SSI vs SSDI: Denial & Appeal Guide – Hawaii, HI

Introduction: Why SSDI Denials Matter in Hawaii

Receiving a Social Security Disability Insurance (SSDI) denial can feel overwhelming, especially for residents of Honolulu, Hilo, Kahului, Līhuʻe, and other communities across the Hawaiian Islands who may already be struggling with serious medical conditions. According to the Social Security Administration’s (SSA) OASDI Beneficiaries by State report for 2022, more than 32,000 disabled workers in Hawaii rely on monthly SSDI benefits. Yet the SSA denies a significant percentage of first-time applications—nationally, roughly two-thirds—as shown in the federal Annual Statistical Report on the Social Security Disability Insurance Program. A denial is not the end of the road; Hawaiian claimants have multiple federally protected opportunities to appeal.

This guide explains the difference between Supplemental Security Income (SSI) and SSDI, common reasons for SSDI denials, the federal regulations that control appeals, and the exact steps a Hawaii resident should follow after receiving an unfavorable decision. While we lean slightly toward protecting claimants’ rights, every statement is grounded in authoritative law such as the Social Security Act, 20 CFR Part 404, and published SSA data.

Understanding Your SSDI and SSI Rights

The Core Distinction: SSI v. SSDI

SSDI is an insurance program funded by payroll taxes (FICA). You qualify by earning sufficient work credits and meeting the SSA’s definition of disability in 20 CFR §404.1505. In contrast, SSI is a need-based program under Title XVI of the Social Security Act for individuals with limited income and resources, regardless of work history.

• SSDI monthly benefits are calculated on your past earnings; SSI has a federal benefit rate adjusted by income offsets.

• Medicare eligibility begins 24 months after SSDI entitlement; SSI recipients in Hawaii qualify for Medicaid upon approval.

• You may file for both programs simultaneously (a “concurrent claim”) if you meet both financial and work-credit rules.

The SSA’s Definition of Disability

Under 42 U.S.C. §423(d) (Social Security Act §223), you must prove that you have a medically determinable impairment expected to last at least 12 months or result in death, preventing you from engaging in substantial gainful activity (SGA). For 2024, SGA is $1,550 per month for non-blind individuals (SSA SGA Chart).

Federal Rights and Protections

Claimants are entitled to:

Written notice of any determination per 20 CFR §404.904.

• Representation by an attorney or qualified non-attorney representative at all stages (20 CFR §404.1705).

• Four appeal levels—reconsideration, administrative law judge (ALJ) hearing, Appeals Council review, and federal district court.

• Timely filing rights, typically 60 days from receipt of a decision (20 CFR §404.909, §404.933).

Common Reasons the SSA Denies SSDI Claims

1. Insufficient Medical Evidence

If your medical records do not substantiate functional limitations, the SSA may decide you can still perform substantial gainful activity. Hawaii residents often obtain treatment from facilities such as The Queen’s Medical Center in Honolulu or Hilo Medical Center. Ensure these providers send complete records.

2. Failure to Follow Prescribed Treatment

Under 20 CFR §404.1530, the SSA can deny benefits if you refuse treatment without a “justifiable cause,” e.g., severe side effects or lack of available facilities on neighbor islands.

3. Earnings Above SGA

Claimants sometimes continue part-time work that unintentionally exceeds the SGA threshold. Document any unsuccessful work attempts (20 CFR §404.1574(c)).

4. Lack of Recent Work Credits

You generally need to have worked 5 of the last 10 years. Many workers in Hawaii’s tourism and service sectors experience seasonal gaps; consult the SSA’s work credit chart to confirm eligibility.

5. Substance Use Disorders

If drug or alcohol addiction is a contributing factor material to the disability (20 CFR §404.1535), the claim may be denied. You must show the impairment would persist independently of substance use.

Key Federal Regulations Governing Appeals

Below are the most relevant federal rules that every Hawaii claimant should know:

• 20 CFR §404.909 – Filing a request for reconsideration.

• 20 CFR §404.933 – Time and place to request an ALJ hearing.

• 20 CFR §404.967 – Appeals Council review procedures.

• 20 CFR §404.981 – Judicial review in federal district court.

• Social Security Act §205(g), 42 U.S.C. §405(g) – Grants the right to seek review in U.S. District Court for the District of Hawaii.

These rules create a structured, deadline-driven process. Missing a 60-day filing window almost always terminates the appeal unless you demonstrate good cause under 20 CFR §404.911, such as hospitalization on a neighbor island without air service.

Steps to Take After an SSDI Denial

Step 1 – Read the Denial Notice Carefully

The SSA’s letter explains why your claim was denied and outlines appeal rights. It also lists medical exhibits. Make note of the date on the first page; the clock for appeals starts five days after the mailing date.

Step 2 – File a Timely Request for Reconsideration

You can file online at SSA iAppeals, or bring SSA-561 and SSA-3441 forms to the Honolulu field office at 300 Ala Moana Blvd, Rm 1-114, Honolulu, HI 96850. Keep proof of submission.

Step 3 – Submit Updated Medical Evidence

Ask treating physicians across Oʻahu, Maui, Hawaiʻi Island, Kauaʻi, and Molokaʻi to provide updated records, RFC (Residual Functional Capacity) forms, and specialist opinions. Electronic records (eMR) speed processing at the Honolulu Disability Determination Service (DDS).

Step 4 – Prepare for the ALJ Hearing

If reconsideration is denied, request a hearing within 60 days. Hearings for Hawaii cases are held in person or by video at:

Office of Hearings Operations (OHO) 300 Ala Moana Blvd, Rm 5-104, Honolulu, HI 96850

At this stage, you may submit pre-hearing briefs, call vocational and medical experts, and testify under oath. A representative familiar with SSA case law—such as Choy v. Berryhill, Civ. No. 17-00292 HG (D. Haw. 2018)—can cross-examine experts to highlight errors in the vocational analysis.

Step 5 – Appeals Council Review

If the ALJ rules against you, file form HA-520 within 60 days. The Appeals Council in Falls Church, Virginia, may grant, deny, or remand your case.

Step 6 – Federal District Court

Final SSA decisions are reviewable in the U.S. District Court for the District of Hawaii, 300 Ala Moana Blvd, Honolulu, HI. File a civil complaint within 60 days of Appeals Council denial citing jurisdiction under 42 U.S.C. §405(g).

When to Seek Legal Help for SSDI Appeals

Although you may self-represent, retaining a Hawaii disability attorney often improves outcomes. The SSA’s Government Accountability Office study found represented claimants were nearly three times more likely to succeed at hearings. Attorney fees are capped by 42 U.S.C. §406(a)—currently 25% of past-due benefits or $7,200, whichever is lower—paid only if you win.

Licensing Rules in Hawaii

Attorneys must be licensed by the Hawaii State Bar Association. An out-of-state lawyer must associate with local counsel or apply pro hac vice under Rule 1.9 of the Hawaiʻi Rules of Appellate Procedure for district-court representation.

Red Flags That You Need Counsel

• Complex medical conditions (e.g., mixed connective-tissue disease, traumatic brain injury).

• Adverse vocational expert testimony.

• Missed deadlines requiring good cause arguments.

• Prior adverse credibility findings.

Local Resources & Next Steps

SSA Offices Serving Hawaii

Honolulu Field Office 300 Ala Moana Blvd, Rm 1-114, Honolulu, HI 96850 Hilo Field Office 111 E Puainako St, Ste 710, Hilo, HI 96720 Kahului Field Office 2200 Main St, Ste 125, Wailuku, HI 96793 Līhuʻe Field Office 4370 Kukui Grove St, Ste 105, Līhuʻe, HI 96766

Medical Providers Familiar With Disability Documentation

• The Queen’s Medical Center – Honolulu

• Maui Memorial Medical Center – Wailuku

• Kona Community Hospital – Kealakekua

• Wilcox Medical Center – Līhuʻe

Vocational Rehabilitation Services

The Division of Vocational Rehabilitation (DVR) under Hawaii’s Department of Human Services offers job counseling, training, and assessments that can become key evidence under 20 CFR §404.1571.

Community Legal Aid

Legal Aid Society of Hawaii – Disability benefits advocacy Legal Aid Society of Hawaii

• University of Hawaii Elder Law Program (specific to older adults)

Next Steps Checklist

• Mark your 60-day appeal deadline on a calendar.

• Request updated medical records immediately.

• Contact a Hawaii-licensed disability attorney for a file review.

• Track all SSA correspondence and keep certified mail receipts.

• Prepare personal statements detailing daily functional limits.

Legal Disclaimer: This article is for informational purposes only and does not constitute legal advice. Laws and regulations change. Consult a licensed Hawaii attorney regarding your specific situation.

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