Disability Claim Denied in New Mexico: What to Do

Receiving a denial letter from the Social Security Administration can be devastating, especially when you are unable to work due to a disability. In New Mexico, as across the nation, the majority of initial Social Security Disability Insurance (SSDI) applications are denied. Understanding why claims are denied and what steps you can take next is essential to securing the benefits you deserve.

The denial of your disability claim does not mean your case is over. The Social Security Administration provides multiple levels of appeal, and many applicants who are initially denied eventually receive approval. The key is taking prompt action and understanding the appeals process specific to New Mexico.

Common Reasons for SSDI Denials in New Mexico

The Social Security Administration denies disability claims for various reasons. Understanding these common causes can help you address weaknesses in your application or appeal:

• Insufficient medical evidence: The SSA requires comprehensive medical documentation proving your condition prevents you from working. Many claims are denied simply because the medical records do not adequately demonstrate the severity of the disability.
• Failure to follow prescribed treatment: If you have not followed your doctor's recommended treatment plan without good reason, the SSA may deny your claim on the grounds that your condition might improve with proper treatment.
• Income exceeds substantial gainful activity limits: If you are earning more than the SGA limit ($1,550 per month for non-blind individuals in 2024), your claim will be denied regardless of your medical condition.
• Lack of work credits: SSDI requires that you have worked and paid into Social Security for a sufficient period. Generally, you need 40 work credits, with 20 earned in the last 10 years.
• Non-cooperation with the SSA: Failing to attend consultative examinations, not providing requested information, or missing deadlines can result in denial.
• Short-term disability: The SSA only approves claims for disabilities expected to last at least 12 months or result in death.

Technical denials based on income or work credits are difficult to overturn, but medical denials can often be successfully appealed with additional evidence and proper representation.

The Appeals Process for New Mexico Residents

If your disability claim has been denied, you have the right to appeal the decision. The appeals process consists of four levels, and you must file your appeal within 60 days of receiving your denial notice. The SSA assumes you received the notice five days after the date on the letter, giving you effectively 65 days from that date.

Reconsideration: This is the first level of appeal. Your case will be reviewed by a different SSA examiner who was not involved in the initial decision. You can submit additional medical evidence at this stage. New Mexico cases are processed through the SSA offices in Albuquerque, Las Cruces, Santa Fe, and other regional locations. Unfortunately, reconsideration approval rates remain low, typically around 10-15 percent.

Administrative Law Judge Hearing: If reconsideration is unsuccessful, you can request a hearing before an Administrative Law Judge. This is the most critical stage of the appeals process and where most claims are won. ALJ hearings for New Mexico residents are conducted at hearing offices in Albuquerque and other locations throughout the state, or by video conference. At this hearing, you can testify about your limitations, present witnesses, and have a representative argue your case. Approval rates at the ALJ level are significantly higher than earlier stages.

Appeals Council Review: If the ALJ denies your claim, you can request review by the Appeals Council in Falls Church, Virginia. The Appeals Council may deny review, remand the case back to the ALJ, or issue its own decision. This stage has low approval rates and long wait times.

Federal Court: The final level of appeal is filing a lawsuit in federal district court. For New Mexico residents, this would be the United States District Court for the District of New Mexico. This option is expensive and time-consuming but may be necessary in cases involving legal errors.

Strengthening Your Appeal

To improve your chances of success on appeal, you should take several important steps:

Obtain comprehensive medical records: Gather all relevant medical documentation, including doctor's notes, test results, imaging studies, hospital records, and mental health treatment records. The more detailed and recent your medical evidence, the stronger your case becomes.

Get a residual functional capacity assessment: Ask your treating physician to complete an RFC form detailing your specific limitations regarding sitting, standing, walking, lifting, concentration, and other work-related activities. An RFC from your long-term treating doctor carries significant weight.

Document your symptoms: Keep a detailed journal of your daily symptoms, limitations, side effects from medications, and how your condition affects your ability to perform everyday tasks. This personal testimony can supplement medical records.

Continue treatment: Ongoing medical treatment demonstrates the severity and persistence of your condition. Gaps in treatment can hurt your credibility unless you have valid reasons such as inability to afford care or lack of insurance.

Hire an experienced representative: Disability attorneys and advocates who specialize in Social Security cases understand the system, know what evidence the SSA requires, and can effectively present your case at hearings. Representatives typically work on contingency, meaning they only get paid if you win your case, with fees capped at 25 percent of past-due benefits up to $7,200.

New Mexico-Specific Considerations

New Mexico has several characteristics that affect disability claims. The state has a high poverty rate and significant rural populations, which can create challenges in accessing adequate medical care. If you have gaps in treatment due to financial hardship or lack of nearby medical providers, document these circumstances as they may explain inconsistencies in your medical records.

New Mexico also has a significant Native American population. Tribal members receiving care through Indian Health Services should ensure all IHS records are included in their disability application, as these records are equally valid as other medical evidence.

The wait times for ALJ hearings can vary by location within New Mexico. Currently, the Albuquerque hearing office has wait times of approximately 12-18 months, though this fluctuates. Video hearings may offer shorter wait times and are equally effective as in-person hearings.

Taking Action After a Denial

Time is critical when your disability claim is denied. The 60-day appeal deadline is strict, and missing it means starting the entire process over from the beginning. As soon as you receive a denial notice, begin gathering additional medical evidence and consider consulting with a disability attorney.

Even if you are approaching the 60-day deadline, file your appeal to preserve your rights. You can continue gathering evidence after filing. Do not let discouragement prevent you from appealing—many successful disability recipients were initially denied and won on appeal.

Remember that proving disability requires demonstrating that your condition prevents you from performing not just your previous job, but any substantial work existing in the national economy. The SSA will consider your age, education, work experience, and transferable skills when making this determination.

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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