SSI vs SSDI Denial & Appeal Guide for Maine, ME

Introduction: Why This SSDI Denial Guide Matters to Mainers

Maine’s rugged coastline and rural interior mean many residents travel long distances for medical care and Social Security hearings. According to the Social Security Administration (SSA), roughly two-thirds of initial Social Security Disability Insurance (SSDI) applications filed nationwide are denied. Claimants in Maine are no exception. Whether you live in Portland, Bangor, Lewiston, or a small Down East community, understanding the appeal process can be the difference between receiving crucial monthly benefits and facing prolonged financial hardship. This guide provides a step-by-step roadmap—grounded in federal regulations and tailored to Maine—to help you protect your rights after an SSDI denial.

Understanding Your SSDI Rights

SSDI vs. SSI in Plain English

SSDI is an insurance program funded by payroll taxes (FICA). You must have worked long enough and recently enough to earn “quarters of coverage.” Supplemental Security Income (SSI) is a need-based program for individuals with limited income and resources, regardless of work history. Both programs use the same medical standard of disability found in 20 C.F.R. §404.1505 and §416.905, but financial eligibility differs.

This article focuses on SSDI denials and appeals. If you also applied for SSI, many steps overlap, but income/resource rules will apply separately.

Your Legal Entitlements Under Federal Law

• The right to receive a written notice explaining the reason for denial. 20 C.F.R. §404.130.

• The right to appeal within 60 days of receiving the notice. Social Security Act §205(b).

• The right to examine your claims file before any hearing (20 C.F.R. §404.929).

The right to representation by an attorney or qualified non-attorney. Representative fees are capped under 20 C.F.R. §404.1725.

Common Reasons SSA Denies SSDI Claims

Insufficient Medical Evidence The decision writers and medical consultants could not find objective evidence—such as MRI results or treating-physician notes—showing that your impairment prevents all substantial gainful activity (SGA). Failure to Follow Prescribed Treatment Under 20 C.F.R. §404.1530, a claimant who refuses reasonable treatment without good cause may be denied. Work Activity Above SGA Levels If you earned more than the SGA amount ($1,550 per month for non-blind claimants in 2024), your application will be denied at Step 1 of the sequential evaluation. Duration Requirement Not Met Your impairment must last—or be expected to last—at least 12 consecutive months or result in death (20 C.F.R. §404.1509). Non-Compliance With SSA Requests Missing consultative exams or failing to return SSA questionnaires often leads to a denial labeled “insufficient evidence.”

Federal Legal Protections & Regulations

The Sequential Evaluation Process

SSA uses a five-step test codified at 20 C.F.R. §404.1520:

• Step 1: Are you working at SGA level?

• Step 2: Do you have a severe medical impairment?

Step 3: Does your condition meet or equal a Listing in the SSA Blue Book?

• Step 4: Can you perform past relevant work?

• Step 5: Can you adjust to other work in the national economy?

Appeal Deadlines and Statutes

All levels share the same 60-day deadline plus a 5-day mailing grace period (20 C.F.R. §404.933(b)):

• Request for Reconsideration

• Request for Hearing by an Administrative Law Judge (ALJ)

• Appeals Council Review

• Federal District Court Complaint (within 60 days of Appeals Council denial). Maine claimants file in the U.S. District Court for the District of Maine, with courthouses in Portland and Bangor.

Steps to Take After an SSDI Denial

1. Read the Denial Notice Carefully

The notice outlines medical and vocational rationale. Note the date on the first page—your appeal clock starts there.

2. Request Reconsideration

File SSA Form 561-U2 online or at your local field office. In Maine, the larger offices are:

• Portland: 550 Forest Ave., Portland, ME 04101

• Bangor: 202 Harlow St., Bangor, ME 04401

Attach any new medical evidence or list providers, such as Northern Light Eastern Maine Medical Center or Maine Medical Center.

3. Prepare for an ALJ Hearing

If reconsideration is denied (common), file a hearing request (SSA Form HA-501). Hearings for Maine residents are typically held by video or in the Portland Office of Hearings Operations (OHO) at 400 Congress St., Suite 420. Use the time before the hearing to:

• Obtain updated treatment records and diagnostic tests.

• Ask treating physicians for Medical Source Statements addressing functional limitations.

Review the hearing procedures.

4. Appeals Council and Federal Court

Should the ALJ rule against you, submit Appeals Council form HA-520. If the Council also denies, your final option is filing a civil action in U.S. District Court within 60 days (42 U.S.C. §405(g)).

When to Seek Legal Help for SSDI Appeals

Although you may represent yourself, statistical studies published by SSA indicate claimants with representation are more likely to win benefits. A Maine disability attorney can:

• Analyze the denial rationale and identify evidentiary gaps.

• Ensure adherence to 20 C.F.R. procedural rules.

• Cross-examine vocational or medical experts at the hearing.

• File federal court briefs citing First Circuit precedent such as Nguyen v. Chater, 172 F.3d 31 (1st Cir. 1999).

Attorney fees are contingency-based and generally limited to 25% of retroactive benefits, capped at $7,200 unless a federal court awards more.

Local Resources & Next Steps

• Maine Bureau of Rehabilitation Services – Assists with vocational assessments.

• Pine Tree Legal Assistance – May offer free advice for low-income claimants.

• Community Health Centers – Maine has 20+ Federally Qualified Health Centers where sliding-scale care can generate evidence.

SSA Appeals Portal – File reconsideration or hearing requests online. Maine Disability Statistics – University of New Hampshire’s Institute on Disability publishes local data helpful for economic hardship arguments.

Putting It All Together

Facing an SSDI denial can feel overwhelming, but federal law gives every Maine claimant multiple opportunities to appeal. Keep copies of every document, respect the 60-day deadlines, and consider retaining counsel to strengthen your case.

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

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