SSI & SSDI Guide: Appeals in Maryland, Maryland

SSI and SSDI Denials and Appeals: A Claimant-Focused Guide for Maryland, Maryland

If you live in Maryland and received a denial on your Social Security Disability Insurance (SSDI) claim, you are not alone. Many Maryland residents—from Baltimore City to Montgomery, Prince George’s, Anne Arundel, the Eastern Shore, and Western Maryland—face denials at the initial stage. The good news is that a denial is not the end of the process. Federal law provides a structured appeals path, firm deadlines, and core rights designed to give you a full and fair review. Because the Social Security Administration (SSA) is headquartered in Maryland (6401 Security Boulevard, Baltimore, MD 21235), many residents are already familiar with the agency’s presence. Still, navigating the federal rules and timelines can be challenging without a clear roadmap.

This comprehensive legal guide explains your rights under federal law, the reasons SSDI claims are often denied, and the exact steps to appeal—from reconsideration to an Administrative Law Judge (ALJ) hearing, to Appeals Council review, and finally to federal court. It also highlights Maryland-specific context and practical local resources to help you stay organized and on time. While this guide slightly favors protecting claimants, it is strictly based on authoritative sources, including the Social Security Act and the Code of Federal Regulations (CFR). You will find direct links to the SSA’s official materials and controlling regulations throughout.

Whether your claim involves SSDI (based on insured work credits) or you’re also exploring Supplemental Security Income (SSI) due to limited income and resources, the appeals framework is similar. Meeting deadlines is critical: generally, you have 60 days from receipt of a written decision to appeal to the next level, with a mailing presumption of five additional days unless you can demonstrate earlier or later receipt. The sections below detail what to do next, how to strengthen your case with medical evidence, and when to seek representation. If you are searching for help with an SSDI denial appeal maryland maryland, this guide is built to help you protect your rights under federal law.

Understanding Your SSDI Rights

SSDI vs. SSI: The Basics

SSDI is a federal insurance program for workers who paid Social Security taxes and have earned enough work credits. The legal definition of disability for SSDI is set by the Social Security Act and regulations. You must show an inability to engage in substantial gainful activity (SGA) due to medically determinable impairments that have lasted or are expected to last at least 12 months or result in death. See 42 U.S.C. § 423(d) (Social Security Act § 223(d)) and related regulations at 20 C.F.R. §§ 404.1505, 404.1509, and 404.1572–404.1574.

SSI is a separate needs-based program for individuals with limited income and resources who are aged, blind, or disabled. While this guide focuses on SSDI, many medical evaluation rules overlap. In Maryland, you may apply for both SSDI and SSI if you meet the separate program criteria. The appeals process for medical denials is largely aligned across programs, though some financial eligibility issues are unique to SSI.

Your Core Rights in the SSDI Process

• Right to appeal at each stage: You may request reconsideration, an ALJ hearing, Appeals Council review, and file a civil action in federal court. See 20 C.F.R. § 404.900(a).
• Right to representation: You may appoint an attorney or qualified representative to help you. See 20 C.F.R. § 404.1705. All representative fees must be approved by SSA. See 20 C.F.R. § 404.1720 and 42 U.S.C. § 406(a).
• Right to review and submit evidence: You may inspect your file and submit medical and other evidence throughout the process. See 20 C.F.R. §§ 404.1512, 404.1513, 404.916, 404.929, and 404.949.
• Right to an impartial hearing: If you request a hearing, an ALJ will conduct a de novo review. See 20 C.F.R. §§ 404.929–404.944.
• Right to fair timelines: Most appeals must be filed within 60 days of receiving the decision. SSA presumes you received the notice 5 days after the date on the notice unless you show otherwise. See 20 C.F.R. §§ 404.901, 404.909(a)(1), 404.933(b), 404.968(a), and 20 C.F.R. § 422.210(c) (federal court timeline).
• Right to request extensions for good cause: If you miss a deadline, you may ask SSA for more time by showing good cause. See 20 C.F.R. § 404.911.

How SSA Decides Disability

SSA uses a five-step “sequential evaluation” for adults, outlined at 20 C.F.R. § 404.1520. In brief:

• SGA: Are you doing substantial gainful activity? If yes, generally not disabled. 20 C.F.R. §§ 404.1571–404.1574.
• Severity: Do you have a severe medically determinable impairment? 20 C.F.R. §§ 404.1502, 404.1508–404.1513, 404.1520(c).
• Listings: Does your impairment meet or equal a listed impairment? 20 C.F.R. § 404.1520(d) and Listing of Impairments.
• Past Work: Can you perform past relevant work given your residual functional capacity (RFC)? 20 C.F.R. § 404.1520(f).
• Other Work: Can you do other work existing in significant numbers in the national economy? 20 C.F.R. § 404.1520(g).

For insured status, SSA checks your work credits and “date last insured” (DLI). See 20 C.F.R. § 404.130. Medical evidence must establish disability on or before your DLI for SSDI entitlement.

Common Reasons SSA Denies SSDI Claims

Understanding why claims are denied helps you target your appeal. Frequent reasons include:

1) Working Above SGA

If your earnings exceed SGA, SSA generally finds you not disabled at step 1. The SGA concept and evaluation criteria appear at 20 C.F.R. §§ 404.1572–404.1574. If your work was sporadic, heavily accommodated, or ended due to your condition, explain this in your appeal and submit evidence (pay records, employer statements).

2) Insufficient Medical Evidence or Lack of Objective Findings

SSA requires medical evidence from acceptable medical sources. See 20 C.F.R. § 404.1513. If records are incomplete or don’t show functional limitations, SSA may deny at step 2 (non-severe) or steps 4–5. Strengthen your file with longitudinal treatment notes, imaging, specialist reports, and detailed functional assessments.

3) Not Meeting or Equaling a Listing

Few cases meet a listing exactly. However, you can still be found disabled based on RFC and vocational factors at steps 4–5. The medical-vocational rules (the “grids”) are in 20 C.F.R. Part 404, Subpart P, Appendix 2.

4) Past Relevant Work or Other Work Findings

SSA may conclude you can perform past relevant work (step 4) or other work (step 5). These findings often turn on your RFC, age, education, and transferable skills. On appeal, consider vocational evidence, detailed job descriptions, and opinion evidence addressing why you cannot sustain competitive work.

5) Date Last Insured Problems

If you lacked sufficient work credits or the medical evidence does not establish disability on or before your DLI, SSA must deny SSDI. See 20 C.F.R. § 404.130. Target the period before the DLI with older records, witness statements, and retrospective medical opinions where appropriate.

6) Noncompliance or Missed Exams

Failing to attend a consultative examination (CE) or to cooperate with evidence requests can lead to denial. See 20 C.F.R. § 404.1518. If you missed an exam for good cause, explain and reschedule as soon as possible.

7) Failure to Follow Prescribed Treatment

If a treatment prescribed by your medical source would restore your ability to work and you don’t follow it without good reason, SSA may deny. See 20 C.F.R. § 404.1530. Provide explanations and supporting records (e.g., side effects, contraindications, access or affordability issues) to establish good cause.

Federal Legal Protections & Regulations

Key Statutes and Regulations

• Right to a Hearing and Review: Social Security Act § 205(b), (g), 42 U.S.C. § 405(b), (g) provide the right to a hearing and judicial review.
• Definition of Disability: Social Security Act § 223(d), 42 U.S.C. § 423(d).
• Appeals Structure: 20 C.F.R. §§ 404.900–404.999 (Subpart J) detail reconsideration, ALJ hearings, and Appeals Council review.
• Time Limits: 60-day appeal deadlines appear in 20 C.F.R. §§ 404.909(a)(1), 404.933(b), 404.968(a), and 20 C.F.R. § 422.210(c) for federal court actions.
• Evidence Rules: 20 C.F.R. §§ 404.1512–404.1513 govern evidence submissions and acceptable medical sources; 20 C.F.R. § 404.1520c addresses evaluation of medical opinions.
• Five-Day Evidence Rule (Hearings): Generally, you must submit or inform SSA about evidence at least 5 business days before the hearing. See 20 C.F.R. § 404.935.
• Extensions for Good Cause: 20 C.F.R. § 404.911.
• Reopening Prior Decisions: 20 C.F.R. §§ 404.987–404.989.
• Representation and Fees: 20 C.F.R. §§ 404.1705, 404.1720; 42 U.S.C. § 406(a).

Sequential Evaluation and Medical Listings

SSA’s five-step framework at 20 C.F.R. § 404.1520 applies uniformly across the U.S., including Maryland. The “Listing of Impairments” guides step 3 decisions. Even if you don’t meet a listing, you can prevail based on RFC, symptoms, and vocational factors under steps 4–5.

Mailing Presumption and Calculating Deadlines

SSA presumes you receive a notice 5 days after the date on it. See 20 C.F.R. § 404.901. Count 60 days from the date you receive the notice to calculate your appeal deadline for reconsideration, hearing, or Appeals Council review. If needed, request more time and explain good cause under 20 C.F.R. § 404.911.

Federal Court Review

After the Appeals Council acts or denies review, you typically have 60 days to file a civil action in federal district court. See Social Security Act § 205(g), 42 U.S.C. § 405(g), and 20 C.F.R. § 422.210(c). The appropriate venue is generally the U.S. District Court serving your residence. This is a new case focused on whether SSA’s final decision is supported by substantial evidence and whether correct legal standards were used.

Steps to Take After an SSDI Denial

1) Read Your Denial Notice Carefully

The notice explains why SSA denied your claim and includes appeal instructions. Mark the decision date, apply the 5-day mailing presumption (20 C.F.R. § 404.901), and calculate your 60-day deadline. If you need more time, promptly request an extension and show good cause (20 C.F.R. § 404.911).

2) File a Timely Reconsideration (If This Is Your First Appeal)

Most initial SSDI denials in Maryland require a reconsideration within 60 days of receipt. See 20 C.F.R. § 404.909(a)(1). You can submit online or through your local SSA field office. Be prepared to complete updated appeal forms, including a disability report and medical release.

• What to include: New or updated medical records, treatment summaries, test results, and statements describing your functional limitations. Identify any new diagnoses since the initial application.
• Address the reasons for denial: If SSA found your condition non-severe or said you could work, respond with concrete evidence (e.g., RFC assessments, specialist opinions, physical therapy notes).

3) Request an ALJ Hearing if Reconsideration Is Denied

If reconsideration is denied, you can request a hearing before an ALJ within 60 days of receipt. See 20 C.F.R. § 404.933(b). Hearings can often be held by telephone or video where appropriate. See 20 C.F.R. § 404.936. At this stage, detailed evidence and preparation are crucial.

• Know the five-day rule: Generally submit or notify SSA of evidence at least 5 business days before the hearing. See 20 C.F.R. § 404.935.
• Witnesses and testimony: You may testify and present witnesses about your limitations. You can also request subpoenas for documents or witnesses if necessary. See 20 C.F.R. § 404.950(d).
• Medical and vocational experts: The ALJ may call experts. Prepare to question them about how your limitations affect your capacity for work.

4) Seek Appeals Council Review if You Disagree with the ALJ Decision

If the ALJ denies your claim, you have 60 days from receipt to request Appeals Council review. See 20 C.F.R. § 404.968(a). The Appeals Council may review for errors of law, abuse of discretion, lack of substantial evidence, or to consider new and material evidence that relates to the period on or before the ALJ decision. See 20 C.F.R. § 404.970.

• Submit new, material, and time-relevant evidence: Ensure any new records relate to the period on or before the ALJ decision and explain why they were not submitted earlier.
• Target legal errors: Point to specific regulations or rulings that were misapplied. Clarity and specificity can help the Appeals Council identify reversible issues.

5) Federal Court: Last Resort for Administrative Denials

After the Appeals Council issues a final decision or denies review, you generally have 60 days to file a civil action under 42 U.S.C. § 405(g). See also 20 C.F.R. § 422.210(c). In federal court, you argue that SSA’s decision is not supported by substantial evidence or is legally erroneous. Court review focuses on the administrative record; new evidence is limited and subject to strict rules.

Good Cause and Reopening

If you missed a deadline, request an extension citing good cause. See 20 C.F.R. § 404.911. Separately, you may seek reopening of a prior determination within specific time limits for specific reasons. See 20 C.F.R. §§ 404.987–404.989. Reopening is discretionary and different from filing a timely appeal.

When to Seek Legal Help for SSDI Appeals

Many Maryland claimants consult an attorney or qualified representative after the first denial, and especially before an ALJ hearing. Representation can help you navigate the sequential evaluation, obtain targeted medical evidence, prepare you and your witnesses, and frame the case using the correct legal standards and CFR citations.

• Right to representation: You may appoint a representative under 20 C.F.R. § 404.1705.
• Fee approval: SSA must approve fees for representatives. See 20 C.F.R. § 404.1720 and 42 U.S.C. § 406(a). Fee arrangements are regulated, and no fee for services before SSA is payable without approval.
• State licensing: Only attorneys admitted to practice law in Maryland may provide legal advice about Maryland law or represent you in Maryland state courts. Representatives before SSA (including non-attorneys) must still comply with SSA’s representation rules and fee approval process.

If your case involves complex medical issues, a disputed date last insured, or vocational questions (transferable skills, RFC), early representation can be especially valuable.

Local Resources & Next Steps in Maryland

SSA in Maryland

• SSA Headquarters (Maryland): 6401 Security Boulevard, Baltimore, MD 21235. This is SSA’s national headquarters.
• SSA National 800 Number: 1-800-772-1213 (TTY: 1-800-325-0778).
• Locate Your Field Office: Use SSA’s online office locator to find the nearest field office for in-person help and to submit appeals or evidence.

Field offices serve residents throughout Maryland, including the Baltimore area, the National Capital region (e.g., Montgomery and Prince George’s counties), and other parts of the state. Always verify hours and services for your specific location using the official locator.

Medical Evidence From Maryland Providers

SSA relies on objective medical evidence and detailed functional assessments. Work with your Maryland healthcare providers to obtain complete, dated records that reflect your symptoms, diagnoses, test results, treatment response, side effects, and work-related limitations. If SSA schedules a consultative examination, attend the appointment or promptly reschedule if you have good cause (see 20 C.F.R. § 404.1518).

Practical Checklist for Maryland Claimants

• Track all deadlines: Apply the 5-day mailing presumption (20 C.F.R. § 404.901) and the 60-day appeal windows (e.g., 20 C.F.R. §§ 404.909, 404.933, 404.968).
• Update your evidence: Include records from all Maryland providers and any out-of-state specialists. Identify treatment gaps and explain them.
• Describe functional limits: Be specific about sitting, standing, lifting, concentration, attendance, and persistence issues. Provide concrete examples.
• Prepare for expert testimony: If a medical or vocational expert appears at your hearing, prepare targeted questions on your RFC and employability.
• Consider representation: A Maryland disability attorney or qualified representative can help assemble a persuasive record and present your case under the governing regulations.

Frequently Asked Questions for Maryland SSDI Appeals

Does the appeals process differ in Maryland?

No. SSDI is a federal program. The same statutes and regulations apply nationwide, including Maryland. However, local logistics—like which field office you use or whether a hearing is scheduled by phone or video—are handled through SSA’s systems serving Maryland residents.

What if I missed the 60-day deadline?

Request an extension and explain good cause under 20 C.F.R. § 404.911. If an earlier decision is at issue, you may explore reopening under 20 C.F.R. §§ 404.987–404.989, though that is discretionary and limited.

Do I need to stop working to win SSDI?

You must show you cannot engage in substantial gainful activity as defined by SSA. See 20 C.F.R. §§ 404.1572–404.1574. Some limited, unsuccessful, or accommodated work may not preclude benefits; document the details.

What kind of medical opinions help?

Opinions that explain your functional limitations over time, supported by objective findings, can be persuasive. SSA evaluates medical opinions under 20 C.F.R. § 404.1520c, focusing on supportability and consistency.

How do SSI and SSDI interact?

Some claimants apply for both. SSI has distinct financial eligibility rules. The medical appeals process is similar, and you can generally use the same evidence to support both claims.

Detailed Timeline and Action Plan

Initial Denial ➜ Reconsideration (60 Days)

• Gather evidence: Request updated records from your Maryland providers. Confirm coverage dates before your DLI (20 C.F.R. § 404.130).
• Explain changes: Did your condition worsen? Did new diagnoses arise? Include updated medication lists and side effects.
• Submit appeal: File reconsideration within 60 days of receipt (20 C.F.R. § 404.909(a)(1)). Keep proof of submission.

Reconsideration Denial ➜ ALJ Hearing (60 Days)

• Request hearing: File within 60 days (20 C.F.R. § 404.933(b)). Choose telephone or video if appropriate (20 C.F.R. § 404.936).
• Hearing prep: Outline your testimony, list witnesses, and plan questions for any experts. Monitor the 5-day evidence rule (20 C.F.R. § 404.935).
• Focus the issues: If SSA questioned severity, address step 2 evidence. If SSA found you able to do other work, target vocational factors and RFC with detailed limitations.

Unfavorable ALJ Decision ➜ Appeals Council (60 Days)

• Identify legal errors: Cite specific regulations misapplied (e.g., 20 C.F.R. § 404.1520, § 404.1520c).
• Submit new, material, time-relevant evidence: Ensure it relates to the period on or before the ALJ decision (20 C.F.R. § 404.970).
• Request remand or reversal: Explain why substantial evidence does not support the ALJ’s findings or why legal error requires a new hearing.

Appeals Council Denial ➜ Federal Court (60 Days)

• Consult counsel: Judicial review involves legal briefing and record citations under 42 U.S.C. § 405(g) and 20 C.F.R. § 422.210(c).
• File timely: The 60-day period generally runs from receipt of the Appeals Council action.
• Seek appropriate relief: The court may affirm, reverse, or remand for further proceedings.

Evidence Strategy: Building a Strong Maryland Case

Medical Records and Source Statements

• Objective findings: Imaging, labs, physical and mental status exams, and specialist notes.
• Function-focused opinions: Ask providers to address specific work-related functions (sitting, standing, lifting, pace, attendance, interactions) over a sustained workday/week.
• Longitudinal history: Chronic conditions often require records showing consistent limitations over time.
• Medication effects: Document side effects that impact concentration, stamina, or safety.

Non-Medical Evidence

• Work history: Detailed descriptions of past job demands (weights lifted, time on feet, complexity, quotas).
• Activities of daily living: Explain how symptoms limit household, personal care, and community activities.
• Third-party statements: Statements from family or former co-workers can support consistency and severity.

Vocational Considerations in Maryland

At steps 4–5, SSA evaluates whether your limitations allow past relevant work or other work in the national economy. Maryland claimants should be prepared to address transferable skills, how symptoms affect attendance and pace, and whether accommodations provided in a former job reflect a competitive standard. Use precise examples to show why you cannot sustain full-time work.

Local SSA Access and How to Get Help in Maryland

While SSDI is federal, access points matter. Maryland residents can contact SSA by phone, online, or at field offices. For the most accurate, current office information, use the official SSA locator tool. SSA’s Baltimore headquarters location is a reminder that many national operations are coordinated from within the state, but claimant services are delivered through field offices and the hearings system that serves Maryland residents.

Find Your Local SSA Office (SSA Office Locator)SSA Disability Appeals: How to Appeal20 C.F.R. Part 404, Subpart J (Appeals Process)SSA Listing of Impairments (Adult Blue Book)Social Security Act § 205 (Hearings and Judicial Review)

Key Takeaways for Maryland, Maryland Claimants

• Appeal quickly: Apply the 5-day mailing presumption and 60-day deadline at each step (20 C.F.R. §§ 404.901, 404.909, 404.933, 404.968).
• Lead with evidence: Use acceptable medical sources and function-focused opinions (20 C.F.R. § 404.1513; § 404.1520c).
• Prepare for hearings: Follow the five-day evidence rule (20 C.F.R. § 404.935), consider witnesses, and address vocational issues head-on.
• Know your rights: Representation is allowed (20 C.F.R. § 404.1705), and fees must be approved by SSA (20 C.F.R. § 404.1720; 42 U.S.C. § 406(a)).
• Use official resources: Rely on SSA’s appeals portal and locator for accurate directions and local office information.

Legal Disclaimer

This guide provides general information for Maryland, Maryland residents and is not legal advice. Laws and regulations can change, and your situation is unique. You should consult a licensed Maryland attorney about your specific facts and options.

Next Step

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