SSI & SSDI Guide: Denial Appeals in New York, New York

SSDI Denials and Appeals in New York, New York: A Practical Guide for Claimants

Facing a Social Security Disability Insurance (SSDI) denial in New York, New York can feel overwhelming. The city’s fast pace and the state’s complex mix of health systems, employers, and public benefits can make an already stressful process even more confusing. This guide explains how SSDI decisions are made and what you can do when you receive an unfavorable determination, with a slight bias toward protecting claimants’ rights while staying strictly grounded in federal law and authoritative sources. It also touches on Supplemental Security Income (SSI) where relevant, because many New Yorkers apply for both SSDI and SSI.

SSDI is a federal insurance benefit based on your work history and insured status, while SSI is a needs-based program. In New York, initial disability determinations for both programs are made by a state agency working with the Social Security Administration (SSA). If you were denied, you are far from alone—and the appeals process exists specifically to correct errors, consider new evidence, and ensure that disability standards are applied fairly.

Because SSDI rules are federal, the standards are the same in every state, including New York. However, where and how you interact with SSA is local. New York is part of SSA’s New York Region (Region II). Field offices across the five boroughs and throughout New York State accept claims and appeals, and hearing offices within the state conduct Administrative Law Judge (ALJ) hearings. This guide highlights the federal regulations that control the process and directs you to New York–specific resources to help you navigate each step effectively.

If you searched for “SSDI denial appeal new york new york,” you’re in the right place. Below, you’ll learn what the SSA looks for, common reasons for denials, the four levels of appeal, critical filing deadlines, and practical steps you can take now to preserve your rights. This is informational only—every case is different—so consider speaking with a qualified representative to evaluate your specific situation.

Understanding Your SSDI Rights in New York

Core eligibility and insured status

To qualify for SSDI, you must have a medically determinable impairment that prevents substantial gainful activity and is expected to last at least 12 months or result in death. You must also be “insured” under the program based on your work history and Social Security contributions. The insured status rules and entitlement requirements are set by the Social Security Act and regulations. See 42 U.S.C. § 423 (Disability Insurance Benefits) and 20 C.F.R. §§ 404.130 (insured status) and 404.315 (entitlement to disability benefits). While the medical standard is the same nationally, insured-status issues can be decisive—especially if your work was intermittent or you stopped working some time ago.

How SSA evaluates disability

SSA uses the five-step sequential evaluation process to decide whether you are disabled. This framework is codified at 20 C.F.R. § 404.1520 and applies at the initial, reconsideration, and ALJ hearing levels, with the Appeals Council reviewing for legal or factual error. In plain terms, the five steps are:

• Step 1: Are you working above the substantial gainful activity (SGA) level? If yes, generally not disabled. See 20 C.F.R. §§ 404.1571–404.1574.
• Step 2: Do you have a severe medically determinable impairment? See 20 C.F.R. § 404.1520(c).
• Step 3: Does your impairment meet or equal a listed impairment? See 20 C.F.R. pt. 404, subpt. P, app. 1.
• Step 4: Can you do your past relevant work? See 20 C.F.R. § 404.1560(b).
• Step 5: Can you adjust to other work that exists in significant numbers in the national economy? See 20 C.F.R. §§ 404.1560(c), 404.1566.

At Steps 4 and 5, SSA assesses your residual functional capacity (RFC)—the most you can do despite your limitations—under 20 C.F.R. § 404.1545. Evidence from your treating sources and acceptable medical sources is critical. See 20 C.F.R. § 404.1513.

Your rights during the claim and appeal

Even after a denial, you retain important rights, including:

• The right to appeal through four levels: reconsideration, hearing before an ALJ, Appeals Council review, and federal court. See 20 C.F.R. § 404.900(a).
• The right to representation by an attorney or qualified non-attorney representative. See 20 C.F.R. §§ 404.1705–404.1715.
• The right to review your file, submit evidence, and request that SSA assist in obtaining medical records. See 20 C.F.R. § 404.1512.
• The right to a fair hearing and to question vocational and medical experts. See 20 C.F.R. § 404.950.
• The right to have representative fees reviewed and approved by SSA. See 42 U.S.C. § 406(a); 20 C.F.R. §§ 404.1720–404.1730.

These rights exist to ensure the disability standard is applied correctly and that your evidence is fully considered. Taking advantage of them—especially by developing the medical record—can materially affect the outcome of your appeal.

Common Reasons SSA Denies SSDI Claims

Understanding why claims are denied can help you focus your appeal. Frequent reasons include:

1) Insufficient work credits or not insured at date last insured

SSDI is insurance-based. If you lack sufficient recent work credits or your insured status lapsed before you became disabled, SSA will deny the claim. The framework for insured status is at 20 C.F.R. § 404.130, and entitlement to benefits is discussed at § 404.315. If you believe SSA miscalculated your earnings record, you can request a correction with documentation.

2) Working above substantial gainful activity (SGA)

If your earnings exceed SGA, SSA generally finds you not disabled at Step 1. See 20 C.F.R. §§ 404.1571–404.1574. Some work attempts may qualify as an unsuccessful work attempt, but the specifics matter; provide detailed evidence of job demands, dates, and why you stopped.

3) Lack of a medically determinable severe impairment

SSA requires objective medical evidence from an acceptable medical source to establish a medically determinable impairment. See 20 C.F.R. § 404.1513. Claims can be denied if the record lacks diagnostic findings, clinical signs, or longitudinal treatment notes to substantiate severity.

4) Not meeting or equaling a Listing and inadequate RFC evidence

Many claims are denied at Steps 3–5 when the evidence does not meet or equal a Listing in Appendix 1 or does not support functional limitations that preclude past work or other work. Robust treating source opinions and detailed function-by-function assessments under 20 C.F.R. § 404.1545 often make the difference on appeal.

5) Failure to cooperate or attend consultative examinations

SSA can deny if you decline to provide requested evidence or fail to attend a consultative examination (CE) that SSA determines is needed. See 20 C.F.R. § 404.1512 (evidence responsibilities) and § 404.1519a (when SSA purchases CEs). If you missed an exam for good reason, promptly explain and request to reschedule.

6) Failure to follow prescribed treatment

When effective treatment is prescribed and you fail, without good reason, to follow it, SSA may deny. See 20 C.F.R. § 404.1530. Document any side effects, contraindications, access issues, or medical advice that explain why a treatment was not followed.

Denials are not the last word. The appeals process exists to reassess evidence, correct errors, and consider changes in your medical condition. A focused, evidence-driven appeal can overcome many initial problems.

Federal Legal Protections & Regulations That Govern SSDI Appeals

Key statutes and regulations

• Right to a hearing and judicial review: 42 U.S.C. § 405(b) and § 405(g). Section 405(g) authorizes filing a civil action in federal court after the final decision of the Commissioner.
• Disability insurance eligibility: 42 U.S.C. § 423.
• Administrative appeals framework: 20 C.F.R. § 404.900 (four-step administrative review process).
• Sequential evaluation of disability: 20 C.F.R. § 404.1520.
• Evidence rules: 20 C.F.R. § 404.1512 (your responsibility for evidence), § 404.1513 (acceptable medical sources), and § 404.1545 (RFC).
• Reconsideration and hearing procedures: 20 C.F.R. §§ 404.909 (reconsideration), 404.929 (requesting a hearing), 404.938 (notice of hearing), and 404.950 (hearing rights).
• Appeals Council review: 20 C.F.R. §§ 404.967–404.981.
• Judicial review procedures: 20 C.F.R. § 422.210 (time for instituting civil action).

Deadlines (statutes of limitation) to protect

SSDI appeals have strict filing deadlines. Missing a deadline can end your claim unless SSA finds good cause:

• Reconsideration: 60 days from the date you receive the denial notice. See 20 C.F.R. § 404.909(a)(1). SSA presumes you receive notices 5 days after the date on the notice unless you show otherwise. See 20 C.F.R. § 404.901.
• Hearing before an ALJ: 60 days from the date you receive the reconsideration denial. See 20 C.F.R. § 404.933(b)(1), with the presumption of receipt described in § 404.901.
• Appeals Council review: 60 days from the date you receive the ALJ decision. See 20 C.F.R. § 404.968(a)(1).
• Federal court (civil action): Generally 60 days from receiving the Appeals Council’s notice of decision or denial of review. See 42 U.S.C. § 405(g); 20 C.F.R. § 422.210(c).

If you miss a deadline, you may request an extension for good cause. Factors include serious illness, misunderstanding of requirements, or lack of access to records. See 20 C.F.R. § 404.911.

Reopening prior determinations

In some situations, SSA may reopen and revise a prior determination within certain time limits. See 20 C.F.R. § 404.988 (e.g., within one year for any reason, and up to four years for good cause). Reopening is discretionary and fact-specific; it is distinct from the standard appeals process.

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 on the notice; add five days for presumed receipt per 20 C.F.R. § 404.901, and calendar your 60-day deadline. Identify whether the issue is medical (e.g., RFC not severe enough) or technical (e.g., insured status or earnings above SGA).

2) File your appeal promptly and the right way

Appeals can be filed online, by mail, or in person at a local SSA field office. The steps are:

• Reconsideration: File Form SSA-561 or use SSA’s online appeal portal; you can submit additional medical evidence. See 20 C.F.R. § 404.909.
• Hearing before an ALJ: Request a hearing using form HA-501 or online. See 20 C.F.R. § 404.929. You will receive a Notice of Hearing per § 404.938.
• Appeals Council: Request review using form HA-520 or online. See 20 C.F.R. § 404.968.
• Federal Court: If the Appeals Council denies review or issues an unfavorable decision, you may file a civil action in the appropriate U.S. District Court in New York under 42 U.S.C. § 405(g) and 20 C.F.R. § 422.210.

Filing early protects you if there are mailing delays or if you need time to develop medical evidence.

3) Strengthen your medical evidence

Appeals succeed most often when claimants submit targeted, objective evidence:

• Treating source statements: Ask your treating physicians or psychologists to provide detailed opinions addressing your specific functional limitations consistent with 20 C.F.R. § 404.1545.
• Objective testing: Include imaging, labs, nerve conduction studies, pulmonary function tests, or other diagnostics supporting your impairments.
• Longitudinal treatment records: Supply office notes, specialty consults, therapy records, and hospitalization summaries demonstrating chronicity, treatment response, and side effects.
• Daily activities and work attempts: Provide clear descriptions of activities you can and cannot perform, and document unsuccessful work attempts with dates, duties, and reasons you stopped.

SSA may schedule a consultative examination (CE). Attend it, bring identification, and be candid and thorough. See 20 C.F.R. § 404.1519a.

4) Prepare for the ALJ hearing

Hearings are non-adversarial but formal. You have rights to present evidence, testify, and question vocational and medical experts. See 20 C.F.R. § 404.950. Prior to the hearing, review your exhibit file and submit any new evidence at least five business days before the hearing unless an exception applies (see SSA’s evidence submission rules; check your notice for instructions). Develop a theory of your case tied to the five-step framework, and prepare to explain why you cannot perform past work or adjust to other work.

5) Consider representation

While not required, experienced representatives can help identify missing evidence, draft detailed briefs addressing 20 C.F.R. §§ 404.1520 and 404.1545, prepare you for testimony, and cross-examine experts. Representation fees must be approved by SSA. See 42 U.S.C. § 406(a); 20 C.F.R. §§ 404.1720–404.1730.

6) Keep SSA informed

Report changes in address, phone, medical treatment, and work attempts promptly. Provide release forms so SSA can request records. If you cannot attend a scheduled exam or hearing, notify SSA immediately and document good cause for rescheduling.

When to Seek Legal Help for SSDI Appeals

Consider consulting a New York disability attorney or qualified representative when:

• You face complex medical issues or multiple impairments, and the record needs synthesis under 20 C.F.R. § 404.1545.
• You have a technical denial involving insured status or SGA and need guidance on evidence or timing.
• Your claim rests on meeting or equaling a Listing (Appendix 1) and requires specialized medical opinions.
• You have a prior unfavorable decision that may be a candidate for reopening under 20 C.F.R. § 404.988.
• You are approaching or at the federal court stage under 42 U.S.C. § 405(g).

Representation before SSA is governed by 20 C.F.R. §§ 404.1705–404.1715. If your case proceeds to federal court, your attorney must be admitted to practice in the appropriate U.S. District Court in New York. Feel free to ask any prospective representative about their experience with SSDI appeals, hearing practice, and federal litigation.

Local Resources & Next Steps for New York Claimants

SSA offices serving New York, New York

New York is part of SSA’s New York Region (Region II). You can find your nearest field office using the SSA Office Locator. For many claimants in New York City, local field offices accept in-person filings and provide information on your case status. You can also manage your appeal online and by phone.

New York Region information: SSA New York Region (Region II)Find a local office: SSA Office LocatorAppeals overview (all levels): SSA: How to Appeal a Decision Phone options: Call SSA at 800-772-1213 (TTY 800-325-0778) to ask questions, request forms, or schedule appointments. Keep a record of call dates, names of SSA representatives, and confirmation numbers.

New York’s state role in disability determinations

Initial and reconsideration decisions for SSDI and SSI claims in New York are generally made by a state disability determination service working under federal rules. While the standards and appeal rights are federal, understanding that New York participates in the development of the medical record at the early stages can help you coordinate timely medical submissions and attend any scheduled state-facilitated consultative exams.

Hospitals and medical providers

SSA evaluates evidence from your treating sources and acceptable medical sources under 20 C.F.R. § 404.1513. If you receive care in New York—from primary care, specialty practices, or hospital systems—ensure your providers understand the functional nature of disability determinations. Ask for narrative reports addressing work-related abilities such as sitting, standing, lifting, concentration, attendance, and persistence.

Online and in-person filing strategies for New Yorkers

Many New York claimants prefer online filing due to convenience, but in-person follow-up at a field office can be useful, especially when submitting large medical records or addressing identity verification issues. Always retain stamped receipts for in-person filings and download confirmation PDFs for online submissions.

Detailed Walkthrough of the SSDI Appeals Process

Level 1: Reconsideration (60-day deadline)

After an initial denial, you have 60 days from receipt to file reconsideration. See 20 C.F.R. § 404.909(a)(1) and § 404.901 (receipt presumed five days after notice date). This is a fresh review by a different adjudicative team. It is your first and best chance to fix gaps in the evidence quickly. Submit updated medical records, function reports, third-party statements, and any new tests. If SSA requests a consultative exam, attend as scheduled and bring a list of medications and providers.

Level 2: Hearing before an Administrative Law Judge (60-day deadline)

If reconsideration is denied, request a hearing within 60 days. See 20 C.F.R. § 404.929 and § 404.933(b)(1). You will receive a Notice of Hearing setting the date, time, manner (in person, video, or telephone), and issues. See 20 C.F.R. § 404.938. Submit evidence at least five business days before the hearing, unless an exception applies. At the hearing, you can testify, present witnesses, and question vocational and medical experts under 20 C.F.R. § 404.950. Focus on functional limitations and consistency with medical evidence. Be prepared to address past work requirements and transferable skills, as vocational experts will reference the Dictionary of Occupational Titles and other vocational resources.

Level 3: Appeals Council (60-day deadline)

If the ALJ issues an unfavorable decision, you have 60 days from receipt to request Appeals Council review. See 20 C.F.R. § 404.968(a)(1). The Appeals Council reviews for legal error, abuse of discretion, findings unsupported by substantial evidence, or new and material evidence related to the period at issue (with good reason for not submitting it earlier). Outcomes include denial of review (making the ALJ decision final), remand to an ALJ, or a new decision by the Council. See 20 C.F.R. §§ 404.967–404.981.

Level 4: Federal court (civil action under 42 U.S.C. § 405(g))

After a final decision of the Commissioner (often the Appeals Council’s denial of review), you generally have 60 days from receipt to file a civil action in the appropriate U.S. District Court in New York. See 42 U.S.C. § 405(g); 20 C.F.R. § 422.210(c). The court reviews the administrative record and determines whether SSA’s decision is supported by substantial evidence and free of legal error. New evidence typically is not considered unless the case is remanded under the sixth sentence of § 405(g) for new and material evidence with good cause for late submission.

Practical Evidence Tips for New York Claimants

• Identify treating sources early: In New York’s dense medical landscape, it’s common to have multiple providers. Consolidate your provider list with addresses and fax numbers, and sign SSA-827 releases.
• Target RFC evidence: Ask providers to address sitting/standing tolerance, lifting/carrying limits, need for unscheduled breaks, off-task percentages, absenteeism, and mental health limitations in concentration, persistence, and pace. See 20 C.F.R. § 404.1545.
• Explain work attempts: New York’s job market may facilitate short-term or part-time attempts. Document dates, duties, productivity issues, and why the attempts ended to support that they were unsuccessful under 20 C.F.R. §§ 404.1571–404.1574.
• Address treatment access: If insurance networks, waitlists, or transportation impeded treatment, explain in writing. While not a substitute for objective evidence, context can support credibility and good cause issues.

SSI vs. SSDI in New York: Where They Overlap

Many New Yorkers apply for both SSDI and SSI. SSI is means-tested, while SSDI is insurance-based. The medical standard for disability is the same, and appeals follow similar steps and deadlines. However, SSI involves financial eligibility, deeming rules, and resource limits. If you receive an SSI-specific denial (e.g., excess income), correct the financial issue if possible and continue pursuing your SSDI appeal, as success on SSDI may affect SSI eligibility and payments.

Fee Rules, Representation, and Ethics

SSA controls fees for representatives in SSDI cases. Whether you sign a fee agreement or your representative files a fee petition, fees must be approved by SSA and are typically contingent on obtaining past-due benefits. See 42 U.S.C. § 406(a) and 20 C.F.R. §§ 404.1720–404.1730. You have the right to receive and review a written fee agreement. Representatives must act in your best interest, maintain confidentiality, and comply with SSA’s rules on evidence and communications.

In New York, if your case proceeds to federal court under 42 U.S.C. § 405(g), your attorney must be admitted to practice in the appropriate U.S. District Court in New York. You may ask any prospective representative about their admissions and federal litigation experience. Before SSA, attorneys and eligible non-attorney representatives may represent claimants if they meet SSA’s criteria under 20 C.F.R. § 404.1705.

Frequently Asked Questions for New York SSDI Appeals

How long do I have to appeal my SSDI denial?

Generally, 60 days from the date you receive the notice at each administrative level (reconsideration, hearing, Appeals Council), with receipt presumed five days after the date on the notice. See 20 C.F.R. §§ 404.909(a)(1), 404.933(b)(1), 404.968(a)(1), and 404.901. For federal court, see 42 U.S.C. § 405(g) and 20 C.F.R. § 422.210(c).

Can I submit new evidence after a denial?

Yes. You can and should submit new, material evidence at reconsideration and before the ALJ hearing. The Appeals Council has stricter rules, but may consider new evidence related to the period on or before the ALJ decision with good reason for not submitting it earlier. See 20 C.F.R. §§ 404.1512 and 404.970.

Will I have to attend a consultative examination (CE)?

Possibly. If SSA determines your evidence is insufficient, it may schedule a CE at SSA’s expense. Attend and cooperate. See 20 C.F.R. § 404.1519a.

Should I keep working while I appeal?

Working above the SGA level generally results in a finding of not disabled. See 20 C.F.R. §§ 404.1571–404.1574. If you attempt part-time or reduced work, maintain detailed records and discuss your situation with a representative to avoid jeopardizing your claim.

What if I missed a deadline?

You may request an extension for good cause under 20 C.F.R. § 404.911. Provide a written explanation and any supporting documentation.

Checklist: What to Do Now If You Were Denied in New York

• Mark your deadline: Add 5 days to the notice date, then count 60 days. See 20 C.F.R. § 404.901 and § 404.909.
• File the appeal online or at a local SSA office right away.
• Request and review your file; identify missing medical records.
• Obtain updated treating source opinions focusing on RFC (20 C.F.R. § 404.1545).
• Prepare a concise written statement linking your symptoms to functional limits and the five-step framework (20 C.F.R. § 404.1520).
• If a hearing is scheduled, submit evidence timely and prepare testimony; plan to address past work demands and transferable skills.
• Consider representation by a qualified New York disability attorney or SSA-accredited non-attorney representative.

Authoritative Legal and Procedural References

SSA: How to Appeal a Decision (administrative review levels, filing methods)20 C.F.R. § 404.900 (administrative review process)20 C.F.R. § 404.1520 (five-step sequential evaluation)SSA New York Region (regional information for New York)SSA Office Locator (find local offices in New York)

Local Notes for New York, New York Claimants

New York City’s volume of claims means you should act promptly at every stage. Use online services when possible, and follow up with your local field office for confirmation. Keep copies of everything you submit and document all phone calls. If you receive care across multiple health systems, coordinate record requests early so nothing is missing at the hearing level. Finally, be mindful that federal court review is limited: success often turns on building a clear, well-supported record before the ALJ.

Disclaimer

Legal Disclaimer: This guide provides general information for New York residents and is not legal advice. Laws and regulations may change. Consult a licensed New York attorney or qualified representative about your specific situation.

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