Disability Claim Denied in New York: What to Do

Receiving a denial notice from the Social Security Administration can feel devastating, especially when you are living with a serious medical condition that prevents you from working. In New York, thousands of applicants face initial denials every year — but a denial is not the end of the road. The appeals process exists precisely because the SSA denies the majority of initial applications, and many claimants ultimately win benefits after pursuing their rights.

Understanding why claims get denied and what your options are can make the difference between giving up and securing the monthly income you deserve.

Why SSDI Claims Get Denied in New York

The Social Security Administration denies claims for a wide range of reasons, and knowing the specific basis for your denial is the first step toward a successful appeal. Common reasons include:

• Insufficient medical evidence: The SSA could not find enough documentation to confirm the severity of your condition.
• Failure to meet the durational requirement: Your impairment is not expected to last at least 12 months or result in death.
• Substantial Gainful Activity (SGA): You earned above the monthly income threshold ($1,550 in 2024 for non-blind individuals).
• Non-compliance with treatment: You did not follow prescribed medical treatment without a valid reason.
• Lack of work credits: You did not accumulate enough Social Security work credits to qualify for SSDI.
• Technical or administrative errors: Missing paperwork, incorrect information, or a failure to respond to SSA requests.

New York applicants processed through the Office of Disability Determinations (ODD) in Albany or New York City often face denials tied to insufficient treating source evidence. New York's healthcare system is vast, and medical records are sometimes fragmented across multiple providers — which means the SSA may not have received a complete picture of your impairments.

The Four Levels of the SSDI Appeals Process

Federal law gives you four distinct opportunities to challenge an SSDI denial. Each level has strict deadlines, and missing them can permanently bar you from benefits on that application.

1. Reconsideration: You have 60 days from the date of your denial notice (plus 5 days for mailing) to request a reconsideration. A different SSA examiner reviews your file. Statistically, reconsideration has a low approval rate — often under 15 percent — but it is a required step before advancing to a hearing.

2. Administrative Law Judge (ALJ) Hearing: This is where most claimants win their cases. You appear before an ALJ, often at the Hearing Office in New York City, Albany, Buffalo, or Long Island. You can present new medical evidence, call expert witnesses, and cross-examine the vocational expert the SSA may use. Nationally, approval rates at this stage range from 45 to 55 percent. Having an attorney represent you significantly increases your odds.

3. Appeals Council Review: If the ALJ denies your claim, you can request that the Appeals Council review the decision. The Council may reverse the decision, remand the case for a new hearing, or deny review. This step is often a necessary procedural hurdle before accessing federal court.

4. Federal District Court: In New York, federal appeals are filed in the appropriate U.S. District Court — the Southern District (Manhattan), Eastern District (Brooklyn), Northern District (Albany), or Western District (Buffalo). A federal judge reviews whether the ALJ's decision was supported by substantial evidence. This level involves complex legal arguments and almost always requires an attorney.

Critical Steps to Take After a Denial in New York

Time is your most valuable resource after receiving a denial notice. The 60-day deadline is strict, and the SSA rarely grants extensions. Take the following steps immediately:

• Read your denial letter carefully. The notice explains the specific reason for denial and contains your appeal rights. Keep this document — it contains your claim number and deadlines.
• Request your claim file. You are entitled to a copy of your entire administrative record. Reviewing it reveals what evidence the SSA actually considered and what is missing.
• Continue medical treatment. Gaps in treatment are often fatal to SSDI claims. Consistent records from treating physicians, specialists, and mental health providers build the foundation for a successful appeal.
• Obtain updated medical opinions. A detailed Residual Functional Capacity (RFC) statement from your treating doctor — explaining precisely what you can and cannot do — carries significant weight before an ALJ.
• Consult a disability attorney. SSDI attorneys work on contingency, meaning you pay nothing unless you win. The SSA caps attorney fees at 25 percent of past-due benefits, with a maximum of $7,200 (as of recent SSA fee caps). There is no financial risk to getting representation.

New York-Specific Resources and Considerations

New York claimants have access to several state and legal aid resources that can help during the appeals process. The New York State Bar Association's Lawyer Referral and Information Service connects applicants with disability attorneys. Legal aid organizations such as Legal Aid Society, Empire Justice Center, and MFY Legal Services provide free representation to low-income individuals in certain cases.

New York also has specific Compassionate Allowance conditions and listing-level impairments that may qualify applicants for expedited processing. Certain cancers, neurological disorders, and rare diseases are automatically approved under the SSA's Compassionate Allowances program — but only if the medical documentation is complete and correctly coded from the outset.

Additionally, New York's high cost of living means that supplemental programs like Supplemental Security Income (SSI) — which has different eligibility criteria than SSDI — may also be available to you if your income and resources are limited. Many claimants qualify for both programs simultaneously, known as concurrent benefits.

How Long Will the Appeals Process Take?

Processing times in New York vary, but applicants should be prepared for a lengthy process. Reconsideration typically takes 3 to 5 months. Waiting for an ALJ hearing can take 12 to 24 months at some New York hearing offices, particularly in New York City, which has historically faced significant backlogs. The Appeals Council can take another 12 months or more.

This is why acting quickly at each stage is critical — every delay in filing an appeal adds months to an already extended timeline. If you are approved, you may be entitled to back pay going back to your alleged onset date (subject to a five-month waiting period and other limitations), which can represent a substantial lump sum.

A denied claim is not a final answer. The appeals system was designed to correct errors and give claimants a fair opportunity to be heard. With the right medical documentation, legal representation, and a clear understanding of the process, many New Yorkers who were initially denied do eventually receive the benefits they are owed.

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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