SSDI Denial & Appeal Guide – Michigan, Michigan

Introduction

Every year, thousands of Michigan residents apply for Social Security Disability Insurance (SSDI) because an injury, illness, or chronic medical condition prevents them from engaging in substantial gainful activity. According to the Social Security Administration (SSA), more than 62% of initial disability applications nationwide are denied. In Michigan, the denial rate mirrors that national average, leaving many claimants wondering what to do next. This comprehensive guide explains your rights, common denial reasons, the strict federal rules that govern SSDI, and—most importantly—the precise steps Michigan claimants should take to appeal an unfavorable decision.

The information below is rooted in authoritative sources such as the Social Security Act, the Code of Federal Regulations (CFR), and official SSA policies. While we slightly favor protecting the interests of disability claimants, every fact has been verified. If you live anywhere in Michigan—from Detroit to the Upper Peninsula—understanding this process can make the difference between a continued denial and the benefits you need.

Understanding Your SSDI Rights

What SSDI Provides

SSDI is a federal insurance program funded by payroll taxes under Title II of the Social Security Act. It offers monthly cash benefits and, after 24 months of eligibility, Medicare coverage. To qualify, an individual must:

• Have enough quarters of coverage based on past work (20 CFR §404.130).

• Meet the SSA’s definition of disability—an impairment that is expected to last at least 12 months or result in death and prevents substantial gainful activity (20 CFR §404.1505).

• Be younger than full retirement age.

The Right to Written Notice

Under Section 205(b) of the Social Security Act, every claimant is entitled to a written notice explaining the reasons for a denial and detailing appeal rights. If the SSA disapproves your application, it must:

• Specify the medical and non-medical evidence considered.

• State which impairments do not meet or equal a listing.

• Describe how your Residual Functional Capacity (RFC) was determined.

Four Levels of Federal Appeals

• Reconsideration—a fresh review by a different examiner (20 CFR §404.907).

• Administrative Law Judge (ALJ) Hearing—de novo hearing before an independent judge (20 CFR §404.929).

• Appeals Council Review—error correction or remand (20 CFR §404.967).

• Federal District Court—civil action under 42 U.S.C. § 405(g).

At every stage, you have the right to submit additional evidence, present witnesses, and be represented by an attorney or qualified advocate.

Common Reasons SSA Denies SSDI Claims

Medical Insufficiency

The SSA frequently denies claims because medical evidence does not establish severe limitations for at least 12 continuous months. Diagnostic tests, treatment records, and physician opinions are crucial. Michigan claimants often fail to obtain longitudinal treatment histories from both primary care physicians and specialists.

Earning Above Substantial Gainful Activity (SGA)

If you earned more than the annual SGA threshold—$1,550 per month in 2024 for non-blind individuals—the SSA will find you not disabled regardless of your medical condition. Many denials in Michigan arise when claimants attempt part-time work that slightly exceeds this limit.

Failure to Follow Prescribed Treatment

Per 20 CFR §404.1530, an otherwise qualified claimant can be denied if they fail to follow treatment that could restore the ability to work. Common pitfalls include missing physical therapy sessions or refusing physician-recommended surgery without a justifiable reason.

Non-Cooperation

The SSA may deny a claim if you do not respond to requests for records or fail to attend a Consultative Examination. Keep your address updated with Michigan’s Disability Determination Services (DDS) to avoid missed correspondence.

Federal Legal Protections & Regulations

Key Statutes and Regulations

• Social Security Act §223(d)—defines disability and insurance requirements.

• 20 CFR §404.1505—sets forth the basic definition of disability.

• 20 CFR §404.1520—explains the five-step sequential evaluation process.

• 20 CFR §404.955—governs ALJ decisions and the record.

Statute of Limitations for Appeals

You have strictly 60 days from receipt of a denial notice to file an appeal at each level. The SSA presumes you receive the notice five days after the date on the letter (20 CFR §404.901). Missing this deadline without good cause—such as hospitalization—usually ends your claim.

Attorney Representation Rules in Michigan

Any attorney representing a claimant before the SSA must be in good standing with a state bar—often the State Bar of Michigan—and comply with SSA’s fee-approval process (20 CFR §404.1720). Non-attorney representatives can appear if they meet SSA qualification standards, but only a Michigan-licensed lawyer may file suit in the United States District Court for the Eastern or Western District of Michigan.

Steps to Take After an SSDI Denial

1. Read the Denial Letter Carefully

Identify the alleged deficiencies. Did the DDS examiner claim insufficient evidence? Are they questioning the severity of your impairments? Pinpointing these issues guides you in gathering targeted documentation.

2. Calendar the 60-Day Deadline

Mark the last day to submit your next-level appeal. Michigan courts rarely forgive missed deadlines.

3. File a Request for Reconsideration

Complete Form SSA-561 and submit it online or in person at your local field office. Michigan offices include:

• Detroit Field Office: 1149 W Lafayette Blvd, Detroit, MI 48226

• Grand Rapids Field Office: 1925 Breton Rd SE, Grand Rapids, MI 49506

Attach any new medical evidence, such as updated MRI results or recent hospitalization records.

4. Prepare for the ALJ Hearing

The average wait time for a Detroit Hearing Office date was approximately 9.9 months in 2023, according to SSA statistics. Use this time to:

• Request treating-physician opinions using SSA Form HA-1151.

• Keep consistent medical appointments.

• Maintain a symptom journal documenting daily limitations.

Tip: Vocational expert testimony can be challenged with up-to-date U.S. Department of Labor job-numbers data.

5. Appeals Council and Federal Court

If the ALJ denies your claim, file a Request for Review with the Appeals Council in Falls Church, VA. Should they affirm the denial, a licensed Michigan attorney can file a civil action in the appropriate federal district court. You must do so within 60 days (42 U.S.C. §405(g)).

When to Seek Legal Help for SSDI Appeals

High Denial Rates Favor Professional Advocacy

SSA data show that nationally in FY 2023, about 34% of claimants were awarded benefits at the ALJ level. Representation significantly improves success rates. A Michigan disability attorney can:

• Obtain missing medical records quickly through established provider contacts.

• Frame legal arguments under 20 CFR §404.1527 (medical opinion evidence) and relevant Sixth Circuit precedents.

• Cross-examine vocational experts to expose flawed job-number methodologies.

Contingency-Fee Structure

SSA caps attorney fees at 25% of past-due benefits or $7,200, whichever is less, and the SSA must approve any fee agreement (20 CFR §404.1728). This means no upfront payment for most Michigan claimants.

Local Resources & Next Steps

Michigan Disability Determination Services (DDS)

Address: 3038 W Grand Blvd, Suite 4-450, Detroit, MI 48202. DDS is the state agency that makes the initial medical determination under SSA contract.

Community Health Providers

• University of Michigan Health System—Ann Arbor (tertiary care, specialized diagnostics)

• Spectrum Health—Grand Rapids (regional rehabilitation services)

Vocational Rehabilitation

Michigan Rehabilitation Services help disabled residents return to suitable work or document inability to perform jobs. Engage early to build your SSA record.

Online Resources

SSA Disability Benefits Overview Official SSA Appeals Portal Electronic Code of Federal Regulations – 20 CFR Part 404 Michigan Rehabilitation Services

Legal Disclaimer

This guide is for informational purposes only and does not constitute legal advice. Consult a licensed Michigan attorney for advice 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.