Good Disability Lawyers Near Me: SSDI – California, California

SSDI Denials and Appeals in California, California: A Practical Guide for Claimants

Facing a Social Security Disability Insurance (SSDI) denial in California can be overwhelming. The denial notice often arrives with legal terms, tight deadlines, and references to the federal regulations that govern your rights. This guide is designed to help California residents understand the SSDI appeals process, what to do next, and how to protect your claim. While it slightly favors the claimant’s perspective, everything here is grounded in authoritative sources such as the Social Security Administration (SSA), the Code of Federal Regulations (CFR), and the Social Security Act.

California is part of the SSA’s San Francisco region (often referred to as Region 9), and the state has numerous SSA field offices and hearing locations that serve millions of workers. Many claimants here also receive short-term wage replacement through California’s separate State Disability Insurance (SDI) program administered by the Employment Development Department (EDD). That program is different from federal SSDI. Understanding the distinction is critical: SSDI is a federal insurance benefit based on your work history and disability under federal law, while California SDI is a separate state program; they follow different rules and timelines.

If your SSDI application was denied, you are not alone—many initial claims are denied nationwide for technical or medical reasons. Fortunately, federal regulations give you a structured, multi-level appeal. Deadlines are strict, but if you act promptly, you can preserve your rights and get a fresh look at your case by new reviewers and ultimately an Administrative Law Judge (ALJ). Below you’ll find what you need to know about your rights, common reasons for denials, key federal protections, step-by-step appeal instructions, when to seek legal help, and how to connect with SSA resources near you in California.

Understanding Your SSDI Rights in California

What SSDI Is and Who Qualifies

SSDI provides monthly benefits to insured workers who meet the federal definition of disability. To be “insured,” you generally need sufficient work credits based on your past contributions to Social Security through payroll or self-employment taxes. The insured status framework is set out in federal regulations and statutes, including 20 CFR Part 404 (see, for example, 20 CFR Subpart B governing insured status).

The legal definition of “disability” for SSDI is established by the Social Security Act and regulations. Under the Act, an individual is disabled if they are unable to engage in any substantial gainful activity due to a medically determinable physical or mental impairment that has lasted or is expected to last at least 12 months or result in death. See Social Security Act §223, codified at 42 U.S.C. §423(d), and 20 CFR 404.1505 and 404.1509 (duration requirement).

The Five-Step Sequential Evaluation

SSA uses a five-step process to decide disability, codified at 20 CFR 404.1520:

• Step 1 (Work Activity): Are you performing substantial gainful activity (SGA)? If yes, the claim is generally denied. See 20 CFR 404.1571–404.1576.
• Step 2 (Severity): Do you have a severe medically determinable impairment? See 20 CFR 404.1521.
• Step 3 (Listings): Does your impairment meet or equal a listed impairment? See 20 CFR Part 404, Subpart P, Appendix 1.
• Step 4 (Past Work): Can you perform your past relevant work given your residual functional capacity (RFC)? See 20 CFR 404.1520(f) and 404.1565.
• Step 5 (Other Work): Can you adjust to other work that exists in significant numbers in the national economy? See 20 CFR 404.1560–404.1569a.

Throughout this analysis, the burden of proof initially rests with the claimant to show inability to perform past work; at Step 5, it shifts to SSA to show there is other work you can perform given your age, education, work experience, and RFC.

Your Evidence Rights

Claimants have the right to submit medical and non-medical evidence, including treating source opinions, objective test results, and detailed statements about functional limitations. Evidence provisions appear in 20 CFR 404.1512 (responsibility for evidence) and 404.1513 (acceptable medical sources). If your case reaches a hearing, the “five-day rule” requires you to inform SSA about or submit all written evidence no later than five business days before the hearing unless you can show good cause. See 20 CFR 404.935.

Common Reasons SSA Denies SSDI Claims

Technical Denials

Some denials occur without a full medical review. Frequent technical reasons include:

• Insufficient insured status: You may not have enough recent work credits to qualify, particularly if you stopped working long ago. See the insured status rules in 20 CFR Part 404, Subpart B.
• Work activity at SGA levels: If you are working and your earnings indicate SGA, the claim may be denied at Step 1. See 20 CFR 404.1572–404.1574.
• Failure to cooperate: Not returning SSA forms, declining to attend a consultative examination, or failing to provide requested information can lead to denial. See 20 CFR 404.1517–404.1519t regarding consultative exams.

Medical Denials

When SSA evaluates medical eligibility, common denial reasons include:

• Insufficient objective evidence: Lack of clinical findings, diagnostic imaging, or lab results to substantiate severity. See 20 CFR 404.1512.
• No severe impairment: SSA finds that your impairments cause no more than minimal limitations. See 20 CFR 404.1520(c).
• Impairment duration: The condition is not expected to last 12 months or result in death. See 20 CFR 404.1509.
• Ability to perform past work: Based on your RFC, SSA decides you can still perform your past relevant work. See 20 CFR 404.1560(b) and 404.1565.
• Ability to perform other work: At Step 5, SSA identifies other jobs in the national economy that fit your RFC and vocational factors. See 20 CFR 404.1560(c) and 404.1566.
• Failure to follow prescribed treatment: In certain circumstances, if you do not follow prescribed treatment without a good cause, you may be denied. See 20 CFR 404.1530.

Many of these issues can be addressed on appeal by supplying missing records, clarifying functional limitations, securing well-supported medical source statements, and correcting misunderstandings about job demands or past work classifications.

Federal Legal Protections & Regulations That Shape Your Appeal

Administrative Review Process

The SSDI administrative review process is governed by 20 CFR 404.900 and related sections. Generally, there are four levels:

• Reconsideration (a new review by someone who didn’t make the initial decision). See 20 CFR 404.907–404.921.
• Hearing before an Administrative Law Judge (ALJ). See 20 CFR 404.929–404.961.
• Appeals Council review (discretionary). See 20 CFR 404.967–404.983.
• Federal court review in U.S. District Court. See 42 U.S.C. §405(g) and 20 CFR 422.210.

Each level has specific filing deadlines. Missing a deadline can end your claim, but you may request an extension if you can show “good cause.” See 20 CFR 404.911.

Deadlines You Must Know

• Reconsideration: You generally have 60 days after you receive the denial to request reconsideration. SSA presumes you receive notices 5 days after the date on the notice. See 20 CFR 404.909(a)(1) and 20 CFR 404.901 (mailing presumption).
• Hearing before an ALJ: If reconsideration is denied, you generally have 60 days after receipt of the reconsideration determination to request a hearing. See 20 CFR 404.933(b).
• Appeals Council: You generally have 60 days after receipt of the ALJ decision to request Appeals Council review. See 20 CFR 404.968(a).
• Federal court: To seek judicial review, you must file a civil action within 60 days after receiving the Appeals Council’s notice of denial or decision. See 42 U.S.C. §405(g) and 20 CFR 422.210(c).

If you miss a deadline, you can ask SSA to extend your time by showing good cause. SSA considers factors like serious illness, records destroyed by fire, or other circumstances beyond your control. See 20 CFR 404.911(b).

Reopening a Decision

In limited circumstances, SSA can reopen and revise a determination or decision after it becomes final, subject to strict time limits and standards. See 20 CFR 404.987–404.989 for the rules on reopening for any reason within 12 months, or for “good cause” within specified timeframes.

Right to Representation and Fees

You have the right to appoint a representative at any time, including during the administrative process. See 20 CFR 404.1700–404.1717. Representatives may be attorneys or qualified non-attorneys. Attorney fees for SSDI cases must be approved by SSA under the Social Security Act, 42 U.S.C. §406(a), and implementing regulations including 20 CFR 404.1720–404.1725. Fees are typically contingent on a favorable outcome and paid out of past-due benefits, but SSA must approve the fee amount or fee agreement before any fee is collected.

Steps to Take After an SSDI Denial in California

1) Read Your Denial Notice Carefully

Your denial letter will explain why SSA denied your claim, what evidence they considered, and how to appeal. It will also contain the date of the notice that starts the clock for your appeal. Calendar the deadline immediately. Remember, you generally have 60 days from receipt to appeal, with a presumption that you received the notice 5 days after the date on the letter. See 20 CFR 404.909(a)(1) and 404.901.

2) File Your Appeal on Time (Do Not Start Over)

Do not file a new application unless a qualified representative tells you it is appropriate for your situation. Filing a reconsideration preserves your earliest protective filing date and keeps your claim moving through the official administrative review process. You can often appeal online via SSA’s official appeals portal.

• Reconsideration: Use SSA-561 (Request for Reconsideration), complete SSA-3441 (Disability Report – Appeal), and sign a new SSA-827 (Authorization to Disclose Information) so SSA can gather updated medical records.
• Hearing: If reconsideration is denied, file your request for hearing promptly and continue submitting updated evidence. See 20 CFR 404.933.

3) Strengthen the Medical Record

SSDI cases turn on medical evidence. Ask your treating providers for:

• Objective testing (imaging, labs, pulmonary function tests, neuropsychological testing, etc.), if relevant.
• Longitudinal treatment notes showing persistent symptoms and functional impact.
• Treating source statements that explain specific functional limitations (e.g., sitting, standing, lifting, off-task time, absenteeism), consistent with the record.

If SSA schedules a consultative examination (CE), attend it. Not cooperating with a CE can lead to denial for insufficient evidence. See 20 CFR 404.1517–404.1519t.

4) Document Functional Limitations

Beyond diagnoses, SSA evaluates how impairments limit your ability to perform work activities. Detailed statements from you and third parties about your daily activities, need for breaks, difficulties with concentration or social interaction, and effects of pain or medication side effects can help contextualize the medical evidence. See the evidence responsibilities in 20 CFR 404.1512 and acceptable sources in 20 CFR 404.1513.

5) Prepare for the Hearing (If Your Case Advances)

At the ALJ hearing, you have the right to review your file, submit evidence, and present testimony. Expert witnesses may testify, including a vocational expert (VE) and sometimes a medical expert (ME). You or your representative can question these experts. Submit your evidence at least five business days before the hearing unless you can establish good cause for late submission. See 20 CFR 404.935.

6) Consider Legal Representation

SSDI regulations and evidence rules are technical. An experienced representative may help you identify missing medical proof, craft a theory of disability aligned with 20 CFR 404.1520, prepare you for testimony, and address VE job-number and transferability issues. Representation is your right, and fees must be approved by SSA. See 20 CFR 404.1700–404.1725 and 42 U.S.C. §406(a).

When to Seek Legal Help for SSDI Appeals

Because SSDI denials often turn on narrowly interpreted rules and close credibility questions, many Californians choose to consult a representative as soon as they receive a denial. Consider hiring help if:

• You face a reconsideration deadline and need to preserve your earliest filing date.
• Your medical file is incomplete or your providers have not offered functional opinions.
• You have past work that is difficult to classify, or transferable skills issues at Step 5.
• You have a complex medical profile (e.g., multiple impairments, rare conditions, combination of physical and mental health limitations).
• You want help preparing a pre-hearing brief that aligns the evidence with the Listings, RFC analysis, and vocational framework.

In California, attorneys are regulated by the State Bar of California. For court matters within California, you should seek advice from a California-licensed attorney. For SSA proceedings, an attorney licensed and in good standing in any U.S. state may represent claimants before SSA. See representation rules at 20 CFR 404.1705. In all cases, fees for SSDI representation require SSA approval under 42 U.S.C. §406(a) and 20 CFR 404.1720–404.1725.

Local Resources & Next Steps for California Claimants

SSA Offices and Hearing Locations in California

California has numerous SSA field offices across the state and several hearing offices where ALJ hearings are held, including locations in major metropolitan areas such as Los Angeles, San Diego, San Francisco, Sacramento, San Jose, and Fresno. California is served by SSA’s San Francisco regional structure. To find the specific field office or hearing location assigned to your claim—and to confirm hours and services—use the SSA office locator by entering your ZIP code.

For in-person assistance, appointments are often recommended. Many appeal steps can be completed online, including filing a reconsideration or hearing request and uploading evidence. Always keep copies of anything you submit and confirm receipt when possible.

Coordinating Care and Documentation

Given the size and diversity of California’s healthcare landscape, claimants should ensure all relevant providers—primary care, specialists, hospitals, and therapists—are listed on the SSA-3441 and that records are up to date. Where possible, request detailed medical source statements addressing functional limits. If you also receive California State Disability Insurance (SDI), remember that the state program has different criteria and timeframes; an SDI approval does not guarantee federal SSDI approval, but the medical evidence used for SDI can still support your SSDI claim if it documents functional limitations and diagnostic findings.

Practical Tips for California SSDI Appeals

• Track deadlines: Use a calendar and set reminders for your 60-day appeal windows. See 20 CFR 404.909, 404.933, and 404.968.
• Keep records organized: Maintain a file with denial notices, appeal confirmations, medical records, and correspondence.
• Communicate with providers: Let your doctors know you have a disability claim and ask them to document objective findings and functional impact over time.
• Be consistent: Ensure your statements to SSA, your doctors, and on any state SDI forms are consistent and accurate.
• Follow treatment: Follow reasonable medical treatment unless you have a documented, good-cause reason not to. See 20 CFR 404.1530.

Detailed Walkthrough of Each Appeal Level

Reconsideration

At reconsideration, a new adjudicator reviews your file and any new evidence. Provide updated medical records, treatment notes, and testing since the initial decision. If SSA requests a consultative exam, attend as scheduled. You may also submit personal statements and third-party function reports that clarify day-to-day limitations. The reconsideration process is governed by 20 CFR 404.907–404.921, with the filing deadline at 20 CFR 404.909(a)(1).

Hearing Before an ALJ

If reconsideration is denied, request a hearing within 60 days. See 20 CFR 404.933(b). Before the hearing, review your exhibit file and ensure all relevant evidence is in the record. Comply with the five-day evidence rule (20 CFR 404.935). At the hearing, the ALJ will take testimony and may hear from a vocational expert and, when appropriate, a medical expert. You or your representative can cross-examine these experts, challenge job numbers or transferability assumptions, and argue that your limitations preclude competitive employment.

Appeals Council

After an unfavorable ALJ decision, you have 60 days to request Appeals Council review. See 20 CFR 404.968(a). The Appeals Council may deny review, remand your case for a new hearing, or in rare instances issue its own decision. To obtain review, you generally must show an error of law, lack of substantial evidence, abuse of discretion, or present new and material evidence that relates to the period on or before the ALJ decision and for which there is good cause for not submitting it earlier. See 20 CFR 404.970.

Federal Court

If the Appeals Council denies review or issues an unfavorable decision, you may file a civil action in the U.S. District Court within 60 days of receiving the final decision. See 42 U.S.C. §405(g) and 20 CFR 422.210. The federal court reviews the administrative record to determine whether the decision is supported by substantial evidence and whether the correct legal standards were applied. It can affirm, reverse, or remand the case to SSA for further proceedings.

Key Federal Regulations and Statutes to Know

• 20 CFR 404.900: Administrative review process—levels of appeal and procedural framework.
• 20 CFR 404.909, 404.933, 404.968: Deadlines for reconsideration, hearing, and Appeals Council.
• 20 CFR 404.1520: Five-step sequential evaluation process.
• 20 CFR 404.1512, 404.1513: Evidence responsibilities and acceptable medical sources.
• 20 CFR 404.935: Five-day evidence rule for hearings.
• 20 CFR 404.911: Good cause for late filing.
• 20 CFR 404.987–404.989: Reopening determinations and decisions.
• 42 U.S.C. §423(d): Statutory definition of disability.
• 42 U.S.C. §405(b) and §405(g): Hearings and judicial review.
• 42 U.S.C. §406(a) and 20 CFR 404.1720–404.1725: Representative fees and approval.

California-Specific Notes and Practical Considerations

Regional administration: California SSDI claims and hearings are administered within SSA’s San Francisco regional structure. Hearing sites exist across the state, including large population centers such as Los Angeles, San Diego, San Francisco, Sacramento, San Jose, and Fresno.

State SDI vs. federal SSDI: California State Disability Insurance (SDI) is a temporary wage-replacement program distinct from federal SSDI. An SDI approval can support your SSDI record by providing treatment notes and functional details, but it does not control the federal outcome, which follows the five-step SSDI framework and duration requirement under 20 CFR 404.1520 and 404.1509.

Representation in California: If you are seeking legal services specific to California law or court proceedings, choose a lawyer licensed by the State Bar of California. For SSA administrative proceedings, attorneys in good standing licensed in any U.S. state may represent you under 20 CFR 404.1705. Fee agreements must be approved by SSA under 42 U.S.C. §406(a).

FAQ for California SSDI Claimants

How long do I have to appeal my SSDI denial?

Generally, 60 days from receipt of the notice (with a 5-day mailing presumption). See 20 CFR 404.909(a)(1), 20 CFR 404.933(b), 20 CFR 404.968(a), and 20 CFR 404.901 (receipt presumption). You can request more time for good cause. See 20 CFR 404.911.

Should I file a new application or appeal?

In most cases, appeal rather than starting over. Appealing preserves your earliest filing date and keeps you in the official review process under 20 CFR 404.900. A new application can forfeit valuable backpay potential unless there’s a strategic reason to refile.

What if I missed the deadline?

Ask SSA for more time and explain the good-cause reasons with documentation if available. See 20 CFR 404.911. If SSA declines, reopening rules at 20 CFR 404.987–404.989 may offer limited options.

Do I need a California-licensed attorney?

For representation before SSA, an attorney licensed in any U.S. state may represent you if they meet 20 CFR 404.1705 requirements. For legal issues involving California courts or California-specific law, consult a California-licensed attorney regulated by the State Bar of California.

How can I find my local SSA office in California?

Use the SSA office locator to find your nearest field office and to confirm business hours and services. You can also complete many appeal steps online, including filing a reconsideration or hearing request, and uploading evidence.

How to Present Strong Medical and Vocational Evidence

Medical Source Opinions

Well-supported opinions from treating providers that cite clinical findings and explain specific functional limitations can be persuasive. Ensure the opinions address the work-related abilities relevant to your condition, such as lifting limits, need for unscheduled breaks, time off-task, limits in standing/walking, or cognitive/social limitations.

Objective Testing and Longitudinal Treatment

SSA weighs objective findings heavily. When appropriate, include imaging (e.g., MRI, CT), nerve conduction studies, pulmonary or cardiac testing, neuropsychological evaluations, or other diagnostics that corroborate reported symptoms. Consistent treatment over time strengthens your credibility and helps establish the 12-month duration requirement. See 20 CFR 404.1509.

Vocational Evidence

Document your job duties and physical/mental demands of past work. SSA classifies past work by exertional and skill levels when analyzing transferability and Step 4/5 issues. Misclassification or incomplete descriptions of past work can lead to denials, so supply detailed job descriptions and, if possible, employer statements clarifying actual requirements.

Important Note on Search Phrases

To help California residents locate accurate information about appeals, this guide includes the phrase “SSDI denial appeal california california” to align with common search behavior, as well as “social security disability,” “california disability attorney,” and “SSDI appeals.”

Authoritative Resources

SSA: How to Appeal a DecisionSSA Office Locator (Find Your Local Field Office)eCFR: 20 CFR 404.900 (Administrative Review Process)eCFR: 20 CFR 404.1520 (Five-Step Sequential Evaluation)Social Security Act §405 (Hearings and Judicial Review)

How to Get Help in California

If you are searching for good disability lawyers near me and you live in California, consider the following steps:

• Confirm that any attorney you contact is in good standing and, if offering California-specific legal services, licensed by the State Bar of California.
• Ask potential representatives about their approach to evidence development under 20 CFR 404.1512 and the five-day rule at 20 CFR 404.935.
• Request a case review to identify gaps in the record and whether updated diagnostics or treating source statements could strengthen your claim.
• Discuss fee structure and SSA approval requirements under 42 U.S.C. §406(a) and 20 CFR 404.1720–404.1725.

Legal Disclaimer

This guide provides general information for California residents about SSDI denials and appeals. It is not legal advice. Laws and regulations change, and outcomes depend on specific facts. For advice on your situation, consult a licensed California attorney or qualified representative.

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