.g., decline in light-duty retail positions due to automation.

Local Resources & Next Steps

Key SSA Field & Hearing Offices

Los Angeles Downtown SSA Field Office 1122 S. Broadway, Los Angeles, CA 90015 | 8:00 a.m.–4:00 p.m.Oakland Hearing Office (OHO) 7700 Edgewater Dr., Suite 400, Oakland, CA 94621San Francisco Hearing Office (OHO) 560 Kearny St., Suite 400, San Francisco, CA 94108

California Disability Determination Service (DDS)

Main headquarters: 1450 Executive Pkwy., Sacramento, CA 95833.

Medical Facilities Frequently Cited in SSDI Records

• University of California, San Francisco (UCSF) Medical Center
• Stanford Health Care
• UCLA Ronald Reagan Medical Center

Pro Bono & Low-Cost Legal Aid

• Legal Aid Society of San Diego
• Disability Rights California (statewide hotline: 800-776-5746)

Authoritative References

20 CFR §404.909 – Appeal Deadlines SSA Listing of Impairments Program Operations Manual System (POMS) SSA Appeals Process Flowchart Congressional Research Service – Social Security Disability Insurance Primer### Legal Disclaimer

This article is for informational purposes only and does not constitute legal advice. Consult a licensed California 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.