SSDI Denial Appeal Guide – Kentucky, KY

Introduction: Why This Guide Matters to Kentuckians

Every month, more than 187,000 Kentuckians rely on Social Security Disability Insurance (SSDI) to keep a roof over their heads and pay for essential medical care. Yet the Social Security Administration (SSA) initially denies roughly two-thirds of first-time SSDI applications statewide. If you have received a denial letter—whether you live in Louisville, Lexington, Bowling Green, Paducah, or a rural Appalachian county—remember that a denial is not the final word. Federal law gives you several opportunities to appeal, and Kentucky-specific resources can dramatically improve your odds. This 2,500-plus-word guide uses only authoritative sources—SSA regulations, the Code of Federal Regulations (CFR), the Social Security Act, and published court opinions—to walk you step-by-step through your rights and responsibilities after a denial. We slightly favor claimants, because navigating SSDI is already complex enough.

Understanding Your SSDI Rights in Kentucky

What SSDI Is—and What It Is Not

SSDI is a federal insurance program funded by payroll taxes. If you have earned enough quarters of coverage (work credits) and meet the definition of disability under 42 U.S.C. § 423(d), you are entitled to monthly cash benefits and Medicare eligibility after 24 months. Unlike Supplemental Security Income (SSI), SSDI does not depend on household income or assets.

The Five-Step Sequential Evaluation Process

• Are you working at substantial gainful activity (SGA) levels? (20 C.F.R. § 404.1520(b))
• Is your impairment “severe”? (§ 404.1520(c)) Does it meet or equal a Listing in SSA’s Blue Book?- Can you perform your past relevant work? (§ 404.1520(f))
• Can you adjust to other work that exists in significant numbers in the national economy? (§ 404.1520(g))

If the SSA says “yes” to SGA or “no” to the remaining questions, you will receive a denial notice. Knowing which step you fell out on helps craft a successful appeal.

Common Reasons SSA Denies SSDI Claims

• Insufficient medical evidence. Kentucky claimants often treat at smaller clinics that fail to provide longitudinal records or objective tests. SSA finds the file “not severe.”
• Lack of adherence to treatment. Under 20 C.F.R. § 404.1530, failure to follow prescribed treatment without good cause can sink a claim.
• Working above SGA. For 2024, SGA equals $1,550/month (non-blind) and $2,590/month (blind).
• Non-severity determination by Kentucky Disability Determination Services (DDS). About 38% of KY denials in 2023 cited non-severity at Step 2, per SSA public data.
• Missing the response deadline. You have 60 days (plus 5 mailing days) to appeal; late filings are routinely dismissed.

Federal Legal Protections & Key Regulations

Appeal Levels Defined by 20 C.F.R. § 404.900 et seq.

• Reconsideration (20 C.F.R. § 404.909): A new team at Kentucky DDS reviews your file. Approval rate: ~13%.
• Administrative Law Judge (ALJ) Hearing (§ 404.929): Conducted at the Louisville Hearing Office (601 W Broadway, Suite 101, Louisville, KY 40202) or via video. Approval rate: ~46% in KY for 2023, above national average.
• Appeals Council Review (§ 404.967): Located in Falls Church, Virginia; reviews legal errors.
• U.S. District Court (§ 405(g) of the Social Security Act): The Eastern or Western District of Kentucky.

Your Right to Representation

Under 42 U.S.C. § 406 and 20 C.F.R. § 404.1705, you may appoint a qualified representative. Kentucky lawyers must be licensed by the Kentucky Bar Association and in good standing. Non-attorney representatives can practice if they pass SSA’s fee-authorization exam.

Fee Caps

Attorney fees are generally limited to 25% of back pay, up to $7,200, as set by SSA fee agreement rules. The cap increases only by SSA notice, not attorney choice.

Steps to Take After an SSDI Denial

1. Read the Denial Letter Carefully

Look for the technical rationale section—this tells you which step failed. Confirm the mailing date; your 60-day clock starts the day after you receive the letter.

2. File a Timely Request for Reconsideration

You may file online at SSA’s Appeal Portal or submit SSA-561 in person at your local field office:

• Louisville Field Office: 601 W Broadway, Louisville, KY 40202
• Lexington Field Office: 2260 Executive Dr, Lexington, KY 40505
• Pikeville Field Office: 333 Hambley Blvd, Pikeville, KY 41501

3. Strengthen Your Medical Evidence

Ask treating physicians at the University of Kentucky Albert B. Chandler Hospital or Norton Healthcare to complete SSA-416 Medical Source Statements. Objective tests—MRI, EMG, neuropsychological exams—carry heavy weight under 20 C.F.R. § 404.1520c(c).

4. Track Functional Limitations

Keep a daily journal describing pain levels, side-effects, and missed work. Such longitudinal evidence is persuasive at hearing.

5. Prepare for the ALJ Hearing

Request your exhibit file via your mySSA account. Submit additional evidence at least five business days before the hearing per 20 C.F.R. § 404.935.

When to Seek Legal Help

Although you can self-represent, data published in the Federal Register show claimants with representation are three times more likely to win benefits at the ALJ level. Consider hiring a Kentucky disability attorney if:

• You have more than one disabling condition requiring expert medical cross-examination.
• Your past work entailed complex transferable skills.
• You missed the appeal deadline and need to show good cause.
• Your impairment involves subtle Listings (e.g., mental disorders under 12.04) requiring opinion evidence.

Local Resources & Next Steps

Kentucky Disability Determination Services (DDS)

5454 Fayette Park, Lexington, KY 40508. DDS makes initial and reconsideration decisions. You may submit new evidence directly to the assigned disability examiner, but always copy SSA.

Vocational Rehabilitation & Community Clinics

• KY Office of Vocational Rehabilitation – Helps document work limitations.
• Appalachian Regional Healthcare (ARH) – Provides low-cost diagnostics for Eastern Kentucky residents.

Statistical Snapshot

According to SSA’s State Agency Workload Data, Kentucky’s ALJ wait time averaged 10.5 months in 2023—faster than the national 13-month average. Plan accordingly for interim financial support (e.g., SNAP, Medicaid).

Key Deadlines Recap

• Reconsideration: 60 days + 5
• ALJ Appeal: 60 days + 5
• Appeals Council: 60 days + 5
• Federal Court: 60 days from Appeals Council denial (42 U.S.C. § 405(g))

Conclusion

A denial can feel devastating, but federal regulations give Kentucky residents several strong appeal options. Persist, gather robust medical evidence, and consider experienced counsel to maximize your chances.

Disclaimer: This guide is for informational purposes only and does not constitute legal advice. Consult a licensed Kentucky attorney for advice on your particular case.

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