SSDI Denial Appeal Guide for Massachusetts, MA

Introduction: Why This Guide Matters to Massachusetts Claimants

The Commonwealth of Massachusetts is home to roughly 6.9 million residents, and nearly one in ten lives with a disability serious enough to limit full-time work. For these residents, Social Security Disability Insurance (SSDI) benefits are a lifeline. Yet, according to the Social Security Administration (SSA), more than 60 percent of Bay State initial SSDI applications are denied. If you have received a denial letter—officially called a Notice of Disapproved Claim—you are not alone, and you still have options.

This comprehensive, claimant-focused guide explains your rights, appeal deadlines, and strategies under federal law, all tailored to Massachusetts (MA). It cites controlling authority such as 20 C.F.R. §§404.900–404.968 and Social Security Act §205(b), and it offers local resources—from the Boston SSA hearing office on Causeway Street to pro bono legal clinics at Suffolk University Law School. Our goal is to empower you to pursue the benefits you have earned through years of payroll contributions.

Understanding Your SSDI Rights in Massachusetts

The Federal Framework

SSDI is a federal insurance program funded by FICA payroll taxes. Under Social Security Act §223(d), you are entitled to benefits if you:

• Have a severe, medically determinable impairment expected to last 12 months or result in death; and

• Cannot perform substantial gainful activity (SGA)—$1,470 per month in 2023 ($2,460 if blind).

Your right to challenge an adverse SSA decision is protected by 20 C.F.R. §404.900, which establishes a four-level administrative review process, plus judicial review in U.S. District Court.

Massachusetts-Specific Considerations

SSDI is a federal benefit, but your claim is handled locally by the Disability Determination Services (DDS) in Worcester. DDS examiners and contracted physicians evaluate your file according to SSA rules. Knowing how Massachusetts DDS operates—its average processing time is about 4.5 months—helps you track deadlines.

Unlike some states, Massachusetts supplements disabled workers mainly through state vocational rehabilitation services rather than state-funded disability benefits. Therefore, winning SSDI is often crucial to long-term financial security.

Common Reasons SSA Denies SSDI Claims

• Insufficient Medical Evidence. Under 20 C.F.R. §404.1520(a)(4), you must prove not only diagnosis but functional limitations. Missing imaging studies, inconsistent provider notes, or gaps in treatment can sink a case.

• Engaging in SGA. If recent earnings exceed SGA thresholds, DDS must deny. Gig-economy income reported on 1099s often trips up applicants.

• Failure to Follow Prescribed Treatment. Per 20 C.F.R. §404.1530, disregarding reasonable medical advice without good cause can justify denial.

• Durational Requirement Not Met. Conditions anticipated to improve in under 12 months (e.g., uncomplicated fractures) do not qualify.

• Prior Denial Not Properly Appealed. Filing a new claim instead of appealing within 60 days can restart the process and cause res judicata issues.

Federal Legal Protections & Regulations You Should Know

Key Regulations

• 20 C.F.R. §404.935—Requires you to submit all evidence at least five business days before a hearing or show good cause.

• 20 C.F.R. §404.1520—Outlines the five-step sequential evaluation used at every adjudicative level.

Statute of Limitations and Deadlines

• 60 Days from receipt of any SSA decision to request the next appeal step (20 C.F.R. §404.909, §404.933). SSA presumes you receive notices within five days of mailing.

• Federal Court Filing: 60 days after the Appeals Council denial (42 U.S.C. §405(g)).

Right to Representation

You may appoint an attorney or qualified non-attorney representative at any stage (20 C.F.R. §404.1705). In Massachusetts, attorneys must be licensed by the Supreme Judicial Court and in good standing with the Board of Bar Overseers. Fees are contingency-based and capped at 25 percent of past-due benefits or $7,200 (effective Nov. 2022) unless raised by petition.

Steps to Take After an SSDI Denial

1. Read the Notice Carefully

The denial letter explains why DDS disapproved your claim and sets your 60-day deadline. Flag the stated medical and vocational findings—these will guide the evidence you must add.

2. File a Timely Request for Reconsideration Massachusetts uses the Reconsideration step (some states don’t). File online through SSA’s iAppeals portal or submit Form SSA-561 by mail to your local field office (e.g., Boston Office, 10 Causeway St. Rm 148, Boston, MA 02222). Attach new medical records and a Form SSA-827 for each additional provider.

3. Request an Administrative Law Judge (ALJ) Hearing if Reconsideration Fails

About 13 months after filing, you’ll receive notice of hearing at the Boston ODAR (Office of Hearing Operations) or satellite sites in Lawrence and Springfield. The ALJ reviews your case de novo. Submit all evidence five business days before the hearing (20 C.F.R. §404.935) or show good cause.

4. Prepare Thoroughly for the Hearing

• Updated Rad Reports & Function Forms. Secure imaging, lab work, and treating-source statements on limitations (RFC letters).

• Vocational Witness Cross-Examination. Most MA ALJs call a vocational expert (VE). Prepare alternative hypotheticals that support disability.

• Expert Opinions. Under Biestek v. Berryhill, 587 U.S. ___ (2019), VE testimony must be supported by substantial evidence; object if data sources are not disclosed.

5. Appeals Council Review

The Council in Falls Church, VA, will review only legal errors or new material evidence per 20 C.F.R. §404.970. Massachusetts claimants may submit new evidence if it relates to the period on or before the hearing decision and there is a reasonable probability it would change the outcome.

6. U.S. District Court Action

File a civil complaint in the U.S. District Court for the District of Massachusetts (Boston, Springfield, or Worcester divisions). Under 42 U.S.C. §405(g), the court can affirm, reverse, or remand the SSA decision. Federal civil filing fees ($402) may be waived by a Form AO 240 in forma pauperis motion.

When to Seek Legal Help for SSDI Appeals

Indicators You Need Counsel

• Complex medical issues (e.g., mental impairments combined with physical limitations).

• Prior denials creating res judicata risk.

• Imminent hearing date with incomplete record.

• Allegations of non-compliance with treatment.

A Massachusetts disability attorney can:

• Gather treating-source RFC statements consistent with 20 C.F.R. §404.1527(c) weight factors.

• Draft pre-hearing briefs citing First Circuit precedent (e.g., Avery v. Sec’y of HHS, 797 F.2d 19 (1st Cir. 1986)).

• Cross-examine VEs and medical experts effectively.

• Monitor deadlines and file appeals electronically.

Local Resources & Next Steps

Key SSA Offices

• Boston Field Office: 10 Causeway St., Boston, MA 02222 • Phone: 866-635-0647

• Springfield Field Office: 70 Bond St., Springfield, MA 01104 • Phone: 877-714-0393

• Worcester DDS (for medical determinations): 333 Shrewsbury St., Worcester, MA

Free & Low-Cost Legal Help

Massachusetts Legal Services—statewide directory of pro bono disability representation. Harvard Legal Aid Bureau—Boston-based clinic accepting some SSA appeals. Disability Law Center of Massachusetts—state Protection & Advocacy agency.

Vocational & Medical Documentation

Consider obtaining functional capacity evaluations from leading medical centers such as Mass General Hospital or UMass Memorial. Keep a diary tracking pain levels, medication side effects, and failed job attempts—evidence often credited by ALJs (Avery, 1st Cir.).

Stay Organized

• Create a binder or encrypted folder for all SSA correspondence.

Use SSA’s mySocialSecurity portal to verify earnings records and appeal status.

• Calendar every 60-day deadline plus five mailing days.

Conclusion

Facing an SSDI denial can feel overwhelming, but Massachusetts claimants have clear rights and defined procedural steps to challenge the decision. By understanding federal regulations, meeting strict deadlines, and gathering persuasive medical evidence, you can significantly improve your chances of approval. If you need help, experienced Massachusetts disability attorneys stand ready to guide you through the process from Reconsideration to federal court.

Legal Disclaimer: This guide provides general information for Massachusetts residents and is not legal advice. Laws and SSA policies change. For advice about your specific case, consult a licensed Massachusetts attorney.

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