SSI vs SSDI: Appeal Guide for Washington, WA

Introduction: Why SSDI Denials Matter in Washington State

For residents of Washington State—whether you live in Seattle, Spokane, Tacoma, Vancouver, or in rural counties east of the Cascades—a Social Security Disability Insurance (SSDI) denial can be financially and emotionally devastating. The Washington Employment Security Department reported that approximately 23% of working-age adults in the state live with a disability. Yet the Social Security Administration (SSA) denies more than half of all initial SSDI applications filed nationwide, including here in Washington. Knowing how to respond to a denial quickly and correctly can protect your right to benefits and prevent unnecessary financial hardship. This guide explains the difference between Supplemental Security Income (SSI) and SSDI, outlines the federal regulations that govern disability claims, and provides a step-by-step roadmap for appealing a denial in Washington State.

Understanding Your SSDI Rights in Washington

SSI vs. SSDI: A Quick Refresher

SSI (Supplemental Security Income) is a need-based program funded by general tax revenues. It is designed for low-income individuals who are blind, disabled, or age 65 or older, regardless of prior work history. SSDI (Social Security Disability Insurance), by contrast, is an insurance program funded by payroll taxes under Title II of the Social Security Act. Eligibility depends on your work credits and FICA contributions.

If you worked in Washington and paid into Social Security for the required quarters, SSDI is the primary program you will pursue when you cannot work for at least 12 months due to a disabling condition.

Key Federal Rights

• The right to a timely appeal: 20 C.F.R. § 404.909 provides a 60-day period to request reconsideration after receiving a Notice of Disapproved Claim.

• The right to a hearing: 20 C.F.R. § 404.929 guarantees the opportunity to present your case before an Administrative Law Judge (ALJ).

• The right to representation: Sections 206 and 1631(d)(2) of the Social Security Act allow you to appoint an attorney or qualified representative. In Washington, attorneys must be admitted to the Washington State Bar Association (WSBA).

• The right to review your claims file: You may request and inspect your electronic folder at any point during the appeals process.

Common Reasons SSA Denies SSDI Claims

While each case is unique, SSA denial notices often cite recurring issues. Understanding these reasons helps you target weaknesses in your initial application when you appeal.

• Medical evidence is insufficient or outdated. The SSA relies heavily on objective medical findings. If your records from Harborview Medical Center or Providence Sacred Heart Medical Center are incomplete or older than 60 days, the claims adjudicator may determine that your impairment is not severe.

• Ability to perform past work. Under 20 C.F.R. § 404.1520(e), the SSA evaluates whether you can perform past relevant work. If they believe you can return to your former job in the aerospace, tech, or fishing industries common in Washington, they will deny the claim.

• Failure to follow prescribed treatment. Not attending physical therapy at UW Medicine or not taking prescribed medication gives SSA a ground to conclude that your condition could improve with treatment.

• Income exceeding Substantial Gainful Activity (SGA). In 2024, earning more than $1,550 per month (non-blind) disqualifies applicants under 20 C.F.R. § 404.1574.

• Non-compliance with SSA requests. Missing consultative examinations in cities like Yakima or Olympia, or failing to submit requested records, results in technical denials.

Federal Legal Protections & Regulations

Key Statutes & Regulations

• 20 C.F.R. § 404.900–404.999 sets forth the administrative review process, including reconsideration, ALJ hearings, Appeals Council review, and federal court actions.

• 42 U.S.C. § 405(g) authorizes claimants to file a civil action in U.S. District Court—such as the U.S. District Court for the Western District of Washington—within 60 days after receiving notice of Appeals Council denial.

• 20 C.F.R. § 404.1520(a)(4) describes the five-step sequential evaluation process that adjudicators must follow.

• 20 C.F.R. § 404.933 governs the time and manner of requesting an ALJ hearing.

Important Deadlines

• 60 days to request reconsideration of the initial denial.

• 60 days to request an ALJ hearing if reconsideration is denied.

• 60 days to request Appeals Council review after an unfavorable ALJ decision.

• 60 days to file a federal court complaint if the Appeals Council denies review.

E-Filing & Video Hearings in Washington

The SSA offers electronic filing (eAppeals) and video teleconferencing for ALJ hearings. Washington claimants living on the Olympic Peninsula or in Eastern Washington can avoid long travel to the hearing office in Seattle or Tacoma by requesting a video hearing under HALLEX I-2-3-10.

Steps to Take After an SSDI Denial

1. Read Your Notice of Disapproved Claim

The denial letter outlines the reasons and the 60-day deadline. Mark the date stamped on the envelope; SSA presumes five additional days for mailing (20 C.F.R. § 404.901).

2. Gather Additional Evidence

• Obtain updated MRI scans from Virginia Mason Medical Center or MultiCare Deaconess Hospital.

• Request functional capacity evaluations to document limitations on standing, walking, or grasping—critical for labor-intensive jobs in Washington’s agriculture and manufacturing sectors.

• Secure statements from treating physicians compliant with 20 C.F.R. § 404.1527(c) explaining why your impairment prevents sustained work.

3. File a Request for Reconsideration (Form SSA-561-U2)

Submit the form online via SSA's appeal portal or mail it to the local SSA field office.

4. Prepare for the ALJ Hearing

• Write a pre-hearing brief. Summarize medical evidence, cite vocational rulings (e.g., SSR 96-9p) and address the five-step analysis.

• Subpoena key records. If PeaceHealth Southwest Medical Center delays releasing records, your representative can request a subpoena per 20 C.F.R. § 404.950(d).

• Arrange witness testimony. Family or former supervisors can corroborate functional limitations.

5. Appeals Council & Federal Court Options

If the ALJ’s decision is unfavorable, you may request Appeals Council review online. Should the Council deny review, you can file suit in the U.S. District Court for either the Eastern or Western District of Washington. Federal court review focuses on whether the ALJ applied proper legal standards and made findings supported by substantial evidence, as required by Biestek v. Berryhill, 139 S. Ct. 1148 (2019).

When to Seek Legal Help for SSDI Appeals

Why Representation Matters

According to SSA statistics, claimants represented by attorneys or non-attorney representatives are nearly twice as likely to win benefits at the ALJ level. Experienced Washington disability attorneys understand local vocational trends (e.g., tech sector in King County, timber jobs in Grays Harbor) and how those jobs translate into the Dictionary of Occupational Titles (DOT) codes used by vocational experts.

Attorney Fees Are Contingent

Under 42 U.S.C. § 406(a), fees are typically limited to 25% of past-due benefits or $7,200 (2024 cap), whichever is less, and must be approved by SSA. That means no upfront costs.

Choosing a Washington Disability Attorney

Verify admission with the Washington State Bar Association.

• Request a written fee agreement and a copy of SSA Form 1696.

• Ask about experience with the specific ALJ hearing offices in Seattle, Tacoma, and Spokane.

Local Resources & Next Steps

Key SSA Field Offices in Washington

• Seattle Downtown Office: 915 2nd Ave, Seattle, WA 98174

• Spokane Office: 714 N. Iron Bridge Way Ste 100, Spokane, WA 99202

• Vancouver Office: 805 Broadway St Ste 500, Vancouver, WA 98660

• Yakima Office: 801 Fruitvale Blvd, Yakima, WA 98902

Washington Vocational Rehabilitation & Community Clinics

• Washington State Department of Vocational Rehabilitation provides job retraining and may supply functional assessments helpful at appeal hearings.

• Community health clinics like Neighborcare Health in Seattle or CHAS Health in Spokane can offer sliding-scale medical services if you lack insurance.

Useful Online Tools

my Social Security Account – View application status and payment history. SSA-561-U2 Form – Downloadable Request for Reconsideration. Congressional Research Service on SSDI – In-depth federal overview.

Conclusion

Receiving an SSDI denial in Washington State is not the end of your claim—it’s the first step in a multi-level appeals process specifically designed to protect your federal rights. By acting within the strict 60-day deadlines, fortifying your medical evidence, and, when appropriate, hiring a qualified Washington disability attorney, you significantly increase your chances of securing the benefits you earned through years of payroll contributions.

Disclaimer: This guide provides general information and is not legal advice. For advice about your specific situation, consult a licensed Washington attorney.

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