SSDI Claim Denied in Massachusetts: What to Do

Receiving a denial letter from the Social Security Administration can feel like the ground has shifted beneath you. You applied for Social Security Disability Insurance (SSDI) because a medical condition prevents you from working, and now the SSA is telling you no. The good news is that a denial is not the end of the road. The majority of SSDI applications are initially denied, and many claimants who appeal successfully receive benefits they were entitled to all along.

Understanding why denials happen and what your options are under the federal appeals process — as it applies to Massachusetts residents — puts you in a far stronger position to fight back effectively.

Why SSDI Claims Are Denied in Massachusetts

The SSA denies SSDI claims for both technical and medical reasons. Technical denials occur when an applicant does not meet the non-medical requirements, such as insufficient work credits. To qualify for SSDI, you generally must have earned enough work credits through Social Security-taxed employment — typically 40 credits, with 20 earned in the last 10 years before your disability began.

Medical denials are more common and stem from the SSA's determination that your condition does not meet their definition of disability. The SSA requires that your impairment:

• Be expected to last at least 12 months or result in death
• Prevent you from performing your past relevant work
• Prevent you from adjusting to any other substantial gainful work that exists in the national economy

Frequent reasons for medical denial in Massachusetts include insufficient medical documentation, gaps in treatment history, or a determination that your residual functional capacity (RFC) still allows some form of work. The SSA often relies heavily on records from your treating physicians — if those records are incomplete or don't fully capture your functional limitations, your claim suffers for it.

The SSDI Appeals Process for Massachusetts Claimants

Massachusetts residents follow the standard federal SSDI appeals process, which has four distinct levels. Each stage offers a meaningful opportunity to present additional evidence and correct the record.

Reconsideration is the first appeal step. You must file a Request for Reconsideration within 60 days of receiving your denial notice (plus a 5-day mail presumption). A different SSA examiner reviews your file. Statistically, reconsideration has a low approval rate — roughly 13% nationally — which is why many claimants move quickly to the next level.

Administrative Law Judge (ALJ) Hearing is where the odds improve significantly. Massachusetts SSDI applicants are served by the Office of Hearings Operations (OHO), with hearing offices located in Boston, Worcester, and Springfield. At an ALJ hearing, you appear in person or via video before a judge who conducts a de novo review of your claim. You can present testimony, call witnesses, and submit updated medical evidence. Approval rates at the ALJ level are substantially higher than at reconsideration.

Appeals Council Review is available if the ALJ denies your claim. The Appeals Council can grant, deny, or remand your case back to an ALJ. This level involves written arguments rather than a hearing and can be highly technical.

Federal District Court is the final option. Massachusetts claimants file in the United States District Court for the District of Massachusetts. This involves formal litigation and requires demonstrated legal error on the SSA's part.

Critical Steps to Take After a Denial

Acting promptly and strategically after a denial is essential. The 60-day appeal deadline is strictly enforced, and missing it typically means starting the application process over — potentially losing months or years of back pay.

Take the following steps as soon as possible after receiving your denial:

• Read the denial letter carefully. The SSA is required to explain the specific reasons for denial. Understanding exactly what the agency found — or failed to find — shapes your entire appeal strategy.
• Gather updated medical records. Obtain records from all treating providers, including primary care physicians, specialists, mental health providers, and hospitals. Ensure records document not just diagnoses but your functional limitations — how your condition affects your ability to sit, stand, walk, concentrate, and sustain a work schedule.
• Request a Residual Functional Capacity assessment from your doctor. An RFC form completed by your treating physician that details your physical and mental work-related limitations can be one of the most powerful pieces of evidence at an ALJ hearing.
• Document your daily symptoms. A detailed symptom journal describing your pain levels, fatigue, cognitive difficulties, and how your condition affects daily activities can corroborate your medical records.
• Consider legal representation. Studies consistently show that claimants represented by an attorney or advocate at ALJ hearings have significantly higher approval rates than those who proceed alone.

How Massachusetts' Healthcare Resources Can Strengthen Your Appeal

Massachusetts has a robust healthcare infrastructure that SSDI claimants can leverage to build stronger disability claims. Major academic medical centers — including Massachusetts General Hospital, Brigham and Women's, and UMass Memorial Medical Center — often produce detailed, well-documented medical records that SSA adjudicators and ALJs take seriously.

If you have been treating at a community health center or have gaps in your medical history due to lack of insurance, Massachusetts residents may be eligible for MassHealth (Medicaid), which can help you access ongoing treatment and establish the consistent treatment history the SSA looks for. Consistent, documented medical treatment is one of the most important factors in a successful SSDI claim.

Additionally, Massachusetts has vocational rehabilitation services through the Massachusetts Rehabilitation Commission (MRC). While MRC services are designed to help individuals return to work, participation in or referral to vocational services can sometimes appear in your SSA file. Understanding how this information may be interpreted during your appeal is important context your attorney can help you navigate.

What a Disability Attorney Does for Your Claim

SSDI attorneys work on contingency — meaning you pay nothing unless you win. If successful, attorney fees are capped by federal law at 25% of your back pay, up to a maximum of $7,200. There is no out-of-pocket cost to hire representation, which makes legal help accessible regardless of your financial situation while you are out of work.

An experienced SSDI attorney will review your denial letter and file, identify the weaknesses the SSA cited, gather the right medical evidence to address those weaknesses directly, and prepare you thoroughly for your ALJ hearing. At the hearing itself, your attorney can cross-examine the vocational expert the SSA uses to argue you can perform other work — a skill that frequently makes the difference between approval and denial.

The appeals process takes time. Massachusetts ALJ hearings can involve wait times of 12 to 18 months or more from the date of request. Filing promptly, building a complete medical record, and being fully prepared for your hearing are the factors within your control. Every month you delay an appeal is a month of potential back pay that may be lost.

Need Help? If you have questions about your case, call or text 833-657-4812 for a free consultation with an experienced attorney.

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