SSDI Denial Appeal Guide for Tequesta, Texas

Introduction: Why This Guide Matters to Tequesta, Texas Residents

Receiving a Social Security Disability Insurance (SSDI) denial can be overwhelming—especially if you live in a smaller Texas community such as Tequesta. Although Tequesta does not have its own Social Security Administration (SSA) field office, residents are fully protected by federal disability laws and Texas attorney-ethics rules. This comprehensive guide explains the SSDI appeals process, cites the governing federal regulations, and points you toward trustworthy local resources. Every statement below is grounded in authoritative sources such as the Social Security Act, the Code of Federal Regulations (CFR), and published SSA materials. Our goal is to equip you to protect your rights and improve your chances of winning an appeal.

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Understanding Your SSDI Rights

1. What SSDI Provides

SSDI pays monthly cash benefits to workers who have paid enough FICA taxes and become disabled under the SSA’s strict definition. Benefits may also extend to certain spouses and dependent children.

2. The Federal Definition of Disability

Under 20 CFR §404.1505, disability means the “inability to engage in any substantial gainful activity” (SGA) because of a medically determinable impairment expected to last at least 12 months or result in death.

3. Your Due-Process Rights

Section 205(b) of the Social Security Act (42 U.S.C. §405(b)) guarantees you written notice of any adverse decision and the right to a hearing before an impartial Administrative Law Judge (ALJ). This is why every denial letter lists appeal instructions and deadlines.

4. Time Limits You Cannot Miss

• 60 days from the date you receive a denial to request reconsideration (see 20 CFR §404.909(a)).

• An additional 60 days after an unfavorable reconsideration to request an ALJ hearing (20 CFR §404.933(a)).

• 60 days to seek review by the Appeals Council (20 CFR §404.968(a)).

• 60 days to file a civil action in U.S. District Court if the Appeals Council denies review (42 U.S.C. §405(g)).

Common Reasons SSA Denies SSDI Claims

According to SSA statistical reports, fewer than 40 percent of initial SSDI applications are approved nationwide. Tequesta claimants face the same hurdles. The most frequent technical and medical reasons include:

• Insufficient Work Credits – Workers under age 24 usually need 6 work credits in the 3-year period before disability; older workers need more (20 CFR §404.130).

• Earnings Above SGA – If you earned more than the monthly SGA limit ($1,470 for non-blind claimants in 2023) after your alleged onset date, SSA will deny the claim.

• Lack of Objective Medical Evidence – SSA must see records from acceptable medical sources (AMS) proving a severe impairment (20 CFR §404.1513).

• Non-Compliance with Treatment – Failure to follow prescribed therapy without good cause (20 CFR §404.1530).

• Ability to Perform Past Relevant Work – At step 4 of the five-step sequential evaluation (20 CFR §404.1520), SSA can deny if you can still do work you performed in the past 15 years.

• Ability to Adjust to Other Work – At step 5, vocational evidence may show other jobs exist in significant numbers that you can do, leading to a denial.

Federal Legal Protections & Regulations

1. Key Regulations Every Claimant Should Know

• 20 CFR §404.900 – Lays out the four administrative appeal steps.

• 20 CFR §404.1512 – Explains your duty to provide evidence.

• 20 CFR §404.1527 & §404.1520c – Weight given to medical opinions (treating-physician rule for claims filed before 3/27/2017 and supportability/consistency factors after).

• 20 CFR §404.1545 – Residual Functional Capacity (RFC) assessments.

• 20 CFR §404.1560–404.1569 – Vocational rules and Medical-Vocational Guidelines (the “Grid Rules”).

2. Federal Court Oversight

If the Appeals Council affirms your denial, you may file in the U.S. District Court for the Southern District of Texas. Federal judges review the administrative record to ensure the ALJ applied the correct legal standards and that substantial evidence supports the decision (see, e.g., Higginbotham v. Barnhart, 405 F.3d 332 (5th Cir. 2005)).

3. Attorney Licensing & Fees

Under 20 CFR §404.1720–1728, fees for representation are capped at 25 percent of past-due benefits or $7,200, whichever is less, unless a higher amount is approved. In Texas, disability attorneys must be licensed by the State Bar of Texas and follow the Texas Disciplinary Rules of Professional Conduct.

Steps to Take After an SSDI Denial

Step 1 – Read Your Denial Letter Carefully

The letter will cite specific medical or technical grounds. Match those reasons to the regulations above so you can correct weaknesses in your evidence.

Step 2 – File a Timely Request for Reconsideration

Submit SSA-561 or file online within 60 days. Missing the deadline usually forfeits your right to further review unless you show “good cause” (20 CFR §404.911).

Step 3 – Strengthen Your Medical Evidence

Work with treating physicians to obtain updated imaging, lab results, or functional capacity evaluations. Objective evidence often turns a denial into an approval at reconsideration or hearing.

Step 4 – Prepare for the Administrative Law Judge Hearing

The ALJ hearing is your best chance for success; nationwide, about 54 percent of claims are approved at this stage. You may submit briefs, witness statements, and interrogatories to vocational or medical experts ahead of time.

Step 5 – Seek Appeals Council Review (If Necessary)

The Appeals Council may grant, deny, or dismiss your request. Provide evidence of ALJ errors in law or fact, or new, material records.

Step 6 – Federal Court Review

File a complaint in district court within 60 days. The court can affirm, reverse, or remand the case for a new ALJ hearing.

When to Seek Legal Help for SSDI Appeals

Statistics from SSA’s Office of the Inspector General show that claimants represented by attorneys have significantly higher success rates. You should strongly consider hiring a tequesta disability attorney if:

• You have multiple severe conditions requiring coordination of voluminous medical records.

• Your past work was skilled or semi-skilled, making vocational issues complex.

• You need assistance questioning an SSA vocational expert at the ALJ hearing.

• Your claim involves closed periods, partially favorable decisions, or onset-date disputes.

Choosing a Qualified Representative

Verify Texas licensure through the State Bar of Texas website and confirm the attorney has experience with Fifth Circuit federal court practice.

Local Resources & Next Steps

1. Finding Your Nearest SSA Office

Tequesta residents can locate their closest field office by using the SSA’s Office Locator at SSA Office Locator. Enter your ZIP code to obtain the address, phone number, and hours. Field offices in nearby cities such as Houston, Galveston, or Beaumont routinely serve small Texas communities.

2. Texas Vocational Rehabilitation & Medical Providers

• Texas Workforce Commission—Vocational Rehabilitation Services: Helps obtain functional capacity evaluations and job-placement records that may support disability claims.

• UTMB Health Systems and Memorial Hermann (Houston) operate specialty clinics that provide the objective imaging and specialist reports SSA requires.

3. Legal Aid & Low-Cost Clinics

• Lone Star Legal Aid – Offers free legal advice to qualifying low-income Texans.

• Houston Volunteer Lawyers – May place SSDI appeals with pro bono attorneys.

4. Stay Informed with Authoritative Sources

Bookmark these official pages:

SSA – How to Appeal a Decision Electronic Code of Federal Regulations – Part 404 Social Security Act (Title II)

Conclusion

Even though the initial denial rate is high, persistence pays off. By understanding the legal standards, meeting every deadline, and strengthening your medical evidence, you greatly increase the odds of success. If you decide to work with counsel, choose a licensed Texas attorney who practices regularly before SSA and, if needed, the U.S. District Court for the Southern District of Texas.

Legal Disclaimer: This guide is for informational purposes only and is not legal advice. Laws and regulations change. You should consult a licensed Texas attorney about 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.