SSDI Denial Appeal Guide – Massachusetts, Massachusetts

Introduction: Why This Guide Matters to Massachusetts Residents

Each year thousands of workers across Massachusetts apply for Social Security Disability Insurance (SSDI) when injury or illness prevents them from earning a living wage. According to the most recent statistics published by the Social Security Administration (SSA), roughly two-thirds of initial SSDI applications are denied nationwide. Bay State claimants fare only slightly better than the national average, meaning hundreds of applicants in Boston, Worcester, Springfield, Lowell, and other communities receive denial letters every month.
This comprehensive guide explains—step by step—how to protect your rights after an SSDI denial, the strict federal deadlines you must meet, and how the process differs from Supplemental Security Income (SSI). While we present objective legal information drawn directly from federal regulations and court opinions, we intentionally highlight strategies that benefit claimants. If you live in Massachusetts and recently received a Notice of Disapproved Claim or Notice of Reconsideration, the following pages will help you decide what to do next.

Understanding Your SSDI Rights

SSI vs. SSDI—Key Differences Every Bay Stater Should Know

Because both programs are overseen by the SSA, many applicants confuse Supplemental Security Income (SSI) with Social Security Disability Insurance (SSDI). Knowing which program you qualify for is critical:

• SSDI is an earnings-based insurance program under Title II of the Social Security Act, 42 U.S.C. §401 et seq. Eligibility hinges on your work credits and whether SSA finds you “disabled” under 20 C.F.R. §404.1505.

• SSI is a means-tested safety-net benefit created in Title XVI of the Act, 42 U.S.C. §1381 et seq. It serves individuals with low income and limited resources regardless of work history. Disability criteria mirror SSDI, but financial thresholds differ.

Massachusetts residents may apply for both programs simultaneously (called a “concurrent claim”) if they meet the respective requirements. However, if you have a solid earnings record, your denial notice likely concerns SSDI, and the appeals process described below will apply.

Your Right to Appeal Under Federal Law

The Social Security Act guarantees every denied claimant the right to a multi-level administrative appeal followed by federal court review. The four-step sequence is codified at 20 C.F.R. §§404.909–404.981 and reaffirmed by federal courts, including the First Circuit Court of Appeals, which has jurisdiction over Massachusetts. At each stage you may submit new medical evidence, present testimony, and—if you choose—be represented by an attorney or qualified advocate. Representation fees are capped by 42 U.S.C. §406 and must be approved by SSA, offering additional protection to claimants.

Common Reasons SSA Denies SSDI Claims

Understanding why claims are denied helps you target appeal arguments effectively. The SSA typically cites one or more of the following:

• Lack of “severe” impairment. Under 20 C.F.R. §404.1520(a)(4), your condition must significantly limit basic work activities for at least 12 months or be expected to result in death.

• Medical evidence gaps. Missing diagnostic imaging, specialist reports, or updated treatment notes can cause examiners to conclude that your documentation is “insufficient.”

• Residual Functional Capacity (RFC) findings. Examiners may determine you can perform past relevant work or adjust to other work available in the national economy—even if no such jobs exist in Massachusetts.

• Failure to follow prescribed treatment. Per 20 C.F.R. §404.1530, ignoring a doctor’s orders without “good cause” can sink otherwise strong claims.

• Technical errors. Missing signatures, late responses to SSA notices, or applying for the wrong program are surprisingly common reasons for denial.

Fortunately, all of these issues are correctable on appeal—especially when new evidence, physician letters, or vocational expert testimony are introduced.

Federal Legal Protections & Regulations

Key Statutes & Regulations Every Massachusetts Claimant Should Cite

• 20 C.F.R. §404.909 – Establishes the 60-day deadline to request reconsideration of an initial denial.

• 20 C.F.R. §404.933 – Governs the right to an Administrative Law Judge (ALJ) hearing after reconsideration.

• 42 U.S.C. §423(d) – Defines “disability” for SSDI purposes, including the durational requirement.

• 42 U.S.C. §405(g) – Confers jurisdiction on U.S. District Courts (for Massachusetts, the District of Massachusetts) to review final SSA decisions.

• SSA POMS DI 22505.014 – Clarifies how adjudicators weigh treating-source medical opinions.

These authorities carry more weight than generalized internet advice. Citing them in your appeal letter or at your hearing signals to adjudicators that you—or your representative—understand the governing law.

Statute of Limitations & Good-Cause Extensions

The primary deadline for each appeal level is 60 days from the date you receive the SSA notice (presumed to be five days after mailing under 20 C.F.R. §422.210(c)). Missing the deadline usually ends your claim unless you can show “good cause,” such as hospitalization, natural disaster, or documented mental incapacity. While ALJs have discretion to grant extensions, courts strictly construe these rules, so act promptly.

Steps to Take After an SSDI Denial

1. Read the Notice Carefully

Your denial letter contains the “disability determination explanation,” listing medical sources reviewed, impairments considered, and rationale for denial. Highlight any factual errors (e.g., wrong onset date) you can contest.

2. Collect Missing Medical Evidence

Ask your treating physicians at facilities such as Massachusetts General Hospital (Boston) or UMass Memorial Medical Center (Worcester) to provide updated progress notes, objective testing, and a medical source statement addressing your work-related limitations.

3. File a Timely Request for Reconsideration

Use SSA Form 561 and submit it to your local field office—e.g., SSA Boston Office, 10 Causeway St., Room 148, Boston, MA 02222. You may file online via your mySSA account. Keep copies and proof of delivery.

4. Prepare for the Administrative Law Judge Hearing

If reconsideration fails (in Massachusetts, approvals at this stage hover around 14%), request an ALJ hearing. Hearings for Bay State residents are currently scheduled at the Boston ODAR (Office of Disability Adjudication and Review) or by video from Springfield. ALJs allow testimony, cross-examination of vocational experts, and submission of new exhibits up to five business days before the hearing (see 20 C.F.R. §405.331).

5. Appeals Council & Federal Court Review

Should the ALJ issue an unfavorable decision, file a written request for Appeals Council review within 60 days. If the Council denies review or affirms the ALJ, you have another 60 days to file a civil action in the U.S. District Court for the District of Massachusetts. Massachusetts federal judges frequently remand cases back to SSA when ALJs disregard critical medical opinions—an outcome that can ultimately secure benefits.

When to Seek Legal Help for SSDI Appeals

You are entitled to represent yourself at every level, but statistics published in the SSA’s Annual Statistical Report show claimants represented by attorneys win significantly more often. Massachusetts lawyers must be licensed by the Massachusetts Board of Bar Overseers and comply with Supreme Judicial Court Rule 4:01. In addition, representatives must register with SSA’s Appointed Representative Services (ARS). Under 42 U.S.C. §406(a)(2), fees are generally limited to 25% of past-due benefits, capped at $7,200 (as of 2024), and payable only if you win. This contingency model aligns the attorney’s incentives with yours, reducing financial risk.

Local Resources & Next Steps

• Massachusetts Rehabilitation Commission (MRC): Offers vocational rehabilitation, independent living, and assistive technology services statewide.

• Disability Law Center (DLC): The Protection & Advocacy agency for Massachusetts provides free legal assistance on certain disability-related issues.

• Community Health Centers: Boston Medical Center, Codman Square Health Center, and Holyoke Health Center can expedite low-cost medical records for SSDI evidence.

Local SSA Offices:

  - Boston: 10 Causeway St., Room 148, Boston, MA 02222

  - Worcester: 51 Myrtle St., Worcester, MA 01608

  - Springfield: 70 Bond St., Springfield, MA 01104

Before mailing any appeal paperwork, consider scheduling a free consultation with a Massachusetts disability attorney. An experienced lawyer can draft persuasive briefs that weave together medical evidence, vocational analysis, and citations to First Circuit precedent such as Avery v. Secretary of HHS, 797 F.2d 19 (1st Cir. 1986).

Conclusion & Legal Disclaimer

This guide distilled complex federal regulations into actionable steps for Massachusetts workers confronting an SSDI denial. While every effort was made to provide accurate, up-to-date information from authoritative sources, this article is for informational purposes only and does not constitute legal advice. Laws and agency policies change, and each case is fact-specific. Consult a licensed Massachusetts attorney to obtain advice tailored to your situation.

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