SSDI Denial Appeal Guide – Wisconsin, WI

Introduction: Why SSDI Denials Matter in Wisconsin

Every year thousands of Wisconsinites apply for Social Security Disability Insurance (SSDI) because an injury, illness, or chronic condition keeps them from working. Yet, according to publicly available state data published by the Social Security Administration (SSA), fewer than 40 percent of initial Wisconsin applications are approved. That means the majority of claimants receive a Notice of Disapproved Claim and must decide—often within just 60 days—whether to appeal or give up important cash and Medicare benefits. If you live in Milwaukee, Madison, Green Bay, or any of the state’s rural communities, understanding your appeal rights is critical. This guide explains the federal rules, common denial reasons, and the exact steps Wisconsin residents must take to keep their claims alive. While we slightly favor the claimant’s perspective, every fact below is drawn from authoritative sources such as the Social Security Act, the Code of Federal Regulations, and official SSA publications.

Understanding Your SSDI Rights Under Federal Law

The Social Security Act Creates the Benefit

SSDI was created in 1956 under Title II of the Social Security Act, 42 U.S.C. § 401 et seq. Section 223 (42 U.S.C. § 423) sets out the basic eligibility requirements: you must be insured (enough work credits) and disabled under the Act’s definition. Importantly, the statute gives every claimant the right to a hearing after a denial.

Key Federal Regulations Protecting Claimants

• 20 C.F.R. § 404.1520 – the five-step sequential evaluation that adjudicators use to decide if you are disabled.

• 20 C.F.R. §§ 404.900–404.999 – the four-level administrative appeals process (reconsideration, ALJ hearing, Appeals Council review, and federal court).

These regulations apply nationwide, including every SSA field office and hearing location in Wisconsin. You also have the right to appoint a representative (attorney or qualified non-attorney) at any point in the process under 20 C.F.R. § 404.1700.

Common Reasons SSA Denies SSDI Claims in Wisconsin

• Insufficient Medical Evidence – Many claimants rely on sporadic treatment notes. Under 20 C.F.R. § 404.1513, SSA needs objective evidence from acceptable medical sources. If UW Health, Bellin, or Marshfield Clinic records are missing, denial is likely.

• Earnings Above Substantial Gainful Activity (SGA) – For 2024, average monthly earnings over $1,550 (blind: $2,590) show you can engage in SGA. SSA will issue a technical denial.

• Failure to Follow Prescribed Treatment – 20 C.F.R. § 404.1530 permits denial if you unreasonably refuse recommended care without a valid excuse.

• Short Duration Impairments – Conditions must last (or be expected to last) at least 12 months or result in death, per 42 U.S.C. § 423(d)(1)(A).

• Non-Cooperation – Missing consultative exams scheduled by the Disability Determination Bureau (DDB) in Madison can trigger denial under 20 C.F.R. § 404.1518.

Wisconsin-specific tip: the DDB contracts local physicians across the state. If travel is a hardship—common in northern counties—you can request mileage reimbursement or a closer exam.

Federal Legal Protections & Regulations

The Four Levels of Appeal

All SSDI claimants nationwide follow the same multi-step appeals process outlined in 20 C.F.R. § 404.900:

• Reconsideration – File SSA-561 within 60 days of the denial. A new examiner at the Wisconsin DDB reviews your file.

• Administrative Law Judge (ALJ) Hearing – Request Form HA-501 if reconsideration fails. Wisconsin hearings are held primarily at the Milwaukee and Madison Hearing Offices, with video locations in Green Bay, Eau Claire, and La Crosse.

• Appeals Council – Submit Form HA-520 to Falls Church, Virginia. You may argue legal errors, policy misapplication, or new evidence per 20 C.F.R. § 404.970.

• Federal District Court – File a civil action in the U.S. District Court for the Western or Eastern District of Wisconsin within 60 days of the Appeals Council’s denial. Jurisdiction arises under 42 U.S.C. § 405(g).

Statutes of Limitation and Good Cause Extensions

The 60-day deadline begins five days after the date on SSA’s notice (mailing presumption). Good cause extensions are available under 20 C.F.R. § 404.911 for circumstances such as hospitalization or mail delay. Always include documentation (e.g., medical records, postmarked envelopes) when requesting late filing relief.

Steps to Take After an SSDI Denial

1. Read Your Denial Letter Carefully

The notice lists technical and medical reasons for denial and explains how to request reconsideration. Note the issue date.

2. Gather Missing Evidence

Under 20 C.F.R. § 404.1512, the claimant bears the burden of providing evidence. In Wisconsin, important sources often include:

• UW Health hospitals in Madison (600 Highland Ave.)

• Froedtert Hospital & Medical College of Wisconsin in Milwaukee

• Marshfield Clinic Health System records statewide

• VA medical centers in Milwaukee and Tomah for veterans

3. File Your Reconsideration Online or at a Local Office

SSA encourages online filing through SSA’s Appeal Portal, but you can also submit papers at any field office, such as:

• Milwaukee Downtown Office: 310 W. Wisconsin Ave., Suite 260, Milwaukee, WI 53203

• Madison Office: 6011 Odana Rd., Madison, WI 53719

• Green Bay Office: 1561 Dousman St., Green Bay, WI 54303

Keep stamped copies or electronic receipts.

4. Prepare for the Hearing

If reconsideration is denied, request an ALJ hearing. Tips:

• Submit updated records at least five business days before the hearing under 20 C.F.R. § 404.935.

• Identify treating physicians who can complete an RFC form.

• Prepare testimony on past-relevant work and daily limitations.

5. Appeals Council & Federal Court

The Appeals Council can remand or deny. If denied, your last administrative remedy is exhausted, and you may file a federal lawsuit. Because federal litigation involves complex procedural rules (Fed. R. Civ. P. 8, local court rules), most claimants retain counsel at this stage.

When to Seek Legal Help for SSDI Appeals

While you have the right to self-represent, success rates generally improve with professional representation. SSA statistics (Annual Report, Office of Hearings Operations) show claimants with representatives succeed at nearly double the rate of unrepresented claimants at the ALJ level. Wisconsin attorneys are regulated by the State Bar of Wisconsin and must follow Supreme Court Rules Chapter 20. Under 42 U.S.C. § 406(a), attorney fees are capped at 25 percent of past-due benefits or $7,200 (2024 cap), whichever is less, and are paid only if you win.

Consider hiring an attorney if:

• You have multiple denied applications.

• Your case involves complex medical issues (e.g., combined physical and mental impairments).

• You need to cross-examine vocational or medical experts.

• You are approaching the Appeals Council or federal court stages.

Local Resources & Next Steps in Wisconsin

Wisconsin Disability Determination Bureau (DDB)

The DDB, located at 722 Williamson St., Madison, WI 53703, makes the initial and reconsideration decisions for SSA. More information is available at Wisconsin Department of Health Services – DDB.

Free and Low-Cost Legal Aid

• Legal Action of Wisconsin – Provides representation to low-income adults statewide.

• Disability Rights Wisconsin – Advocacy for individuals with disabilities, including benefit denials.

• University of Wisconsin Law School Pro Bono Program – Limited representation projects in Dane County.

Supportive Medical & Vocational Services

• Division of Vocational Rehabilitation (DVR) – May assist with job accommodations, which can be useful evidence of inability to sustain work.

• Community Health Centers – Such as Milwaukee Health Services, Inc., and Scenic Bluffs Community Health Centers in Cashton.

• Mental Health Resources – The statewide 988 crisis line and county-based Comprehensive Community Services (CCS) programs.

Documenting ongoing treatment and complying with DVR recommendations can strengthen your SSDI case.

Conclusion

SSDI denials are common, but they are not the final word. By understanding federal regulations, meeting every deadline, supplementing your record with strong Wisconsin-based medical evidence, and—when necessary—hiring a qualified disability attorney, you significantly increase your chances of securing the benefits you earned through years of work.

Legal Disclaimer

This guide is for informational purposes only and does not constitute legal advice. Laws and regulations change; consult a licensed Wisconsin attorney for advice on 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.

Additional authoritative resources:

20 C.F.R. § 404.900 – SSA Administrative Review Process 20 C.F.R. § 404.1520 – Five-Step Sequential Evaluation SSA Disability Benefits Home Page SSA Office of Hearings Operations & Appeals Wisconsin Disability Determination Bureau