SSDI Denial & Appeal Guide for New York, NY Claimants

Introduction: Why This Guide Matters to New York City Residents

New York, NY is home to more than 8.3 million people, and according to Social Security Administration (SSA) data, over 535,000 city residents receive some form of Social Security benefit. If you live in any of the five boroughs—Manhattan, Brooklyn, Queens, The Bronx, or Staten Island—and your Social Security Disability Insurance (SSDI) application was denied, you are not alone. In 2023, the SSA reported an initial national denial rate of roughly 67 percent. Understanding why claims are denied and how to appeal within strict federal deadlines is essential, especially in a city where the cost of living is one of the highest in the nation.

This comprehensive guide—written with a slight claimant-friendly perspective and grounded in authoritative federal regulations—explains your rights, outlines the entire appeals process, and highlights local New York resources that can help you protect your benefits.

Understanding Your SSDI Rights in New York

Who Qualifies for SSDI?

Under 20 C.F.R. § 404.1505, an individual is considered disabled if he or she cannot engage in substantial gainful activity (SGA) due to a medically determinable impairment that has lasted or is expected to last at least 12 months or result in death. Eligibility also requires enough work credits, documented in your earnings record maintained by the SSA.

Key Rights You Should Know

• The Right to Written Notice: SSA must give you written reasons for any denial (20 C.F.R. § 404.130).

• The Right to Appeal: You have 60 days (plus 5 mailing days) from the date you receive the denial to request reconsideration (Social Security Act § 205(b)).

• The Right to Representation: You may appoint an attorney or qualified representative at any stage of the process. Attorney fees are capped by federal law (currently $7,200 or 25 percent of back pay, whichever is less).

• The Right to Review Your File: You may inspect and receive copies of all evidence in your SSA claims file (20 C.F.R. § 404.1308).

Exercising these rights early can dramatically improve your chances of success, especially in a complex jurisdiction like New York, NY, which falls under the SSA’s New York Region (Region II).

Common Reasons SSA Denies SSDI Claims

Insufficient Medical Evidence SSA adjudicators must see objective documentation—such as MRI reports, lab results, and treating physician notes—showing that your condition meets or equals a Listing in 20 C.F.R. Part 404, Subpart P, Appendix 1. Missing records or gaps in treatment often lead to denial. Failure to Follow Prescribed Treatment Under 20 C.F.R. § 404.1530, failure to follow treatment without a medically acceptable reason can be grounds for denial. Earnings Above the SGA Threshold For 2024, SGA is $1,550 per month for non-blind claimants and $2,590 for blind claimants. If your earnings exceed these limits, SSA will generally deny your claim. Insufficient Work Credits You typically need 20 credits earned in the last 10 years before disability onset. Younger workers need fewer credits, but this technical requirement trips up many claimants. Prior Denial Not Addressed Filing a new application instead of appealing a prior decision can result in an automatic technical denial, particularly in New York where SSA field offices are backlogged.

Knowing these pitfalls can help you and your attorney build a stronger appeal.

Federal Legal Protections & Regulations

Key Statutes and Regulations

• Social Security Act § 205(g) – Grants you the right to federal court review after exhausting administrative remedies.

• 20 C.F.R. § 404.900–404.999 – Lays out the four-level SSA administrative appeal process.

• 20 C.F.R. § 404.1529 – Governs how SSA evaluates pain and other symptoms.

• 42 U.S.C. § 423(d) – Defines disability for SSDI purposes.

Statute of Limitations for Appeals

At every level, you normally have 60 days from receipt of an adverse decision (presumed to be 5 days after the date on the notice) to file the next appeal. Missing these deadlines usually means starting over—an especially costly mistake in New York where initial processing times already exceed the national average.

Steps to Take After an SSDI Denial

1) Reconsideration

File SSA-561 within 60 days. A different claims examiner in the New York Regional Office (26 Federal Plaza) will review your file. Submit new medical records, updated RFC forms, and any work history clarifications.

2) Administrative Law Judge (ALJ) Hearing

If reconsideration fails, request a hearing via SSA-501. In New York City, hearings are usually held at:

Office of Hearings Operations (OHO) 26 Federal Plaza, Room 2909 New York, NY 10278 Come prepared with treating physician testimony and vocational expert cross-examination questions.

3) Appeals Council Review

Submit form HA-520. The Appeals Council in Falls Church, VA will review legal errors, procedural issues, or new evidence that is material and time-relevant.

4) Federal District Court

Under Social Security Act § 205(g), you may file a civil action in the U.S. District Court for the Southern District of New York (500 Pearl Street, Manhattan) within 60 days of Appeals Council denial.

When to Seek Legal Help

While you have the right to self-represent, data published in the SSA’s Annual Statistical Report consistently shows higher approval rates for represented claimants—especially at the ALJ level. A licensed New York disability attorney can:

• Obtain and organize medical evidence in SSA-preferred format.

• Prepare pre-hearing briefs citing 20 C.F.R. regulations and rulings (e.g., SSR 16-3p for symptom evaluation).

• Cross-examine vocational experts to rebut unfavorable job findings.

• Ensure compliance with New York State ethics rules (22 NYCRR § 1200).

Attorney fees require SSA approval and are typically recovered from past-due benefits, so you pay nothing upfront.

Local Resources & Next Steps

Key SSA Field Offices in New York City

• Manhattan: 123 William St., 4th Floor, New York, NY 10038

• Brooklyn (Downtown): 154 Pierrepont St., 6th Floor, Brooklyn, NY 11201

• Bronx: 820 Concourse Village W, Bronx, NY 10451

Most offices are open Monday–Friday, 9:00 a.m.–4:00 p.m.; appointments recommended.

Medical Facilities That Commonly Provide SSDI Evidence

• NYU Langone Health

• Mount Sinai Hospital

• NewYork-Presbyterian/Weill Cornell Medical Center

Ensure your physicians respond promptly to SSA’s Request for Medical Evidence forms.

Free & Low-Cost Legal Clinics

• Legal Aid Society Disability Advocacy Project – (888) 663-6880

• New York Legal Assistance Group (NYLAG) – (212) 613-5000

Authoritative Resources for Further Reading

SSA: Your Right to Question the Decision Made on Your Claim Electronic Code of Federal Regulations – 20 C.F.R. Part 404 Social Security Act § 205

Legal Disclaimer

This article is for informational 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.