SSDI & Medicare Denial Guide – Maryland, MD

Introduction: Facing an SSDI or Medicare Denial in Maryland

Every year thousands of Maryland residents apply for Social Security Disability Insurance (SSDI) to replace lost income when a serious medical condition keeps them from working. According to Social Security Administration (SSA) data, roughly two-thirds of initial applications filed from Maryland are denied. A denial not only delays vital monthly benefits—it postpones the 24-month waiting period that leads to Medicare coverage. If you received a denial letter from SSA’s Disability Determination Services (DDS) in Baltimore, Towson, or another Maryland field office, do not give up. This guide explains your legal rights, key federal regulations, and the exact appeal steps—from Reconsideration through federal court—tailored to Maryland claimants. It slightly favors protecting claimants while remaining strictly factual and based on authoritative sources such as 20 C.F.R. §§ 404.900–404.999 and Section 223 of the Social Security Act.

Throughout this article you will see practical tips, deadlines, and local resources—such as addresses of major Maryland Social Security field offices, contact information for the SSA’s Region III Office of Hearings Operations in Baltimore, and an overview of respected medical centers (e.g., Johns Hopkins Hospital) whose records often support disability claims. Whether you live in Baltimore City, Silver Spring, Frederick, or the Eastern Shore, the process is identical under federal law, but local knowledge can shorten delays and strengthen your evidence. Keep this guide handy as you prepare to protect your right to both SSDI cash benefits and the Medicare coverage that follows.

Understanding Your SSDI Rights in Maryland

What SSDI Provides

SSDI is a federally funded insurance program for workers who paid Social Security taxes (FICA) and can no longer perform substantial gainful activity (SGA) due to a medically determinable impairment expected to last at least 12 months or result in death (20 C.F.R. § 404.1505). Approved beneficiaries receive:

• Monthly cash benefits based on their earnings record.

• Automatic eligibility for Medicare Parts A and B after 24 months of SSDI entitlement (Social Security Act § 223(d)(1)(B)). Certain diagnoses such as end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) qualify for faster Medicare coverage.

• Protection of future retirement benefits by freezing the worker’s earnings record during the disability period.

Eligibility Basics

To qualify you must:

• Have earned the required work credits—generally 20 credits in the 10 years before disability onset for adults aged 31 or older (20 C.F.R. § 404.130).

• Prove you cannot perform past relevant work or adjust to other work existing in significant numbers in the national economy, using the SSA’s five-step sequential evaluation (20 C.F.R. § 404.1520).

• Submit objective medical evidence from acceptable medical sources.

Maryland DDS examiners apply the same federal standards as every state, but familiarity with regional medical facilities such as the University of Maryland Medical Center can expedite record gathering and proper evaluation.

Common Reasons SSA Denies SSDI Claims

Initial denials generally fall into four categories:

• Technical Denials: Insufficient work credits, earnings above SGA ($1,550/month in 2024 for non-blind claimants), or failure to cooperate with SSA requests (e.g., missing a consultative examination).

• Medical Denials: DDS finds the impairment non-severe, short-term, or believes the claimant can perform past work or adjust to other work.

• Duration Denials: Medical evidence fails to establish a 12-month (or terminal) duration.

• Substance Use Factor: If drug or alcohol use is a contributing factor material to disability (20 C.F.R. § 404.1535).

In Maryland, failure to provide complete treatment records from major hospitals like Johns Hopkins Hospital, Sinai Hospital of Baltimore, or Adventist HealthCare Shady Grove Medical Center is a frequent reason DDS cannot fully evaluate impairments. Claimants should request and submit records proactively instead of relying on DDS alone.

Federal Legal Protections & Key Regulations

Statutes, Regulations, and Rulings

Your rights arise from the Social Security Act (42 U.S.C. § 401 et seq.) and its implementing regulations. The most relevant for appeals include:

• 20 C.F.R. §§ 404.900–404.999 – Establish the four-level administrative review process: Reconsideration, Hearing, Appeals Council, and Federal Court.

• 20 C.F.R. § 404.1512 – SSA’s duty to develop the record and the claimant’s reciprocal duty to provide evidence.

• 20 C.F.R. § 404.1520c – The persuasiveness standard for evaluating medical opinions for claims filed on or after March 27, 2017.

• Social Security Ruling (SSR) 16-3p – How SSA evaluates symptoms such as pain and fatigue.

These rules apply nationwide, including all SSA offices in Maryland. If SSA fails to follow them, federal courts within the U.S. District Court for the District of Maryland can reverse or remand denials.

Appeal Filing Deadlines

• Reconsideration: 60 days from receipt of the denial notice (presumed to be 5 days after mailing) (20 C.F.R. § 404.909(a)).

• Hearing before an Administrative Law Judge (ALJ): 60 days from Reconsideration denial (20 C.F.R. § 404.933).

• Appeals Council Review: 60 days from ALJ decision (20 C.F.R. § 404.968).

• U.S. District Court: 60 days from Appeals Council denial or dismissal (42 U.S.C. § 405(g)).

Missing any deadline typically forfeits your right to the next appeal unless you establish “good cause,” such as serious illness or SSA error (20 C.F.R. § 404.911).

Steps to Take After an SSDI Denial

1. Read the Denial Letter Carefully

The notice explains SSA’s rationale and cites specific medical and vocational evidence. In Maryland, these letters originate from the SSA DDS at 300 E. Joppa Road, Suite 408, Towson, MD 21286.

2. File a Timely Request for Reconsideration

You can submit Form SSA-561 online, by mail, or in person at a Maryland field office (addresses below). Include new medical records, updated medications, and statements from treating physicians.

3. Prepare for the ALJ Hearing

If Reconsideration is denied (roughly 88% are in Maryland), request a hearing. Maryland hearings are usually held at:

• Baltimore ODAR – 1010 Park Avenue, Suite 200, Baltimore, MD 21201

• Ellicott City ODAR – 3290 N. Ridge Road, Suite 100, Ellicott City, MD 21043

During the hearing the ALJ will question you and any vocational or medical expert. You may submit pre-hearing briefs citing applicable regulations and medical listing criteria (e.g., 20 C.F.R. Part 404, Subpart P, Appendix 1).

4. Appeals Council Review

The SSA Appeals Council in Falls Church, Virginia (outside Washington, D.C.) reviews Maryland cases upon written request. They may affirm, reverse, or remand the ALJ decision.

5. File a Civil Action in the U.S. District Court for the District of Maryland

Federal court review is the final administrative step. You must serve the U.S. Attorney for the District of Maryland and the SSA Office of the General Counsel within 60 days.

When to Seek Legal Help for SSDI Appeals

Claimants have the right to representation at every stage (20 C.F.R. § 404.1700 et seq.). In Maryland, attorneys must be licensed by the Maryland State Bar and in good standing with SSA’s Office of the General Counsel. Hiring an experienced Maryland disability attorney can:

• Ensure all deadlines and procedural rules are met.

• Gather persuasive opinions from treating physicians at facilities like Johns Hopkins Medicine or MedStar Health.

• Cross-examine vocational experts to challenge transferable skills findings.

• Coordinate SSDI benefits with other programs (e.g., Medicaid, long-term disability insurance).

Representative fees are capped at 25% of past-due benefits, up to $7,200 without special petition (20 C.F.R. § 404.1728(b)(1)).

Local Resources & Next Steps

Maryland SSA Field Offices

• Baltimore Downtown: 1010 Park Ave., Baltimore, MD 21201

• Silver Spring: 10230 New Hampshire Ave., Silver Spring, MD 20903

• Frederick: 100 E. All Saints St., Frederick, MD 21701

• Salisbury: 803 Nanticoke Rd., Salisbury, MD 21801

Check SSA’s locator or call 1-800-772-1213 before visiting to verify hours.

Free & Low-Cost Medical Providers

If you lack insurance while waiting on approval, consider:

Johns Hopkins Hospital Charity Care Baltimore Medical System Clinics

Advocacy & Legal Aid

Disability Rights Maryland – free legal services in certain cases. Maryland Legal Aid – may assist low-income appellants.

Conclusion

An SSDI denial in Maryland is not the end of the road. By understanding federal regulations, adhering to strict deadlines, and supplementing the record with compelling medical evidence, you can overturn an unfavorable decision and ultimately secure both monthly benefits and Medicare coverage. If confusion remains, professional representation can improve your odds at every appeal level.

Legal Disclaimer: This information is provided for educational purposes only and does not constitute legal advice. Consult a licensed Maryland attorney 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.