SSI & SSDI Denial Guide – Massachusetts, Massachusetts

SSDI Denial and Appeal Guide for Massachusetts, Massachusetts

If you live in Massachusetts and received a Social Security Disability Insurance (SSDI) denial, you are not alone—and you have the right to appeal. The Social Security Administration (SSA) uses uniform federal rules in all states, but how you gather evidence, access local SSA offices, and prepare for a hearing can feel very local. This Massachusetts-focused guide explains your rights, key deadlines, and what to expect at each stage of the SSDI appeals process. It slightly favors claimants by highlighting practical steps to strengthen your case without overstating what the law permits.

Because the appeals process is time-sensitive, it is critical to act promptly. In most situations, you have 60 days from the date you receive a denial notice to request the next level of appeal under SSA regulations. The SSA presumes you received decisions five days after the date on the notice unless you show otherwise. This is a federal rule that applies in Massachusetts as it does elsewhere.

While this resource focuses on SSDI, many Massachusetts residents apply for both SSDI and Supplemental Security Income (SSI). The appeals process for SSI follows the same four levels as SSDI, and the SSA often processes the appeals together when both programs are involved. Throughout this guide, you will find references to the federal laws and regulations that govern the process, and links to official SSA resources to help you take the next step from within the Commonwealth.

Primary search phrase included for clarity: SSDI denial appeal massachusetts massachusetts.

Understanding Your SSDI Rights

What SSDI Is and Who Qualifies

SSDI provides monthly benefits to workers who are “insured” through sufficient work history and who meet the SSA’s strict definition of disability. To be insured, you generally must have worked long enough and recently enough under Social Security, which the SSA measures with “quarters of coverage” (work credits). The insured status requirement is set by regulation at 20 C.F.R. § 404.130. The medical definition of disability for adults is defined by statute at 42 U.S.C. § 423(d) and by regulation at 20 C.F.R. § 404.1505.

To decide disability, SSA uses a five-step evaluation sequence found at 20 C.F.R. § 404.1520. In short, the SSA considers: (1) whether you are working at the level of substantial gainful activity (SGA), (2) whether you have a severe medically determinable impairment, (3) whether your impairment meets or equals a listed impairment, (4) whether you can perform your past relevant work, and (5) whether you can perform other work in the national economy considering your age, education, and work experience.

Your Rights During the SSDI Process

• Right to Appeal: You have the right to appeal an unfavorable decision through four levels: reconsideration, hearing before an Administrative Law Judge (ALJ), review by the Appeals Council, and federal court review. Time limits are primarily 60 days for each stage. See 20 C.F.R. §§ 404.909, 404.933, 404.968 and 20 C.F.R. § 422.210 (federal court timetable).

• Right to Representation: You may appoint an attorney or qualified non-attorney representative. Rules governing representatives are found at 20 C.F.R. §§ 404.1700–404.1799, including qualifications at 20 C.F.R. § 404.1705.

• Right to Submit Evidence: You can provide medical and non-medical evidence relevant to your disability. See 20 C.F.R. § 404.1512 (evidence rules) and 20 C.F.R. § 404.1513 (medical sources). SSA can also schedule a consultative examination when needed under 20 C.F.R. §§ 404.1517–404.1519a.

• Right to a Hearing: You can request a hearing before an ALJ after reconsideration is denied. Hearings are non-adversarial. See 20 C.F.R. §§ 404.929, 404.930, 404.944–404.950.

• Right to Good-Cause Extensions: If you miss a deadline due to circumstances beyond your control, you can request more time to appeal. See 20 C.F.R. § 404.911 (good cause for late filing).

Common Reasons SSA Denies SSDI Claims

Insured Status and Work-Related Issues

• Insufficient Work Credits: If you do not meet the insured status requirement, your SSDI claim may be denied regardless of medical severity. See 20 C.F.R. § 404.130.

• Substantial Gainful Activity (SGA): Working and earning at or above SGA levels can lead to a denial at Step 1. See 20 C.F.R. §§ 404.1571–404.1574 for how SSA evaluates work and SGA. SSA adjusts SGA amounts periodically; check official SSA guidance for current thresholds.

Medical Evidence Issues

• Insufficient Medical Evidence: If records do not show a medically determinable impairment, severity, or functional limitations, SSA may deny. See 20 C.F.R. §§ 404.1508 (applicable to earlier claims)/404.1521 (current severity standard), 404.1512.

• Impairment Not Severe or Not Meeting 12-Month Duration: To be disabling, the impairment must be severe and expected to last at least 12 months or result in death. See 20 C.F.R. § 404.1509 (duration) and 20 C.F.R. § 404.1520 (sequential evaluation).

• Failure to Attend a Consultative Exam: If the SSA cannot obtain needed information and you do not attend a scheduled exam without good cause, the claim can be denied. See 20 C.F.R. § 404.1518.

• Failure to Follow Prescribed Treatment: If prescribed treatment could restore your ability to work and you fail to follow it without good cause, that may lead to denial. See 20 C.F.R. § 404.1530.

Vocational and Residual Functional Capacity (RFC) Findings

• RFC Does Not Preclude Past Work: If SSA finds you can still perform your past relevant work (Step 4), denial can result. See 20 C.F.R. § 404.1560(b).

• Ability to Do Other Work: At Step 5, SSA may find other jobs exist in significant numbers that you can perform given your RFC, age, education, and work experience. See 20 C.F.R. § 404.1560(c).

Federal Legal Protections & Regulations That Matter

Key Statutes

• Definition of Disability: Social Security Act § 223(d), codified at 42 U.S.C. § 423(d).

• Judicial Review: Social Security Act § 205(g), codified at 42 U.S.C. § 405(g) (civil action in federal district court).

• Administrative Due Process: Social Security Act § 205(b), codified at 42 U.S.C. § 405(b) (hearing rights).

Core Regulations

• Five-Step Sequential Evaluation: 20 C.F.R. § 404.1520.

• Insured Status: 20 C.F.R. § 404.130.

• Submitting Evidence: 20 C.F.R. § 404.1512 and medical source rules at 20 C.F.R. § 404.1513.

• Consultative Exams: 20 C.F.R. §§ 404.1517–404.1519a.

• Reconsideration Deadline: 20 C.F.R. § 404.909 (60 days).

• ALJ Hearing: 20 C.F.R. §§ 404.929, 404.933 (request within 60 days).

• Appeals Council: 20 C.F.R. § 404.968 (request review within 60 days).

• Civil Action Deadline and Mailing Presumption: 20 C.F.R. § 422.210 (60 days; 5-day receipt presumption).

• Good Cause for Late Filing: 20 C.F.R. § 404.911.

• Representative Qualifications and Fees: 20 C.F.R. §§ 404.1705, 404.1720; statute at 42 U.S.C. § 406(a).

Massachusetts Context Within the Federal Framework

Massachusetts claims are processed under federal rules by the SSA with medical determinations made by a state Disability Determination Services (DDS) unit acting for the SSA. If you proceed to a hearing, your case is heard by a federal Administrative Law Judge. Hearings may be conducted in person, by video, or by telephone, depending on SSA procedures and your case’s scheduling. Appeals Council review and federal court review are also governed by federal law and apply uniformly in Massachusetts.

Steps to Take After an SSDI Denial

1) Read Your Denial Notice Carefully

Your notice explains why SSA denied your claim and how to appeal. Note the date of the notice. SSA presumes you got it five days after the date on the letter unless you can show you received it later. This presumption matters for the 60-day deadline. See 20 C.F.R. § 422.210(c) (mailing presumption) and 20 C.F.R. § 404.909 (60-day appeal window for reconsideration).

2) File a Request for Reconsideration (First Appeal)

Most initial SSDI denials in Massachusetts must first go to reconsideration, where a different reviewer at DDS re-evaluates your claim. You generally have 60 days from receipt of the denial to file. Use SSA’s online appeals system or contact your local office. Reconsideration is governed by 20 C.F.R. § 404.909.

• Strengthen Your File: Submit any new medical records, test results, or physician statements. Ensure your providers detail objective findings and functional limitations (for example, lifting, standing, concentration, attendance).

• Address SSA’s Stated Reasons: If the notice cites SGA, clarify earnings and work attempts. If it cites medical insufficiency, submit missing records and a clear timeline of symptoms and treatment.

3) Request a Hearing Before an Administrative Law Judge (Second Appeal)

If reconsideration is denied, you have 60 days to request a hearing. See 20 C.F.R. §§ 404.929, 404.933. The hearing is your best opportunity to present testimony, submit additional evidence, and explain how your impairments prevent you from sustaining full-time work within SSA’s rules.

• Prepare Thoroughly: Organize records from all Massachusetts and out-of-state providers. Ask your treating sources for function-focused opinions consistent with clinical findings.

• Know the Five-Step Framework: Tailor your testimony to the steps SSA must follow under 20 C.F.R. § 404.1520.

• Vocational Evidence: SSA may call a vocational expert. Be ready to address transferable skills, job demands, and how your limitations affect work readiness and attendance.

4) Seek Appeals Council Review (Third Appeal)

If the ALJ denies your claim, you may request Appeals Council review within 60 days. See 20 C.F.R. § 404.968. The Appeals Council may deny review, grant review, remand for a new hearing, or issue its own decision. Provide a concise, legally grounded argument pointing to errors of law, unsupported findings, or new and material evidence that relates to the period on or before the ALJ decision.

5) File a Civil Action in Federal Court (Fourth Appeal)

If the Appeals Council denies review or issues an unfavorable decision, you have 60 days to file a civil action in the U.S. District Court for the District of Massachusetts. See 42 U.S.C. § 405(g) and 20 C.F.R. § 422.210. The court reviews the administrative record to decide whether SSA’s decision is supported by substantial evidence and free of legal error. This stage is formal litigation governed by federal rules and the court’s local rules.

Good Cause and Missed Deadlines

If you miss a deadline for reasons beyond your control (for example, hospitalization or mail issues), you can request more time. SSA considers “good cause” under 20 C.F.R. § 404.911. Provide a detailed explanation and any supporting documents.

When to Seek Legal Help for SSDI Appeals

While representation is not mandatory, many Massachusetts claimants choose to work with an attorney or qualified representative, especially at the hearing and federal court stages. SSA’s rules allow attorneys in good standing of a state’s bar to represent claimants before SSA. See 20 C.F.R. § 404.1705. Fee agreements must be approved by SSA, and fees for representation before SSA are generally limited by statute and regulation (typically a percentage of past-due benefits subject to a cap). See 42 U.S.C. § 406(a) and 20 C.F.R. § 404.1720.

For legal advice specific to Massachusetts law or to file in the U.S. District Court for the District of Massachusetts, you should consult a Massachusetts-licensed attorney and, for federal litigation, one admitted to practice before that federal court. Beyond legal strategy, a representative can help gather medical evidence, prepare written arguments, question vocational experts at hearings, and ensure compliance with deadlines and SSA evidentiary rules.

Local Resources & Next Steps in Massachusetts

Contacting SSA from Massachusetts

Appeal Online: The fastest way to appeal is through the SSA’s online portal. See: SSA: Appeal a Decision. Find Your Local Office: Locate your nearest Social Security field office serving Massachusetts using the official locator: SSA Office Locator.

• Hearings Information: For hearing-level cases, SSA schedules proceedings at an Office of Hearings Operations serving Massachusetts, or by phone or video where available. For the applicable hearing process, consult SSA’s resources and your hearing notice.

Massachusetts and the SSA Appeals Structure

Massachusetts is part of SSA’s Boston Region. The regional framework does not change your federal rights, but it can affect logistics (e.g., where a hearing is held, scheduling procedures, and local office contacts). The state’s DDS works with SSA to develop medical evidence and make initial and reconsideration determinations under federal rules. You can strengthen your Massachusetts case by ensuring all in-state providers promptly send complete records, including imaging, lab results, and opinion letters describing functional limitations.

Gathering Medical and Vocational Evidence in Massachusetts

• Medical Records: Request complete, up-to-date records from every relevant provider. Ask for detailed notes that explain objective findings and how symptoms limit specific work-related functions (standing, lifting, concentration, social interaction, pace, and attendance).

• Function Reports and Third-Party Statements: Provide accurate function reports. If helpful, ask someone who sees you regularly to submit an observation statement describing your day-to-day limitations.

• Work History and Earnings: Gather accurate job descriptions, physical and mental demands of past work, and precise earnings data if SGA is at issue. See the concept of SGA and related rules at 20 C.F.R. §§ 404.1571–404.1574 and SSA’s current thresholds.

Detailed Look at the Four Levels of Appeal

Reconsideration

Deadline: 60 days from receipt of the denial notice (20 C.F.R. § 404.909).

What to Do: Submit new or previously missing records. If SSA cited a lack of objective evidence, work with your providers to supply test results and examinations. If the denial turned on vocational issues, clarify job duties and limitations.

Tip for Massachusetts Claimants: If you received care from multiple providers across different Massachusetts health systems, verify that each provider’s records were requested, received, and scanned properly by SSA. Follow up—do not assume SSA already has everything.

ALJ Hearing

Deadline: 60 days from receipt of the reconsideration denial (20 C.F.R. §§ 404.929, 404.933).

What to Expect: The ALJ will ask questions about your impairments, treatment, daily activities, and past work. Vocational experts may testify about job demands and availability. You may submit updated evidence close to the hearing; be mindful of SSA’s late-submission rules and good-cause standards.

Preparation:

• Review the five-step framework and be prepared to explain limitations in work-related terms (sitting/standing tolerance, lifting capacity, off-task time, need for unscheduled breaks, attendance issues).

• Consider a medical source statement from a treating provider that ties clinical findings to specific functional limits.

• Be ready to address any failure to follow treatment issues with good-cause explanations when applicable (20 C.F.R. § 404.1530).

Appeals Council

Deadline: 60 days from receipt of the ALJ decision (20 C.F.R. § 404.968).

Scope: The Appeals Council reviews for legal errors, policy compliance, lack of substantial evidence, or considers new and material evidence that relates to the period on or before the ALJ decision. Keep arguments concise and citations precise.

Federal Court

Deadline: 60 days from receipt of the Appeals Council decision or denial of review (42 U.S.C. § 405(g); 20 C.F.R. § 422.210). The presumption of receipt is five days after the date on the notice unless you show otherwise (20 C.F.R. § 422.210(c)).

What Happens: The U.S. District Court for the District of Massachusetts reviews the administrative record. The court does not re-weigh evidence but checks whether the ALJ’s decision is supported by substantial evidence and whether the correct legal standards were applied. The court can affirm, remand, or reverse under the statute.

Frequently Asked, Evidence-Based Questions

How long do I have to appeal an SSDI denial in Massachusetts?

Generally, 60 days from the date you receive the decision to request reconsideration, 60 days to request a hearing after reconsideration, 60 days to request Appeals Council review, and 60 days to file in federal court. See 20 C.F.R. §§ 404.909, 404.933, 404.968 and 20 C.F.R. § 422.210.

Can I work while applying or appealing?

You can work, but earnings at or above SGA may lead to a denial at Step 1. SSA adjusts SGA amounts periodically. See 20 C.F.R. §§ 404.1571–404.1574. If you have earnings, document hours, duties, and accommodations; SSA may consider unsuccessful work attempts under these rules.

Do I need an attorney?

No, but representation can help with gathering evidence, preparing witnesses, and framing legal issues. SSA regulates representation and fees. See 20 C.F.R. §§ 404.1705, 404.1720 and 42 U.S.C. § 406(a).

What if I missed my appeal deadline?

Request an extension and explain your “good cause” under 20 C.F.R. § 404.911. Provide supporting documentation, such as hospitalization records or proof of delayed mail.

Checklist: Strengthening a Massachusetts SSDI Appeal

• Calendar Deadlines: 60-day windows govern each appeal level; add a buffer for the five-day mail presumption.

• Identify Gaps: Review SSA’s denial rationale and list missing records or tests.

• Update Evidence: Request complete records from all treating sources; add functional opinions.

• Address SGA: Provide detailed earnings and job duty information if you worked.

• Prepare Testimony: Explain why you cannot perform sustained, competitive work within SSA’s rules.

• Consider Representation: Contact a qualified representative familiar with Massachusetts hearings and federal rules.

Important Federal Resources

SSA: Appeal a Decision (Official Guide) 20 C.F.R. § 404.909 (Reconsideration and Deadlines) 20 C.F.R. § 404.1520 (Five-Step Sequential Evaluation) 20 C.F.R. § 422.210 (Federal Court Review and Timing) SSA Office Locator (Find a Local Office)

Attorney Licensing and Representation Notes for Massachusetts

Before the SSA, claimants may appoint attorneys licensed in a U.S. state or qualified non-attorney representatives under 20 C.F.R. § 404.1705. Fee arrangements must comply with 42 U.S.C. § 406(a) and 20 C.F.R. § 404.1720. For legal advice about Massachusetts law, consult a Massachusetts-licensed attorney. To file a federal court action in the District of Massachusetts, an attorney must be admitted to practice before that federal court and comply with its local rules in addition to federal statutes and regulations that govern Social Security appeals.

Practical Tips Specific to Massachusetts Claimants

• Use the SSA Office Locator: Massachusetts residents should confirm their assigned field office using the official SSA locator linked above. Office addresses and hours may change; always rely on SSA’s official site for the most current information.

• Coordinate With Providers: Encourage your Massachusetts providers to submit records quickly and include clear functional limitations. SSA assesses your capacity for sustained work, so specificity helps.

• Keep a Symptom and Treatment Log: Document flare-ups, missed days, and side effects. Detailed logs can support testimony and treating source opinions.

• Monitor SSA Notices: Save envelopes and note receipt dates in case you need to rebut the five-day presumption of receipt (20 C.F.R. § 422.210(c)).

Summary: Your Rights, Your Timeline, Your Next Step

SSDI denials in Massachusetts are governed by federal law, and you have the right to appeal at up to four levels. Strict timelines apply: generally 60 days for each step. The strongest appeals focus on closing evidentiary gaps, grounding arguments in the five-step analysis, and, when possible, obtaining well-reasoned medical opinions that align with objective findings. For some claimants, experienced representation helps transform a complex record into a clear, legally grounded case that an ALJ or court can evaluate against the SSA’s standards.

Legal Disclaimer

This guide is for informational purposes only and is not legal advice. Laws and regulations can change, and application of the law depends on specific facts. For advice about your situation, consult a licensed Massachusetts attorney.

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