What Is SSDI? Rights & Appeals in Massachusetts, MA

Introduction: Why SSDI Denials Matter in Massachusetts

If you live anywhere from the Berkshires to Cape Cod, Social Security Disability Insurance (SSDI) can be a financial lifeline when a severe medical condition keeps you from working. Unfortunately, the Social Security Administration (SSA) initially denies roughly two-thirds of SSDI applications nationwide, and Massachusetts residents are no exception. According to the SSA’s State Agency Monthly Workload Data, more than 15,000 Bay Staters receive an unfavorable determination each year. Receiving a denial letter no doubt feels overwhelming, but it is not the end of the road. Federal regulations give you specific, enforceable rights to challenge that decision—and Massachusetts courts routinely enforce those rights. This guide walks you through the process, explains the law, and provides local resources so you can protect your claim.

Understanding Your SSDI Rights

What SSDI Is—and Is Not

SSDI is a federal insurance program funded by payroll taxes under Title II of the Social Security Act. The benefit replaces a portion of lost wages when a “medically determinable impairment” prevents “substantial gainful activity” (SGA) for at least 12 months or is expected to result in death (42 U.S.C. § 423). Unlike Supplemental Security Income (SSI), SSDI is not needs-based; eligibility depends on your work history and payment of Federal Insurance Contributions Act (FICA) taxes.

Your Core Legal Protections

• Due Process. Under the Fifth Amendment and Mathews v. Eldridge, 424 U.S. 319 (1976), you have the right to meaningful notice and an opportunity to be heard before benefits are finally denied.

• Appeal Deadlines. 20 CFR 404.909 and 404.933 give you 60 days from receipt of a denial (SSA presumes five days for mailing) to request the next review stage.

• Representation. Anyone may represent themselves, but 20 CFR 404.1740 requires attorneys or non-attorney representatives to be licensed or otherwise qualified and to follow SSA’s Rules of Conduct. In Massachusetts, licensed attorneys must also comply with the Massachusetts Rules of Professional Conduct enforced by the Board of Bar Overseers.

Common Reasons SSA Denies SSDI Claims

Understanding why claims fail can help you correct the record early. The most frequent bases for denial cited in Massachusetts Disability Determination Services data mirror national trends:

Medical Insufficiency. Records do not substantiate a severe impairment or document functional limitations (20 CFR 404.1520).

• Ability to Perform Past Work. SSA concludes you can still perform work you did in the last 15 years (Step 4 of the sequential evaluation).

• Ability to Adjust to Other Work. Vocational experts identify alternative jobs that exist in significant numbers (Step 5).

• Technical Issues. Lack of insured status, insufficient work credits, or missed deadlines.

• Non-compliance. Failing to attend a Consultative Examination (CE) or to respond to SSA requests.

Because many denials stem from missing or misunderstood evidence, a careful appeal often succeeds where the initial application failed.

Federal Legal Protections & Regulations

Two core regulations structure the entire appeals system:

• 20 CFR 404.900 et seq. — Establishes four administrative appeal levels: Reconsideration, Administrative Law Judge (ALJ) hearing, Appeals Council review, and Federal Court.

• 20 CFR 404.1512 — Details the claimant’s burden to provide medical and nonmedical evidence.

Under 42 U.S.C. § 405(g), you may seek judicial review in the U.S. District Court for the District of Massachusetts after exhausting administrative remedies. Massachusetts claimants file in Boston’s Moakley Federal Courthouse, which has overturned or remanded numerous SSA decisions for errors such as ignoring treating-physician opinions (e.g., Bordes v. Kijakazi, No. 21-cv-11359, 2022 WL 16859239 [D. Mass. Nov. 10, 2022]).

Steps to Take After an SSDI Denial

1. Understand Your Notice of Decision

The denial letter (“Notice of Disapproved Claim”) will state the medical and technical reasons for denial and explain your right to appeal within 60 days. Note the date at the top—your clock starts five days later.

2. File a Request for Reconsideration

Most Massachusetts claimants must request Reconsideration first (Form SSA-561). Submit new medical evidence such as updated imaging or specialist reports. Massachusetts Disability Determination Services in DDS-Fitchburg or DDS-Boston will review your file with a different medical consultant than the one who issued the initial denial.

3. Prepare for an ALJ Hearing

If Reconsideration is denied, request an ALJ hearing using iAppeals online. Hearings for Massachusetts residents are generally held at either the Boston or Springfield Office of Hearing Operations (OHO). You may appear in person, by phone, or by video teleconference. Average wait time in 2023 was roughly 9 months—shorter than the national average, according to SSA OHO statistics.

4. Appeals Council Review

The Appeals Council in Falls Church, Virginia, will examine whether the ALJ committed legal error. You can also submit new, material evidence that relates to the period on or before the ALJ’s decision under 20 CFR 404.970.

5. Federal District Court

Finally, you may file a civil action in the U.S. District Court within 60 days of the Appeals Council’s notice. No new evidence is permitted; the court reviews the administrative record under the “substantial evidence” standard.

When to Seek Legal Help for SSDI Appeals

Although you may represent yourself, statistics show that claimants with qualified representation fare better. The Government Accountability Office found that represented claimants were nearly three times more likely to win benefits at the ALJ level. Massachusetts attorneys typically work on a contingency fee capped at 25 percent of past-due benefits or $7,200, whichever is less, as set by 42 U.S.C. § 406(a)(2)(A). Any fee must be approved by the SSA.

You should strongly consider hiring counsel if:

• You have complex medical records or multiple impairments.

• The SSA questions your work history or insured status.

• You cannot gather evidence or meet deadlines due to your health.

Look for a “massachusetts disability attorney” who is licensed in the Commonwealth and admitted to the federal district court.

Local Resources & Next Steps

Key SSA Field Offices

• Boston SSA Office – 10 Causeway St, Room 148, Boston, MA 02222

• Springfield SSA Office – 70 Bond St, Springfield, MA 01104

Medical Evidence Providers

• Mass General Hospital – Comprehensive specialty records often carry significant weight with SSA evaluators.

• UMass Memorial Medical Center – Provides detailed functional capacity evaluations useful at the ALJ level.

Advocacy and Support

Mass Legal Services – Free legal information and referrals. New England ADA Center – Disability rights education and resources.

Conclusion

A denial letter from SSA is discouraging, but federal law provides a structured path to appeal. By understanding the regulations, gathering solid medical evidence, and—when necessary—retaining experienced legal help, Massachusetts claimants dramatically improve their odds of success. Stay vigilant about deadlines, keep copies of every submission, and do not hesitate to escalate your case through each stage.

Legal Disclaimer: This article is for informational purposes only and does not constitute legal advice. Consult a licensed Massachusetts attorney for advice 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.