SSDI Guide: Social Security & SSI — California, California

SSDI Denial and Appeal Guide for California, California

If you live in California and your Social Security Disability Insurance (SSDI) claim was denied, you are not alone—and you are not out of options. Many eligible Californians receive initial denials, only to prevail later through the appeals process. This comprehensive guide explains your federal rights, the steps to appeal an SSDI denial, key deadlines, and how to navigate the process from California. It is written with a claimant-protective lens while remaining strictly factual and grounded in federal authority.

SSDI is a federal insurance program administered by the Social Security Administration (SSA). It pays monthly benefits to workers who paid Social Security taxes and can no longer engage in substantial gainful activity due to a medically determinable impairment expected to last at least 12 months or result in death. While SSDI is federal, Californians interact locally with SSA field offices and hearing offices within SSA’s San Francisco Region (Region 9). You can find your nearest office using SSA’s official locator tool: Find Your Local SSA Office.California also has a separate state-run short-term disability program (State Disability Insurance, or SDI) through the Employment Development Department (EDD). SDI is different from SSDI—different eligibility rules, different duration, and different adjudication. An SDI decision does not control your SSDI claim, and vice versa. Under federal regulation, SSA is not bound by disability determinations made by other agencies or entities. See 20 C.F.R. § 404.1504.

Below you will find a detailed look at why claims are denied, the appeal levels, critical time limits (usually 60 days at each level), evidence rules, and practical steps Californians can take to improve their chances on appeal. For those searching for “SSDI denial appeal california california,” this guide focuses specifically on the federal process as it applies to California residents.

Understanding Your SSDI Rights

Basic Eligibility and the Five-Step Evaluation

To qualify for SSDI, two broad requirements must be met: (1) you must be “insured” under the Social Security Act (generally by having sufficient work credits), and (2) you must meet the federal definition of disability. SSA evaluates disability claims using a five-step sequential process codified in federal regulation. See, for example, 20 C.F.R. §§ 404.1505 (definition of disability) and 404.1520 (five-step evaluation). In simplified terms, SSA asks:

• Are you engaging in substantial gainful activity (SGA)? If you are working and earning above the SGA level, you generally are not considered disabled. See 20 C.F.R. §§ 404.1571–404.1574.
• Do you have a severe medically determinable impairment? The impairment must impose more than a minimal limitation on basic work activities and be established by objective medical evidence. See 20 C.F.R. §§ 404.1508–404.1521 (and related sections).
• Does your impairment meet or equal a listed impairment? If your condition meets or equals a Listing, you are found disabled at this step. See 20 C.F.R. Part 404, Subpart P, Appendix 1 (Listing of Impairments).
• Can you perform your past relevant work? SSA assesses your residual functional capacity (RFC) and compares it to past work demands. See 20 C.F.R. §§ 404.1520(f), 404.1560(b).
• Can you perform other work in the national economy? If not, you are disabled. SSA considers age, education, and work experience. See 20 C.F.R. §§ 404.1520(g), 404.1560(c), 404.1563–404.1569a.

Your Key Federal Rights as a Claimant

• Right to appeal: You have the right to challenge an unfavorable decision at multiple levels, beginning with reconsideration and progressing to a hearing, Appeals Council review, and federal court. See 20 C.F.R. § 404.900(a).
• Right to representation: You may appoint an attorney or qualified representative to help you at all stages. See 20 C.F.R. §§ 404.1705 (who may be representative), 404.1706–404.1715 (appointment and duties), and 404.1720 (fees subject to SSA approval).
• Right to submit evidence: You can submit medical and non-medical evidence. At the hearing level, the “five-day rule” generally requires you to submit or inform SSA about evidence at least five business days before the hearing, with certain exceptions. See 20 C.F.R. § 404.935.
• Right to a complete record: SSA develops the record, but you also have the right to review your file and ensure it is complete, including obtaining medical records and statements. See 20 C.F.R. §§ 404.1512 (evidence) and 404.1513 (medical and nonmedical sources).
• Right to due process timeframes and notice: Unfavorable decisions include notice of your appeal rights and deadlines. See 20 C.F.R. §§ 404.909, 404.933, 404.968.

Common Reasons SSA Denies SSDI Claims

Insufficient Medical Evidence or Incomplete Records

SSA requires objective medical evidence from acceptable medical sources to establish a medically determinable impairment. If your records are sparse, outdated, or missing key diagnostic findings, an initial denial is more likely. See 20 C.F.R. §§ 404.1512–404.1513. Californians often receive care across large integrated systems; make sure your file includes all treating sources (for example, hospitalizations in Los Angeles, primary care in San Diego, and specialists in Sacramento).

Work Above SGA

If you work at or above SGA levels, SSA will typically deny at step one. Even part-time work may be considered SGA if earnings exceed the threshold. See 20 C.F.R. §§ 404.1572–404.1574. If you attempted to work but had to stop because of your impairments, document why and when.

Impairment Not “Severe”

SSA may deny at step two if it finds your impairment does not significantly limit basic work activities. Thoroughly documenting functional limitations helps avoid this outcome. See 20 C.F.R. § 404.1522.

Does Not Meet or Equal a Listing

Listings are demanding. Many denials occur at step three because the evidence does not strictly match or medically equal a Listing. Even then, you can still win at steps four or five based on functional limitations and vocational factors. See 20 C.F.R. Part 404, Subpart P, Appendix 1.

Residual Functional Capacity (RFC) Findings

SSA may deny based on an RFC assessment that it says allows you to perform past relevant work (step four) or other work (step five). Detailed function-by-function evidence from treating sources—lifting, standing, sitting, concentration, persistence, pace, and reliability—can be pivotal. See 20 C.F.R. §§ 404.1520(e), 404.1545.

Non-Binding Determinations by Other Agencies

California SDI, workers’ compensation, or VA ratings may be considered but are not binding on SSA. A denial may reflect SSA’s independent standard. See 20 C.F.R. § 404.1504. That said, underlying medical evidence from those processes can be highly useful if submitted appropriately.

Insured Status or Date Last Insured Issues

To receive SSDI, you must have sufficient work credits and be disabled before your “date last insured” (DLI). If SSA decides your disability began after your DLI, it will deny the claim. See 42 U.S.C. § 423(c) and 20 C.F.R. §§ 404.130–404.132 (insured status).

Federal Legal Protections & Regulations

Appeal Levels and Deadlines

• Reconsideration: You generally have 60 days from receipt of the denial to request reconsideration. SSA presumes you receive the notice 5 days after the date on it unless you show otherwise. See 20 C.F.R. § 404.909. Good cause for late filing may exist in certain circumstances. See 20 C.F.R. § 404.911.
• Hearing before an Administrative Law Judge (ALJ): If reconsideration is denied, you have 60 days to request a hearing. See 20 C.F.R. § 404.933. At this stage, the five-day evidence rule applies with exceptions for good cause. See 20 C.F.R. § 404.935.
• Appeals Council Review: After an unfavorable ALJ decision, you have 60 days to request Appeals Council review. See 20 C.F.R. § 404.968. The Appeals Council may deny review, remand, or issue a decision.
• Federal Court (U.S. District Court): If the Appeals Council denies review or issues an unfavorable decision, you generally have 60 days to file a civil action in federal district court under Section 205(g) of the Social Security Act, 42 U.S.C. § 405(g). This is a lawsuit challenging the final decision of the Commissioner.

These are federal deadlines that apply to claimants in California and every other state. Each notice from SSA should explain the next step and the exact filing deadline.

Evidence Standards and Submissions

• Medical evidence requirements: A medically determinable impairment must be established by objective medical evidence from acceptable medical sources. See 20 C.F.R. §§ 404.1502 (definitions), 404.1513.
• Duty to submit evidence: You should submit all evidence known to you that relates to whether you are disabled. See 20 C.F.R. § 404.1512. At the hearing, comply with the five-day rule or explain good cause if late. See 20 C.F.R. § 404.935.
• Symptom evaluation: SSA evaluates intensity, persistence, and functional effects of symptoms consistent with the evidence. See 20 C.F.R. § 404.1529.

Representation and Fees

You may appoint an attorney or qualified representative to assist you at any stage. Representatives’ fees must be approved by SSA and are generally subject to a fee agreement or fee petition process. See 20 C.F.R. § 404.1720 (fees) and §§ 404.1705–404.1717 (representation). In California, if you seek legal advice or representation as an attorney-at-law regarding your claim, the lawyer must be licensed by the State Bar of California to practice law in California courts and to provide legal services within the state. Non-attorney representatives may also represent claimants before SSA if they meet federal eligibility requirements under 20 C.F.R. § 404.1705.

Offsets and Coordination with Other Benefits

Receipt of certain public disability benefits (including state workers’ compensation) may reduce SSDI under federal offset rules. See 42 U.S.C. § 424a and 20 C.F.R. § 404.408. California’s state disability insurance (SDI) program is separate; it generally does not impose the same offset as workers’ compensation, but you should disclose all benefits to SSA to ensure accurate calculations.

Steps to Take After an SSDI Denial

1) Read Your Denial Notice Carefully

Your notice will explain why SSA denied your claim and the deadline to appeal. Common reasons include insufficient medical evidence, work at SGA levels, or findings that you can do other work. Identify the stated reasons to tailor your appeal.

2) Calendar Your Deadline and File the Appeal Promptly

At each appeal level, the general deadline is 60 days from receipt of the notice (plus a 5-day mailing presumption). See 20 C.F.R. §§ 404.909, 404.933, 404.968. You can file online or with your local SSA office. Missing a deadline can cause dismissal, though SSA may excuse late filing for “good cause” in limited circumstances. See 20 C.F.R. § 404.911.

3) Close Evidence Gaps

Request and submit up-to-date records from all providers. Californians often receive care in multiple systems (for example, Kaiser, county systems, UC health systems, VA facilities). Make sure to include diagnostic imaging, specialized testing, emergency visits, and detailed treatment notes. Ask treating providers for functional assessments that address work-related limitations (sitting, standing, lifting, concentration, attendance, need for breaks, and reliability).

4) Address Work Activity and Functional Limits

If you attempted to work but could not sustain the job, explain why (e.g., symptom flare-ups, need for unscheduled breaks, excessive absences). If you stopped working, specify the date, why you stopped, and how your symptoms interfered. If you are working below SGA or in a sheltered or accommodated role, clarify those details. See 20 C.F.R. §§ 404.1571–404.1573.

5) Prepare for Reconsideration and the Hearing

Reconsideration is a fresh review by a new adjudicator. If denied again, request a hearing before an Administrative Law Judge (ALJ). Hearings may be in-person, by video, or by telephone. Before the hearing, comply with the five-day evidence rule (20 C.F.R. § 404.935) and consider submitting a pre-hearing brief that outlines the relevant Listings, RFC limitations, and vocational factors.

6) Anticipate Vocational Expert (VE) and Medical Evidence Issues

At hearings, ALJs often take testimony from a VE. Be ready to question job numbers or job requirements if the VE identifies occupations you cannot realistically perform. Medical evidence should directly support the functional limitations that would preclude those jobs. Cite specific examination findings, imaging, or objective tests where possible.

7) Consider Representation

While not required, experienced representatives can help identify medical gaps, obtain supportive opinions, cross-examine vocational experts, and argue how the regulations apply to your case. Under federal rules, fees are contingent and must be approved by SSA. See 20 C.F.R. § 404.1720. In California, if you want legal advice from a lawyer, the attorney should be licensed by the State Bar of California.

8) Keep SSA Informed

Promptly update SSA about changes in your address, phone number, medical treatment, medications, or work activity. Missed notices can cause missed deadlines.

9) Track Your Claim Online

Use your secure my Social Security account to view claim status and confirm that your appeal was received.

When to Seek Legal Help for SSDI Appeals

Consider consulting a representative or California-licensed attorney when:

• Your impairments involve complex medical issues (e.g., combined physical and mental conditions, rare diseases, or fluctuating conditions).
• You are approaching or have passed your date last insured (DLI), making onset evidence critical.
• Your claim depends heavily on vocational factors (age, transferable skills, or educational issues).
• You have had multiple denials and need to prepare for a hearing or Appeals Council review.
• You need help meeting deadlines, complying with the five-day rule (20 C.F.R. § 404.935), or developing medical evidence per 20 C.F.R. § 404.1512.

An experienced representative can help build the record, prepare witnesses, draft briefs, and preserve issues for possible federal court review under 42 U.S.C. § 405(g).

Local Resources & Next Steps for Californians

SSA Offices and Hearing Locations in California

California is served by SSA’s San Francisco Region (Region 9). SSA maintains numerous field offices across the state—including in major cities such as Los Angeles, San Diego, San Jose, San Francisco, Sacramento, Fresno, and Oakland—where you can file appeals and manage your claim. To verify current locations and hours, use SSA’s official locator: Find Your Local SSA Office.Hearing offices (Offices of Hearings Operations, or OHO) serving California claimants include multiple sites across the state. For current hearing office information, visit SSA’s appeals hub: SSA Disability Appeals Overview. You can request that the ALJ hearing be held by telephone or video, subject to SSA procedures.### How California Programs Interact with SSDI

• California State Disability Insurance (SDI): SDI is a state-run, short-term wage replacement program administered by EDD; it is distinct from SSDI. An SDI decision does not bind SSA. See 20 C.F.R. § 404.1504.
• Workers’ Compensation: If you receive California workers’ compensation, SSDI may be reduced due to the federal public disability benefit offset. See 42 U.S.C. § 424a; 20 C.F.R. § 404.408.

Practical Tips for California Claimants

• Consolidate care records: Californians often treat in large health systems (county hospitals, UC medical centers, integrated HMOs). Keep a list of all facilities and request complete records.
• Document functional limits: Ask providers for detailed functional assessments and keep a symptom diary tracking the frequency, duration, and severity of limitations that affect work capacity.
• Be proactive about deadlines: Use calendar alerts for every appeal stage (60-day windows). When needed, request extensions with a written good cause explanation (20 C.F.R. § 404.911).
• Prepare for testimony: Practice describing your typical day, need for breaks, absenteeism, and the real-world impact of your symptoms.

Detailed Overview of the Four Appeal Levels

1) Reconsideration (Initial Review of the Denial)

What it is: A new adjudicator reviews your file and any new evidence. You typically have 60 days to request reconsideration. See 20 C.F.R. § 404.909.

How to strengthen your case: Submit updated medical records, specialist opinions, and clarify any misunderstood facts (e.g., your job ended due to your impairments, not performance). If you have new diagnoses or objective findings, submit them promptly.

2) Hearing Before an ALJ

What it is: A de novo hearing with an Administrative Law Judge. You generally have 60 days to request the hearing after a reconsideration denial. See 20 C.F.R. § 404.933.

How to strengthen your case: Provide a pre-hearing brief that maps your evidence to the five-step framework and, if applicable, to any Listing. Comply with the five-day evidence rule (20 C.F.R. § 404.935) or explain good cause. Prepare to question vocational evidence and ensure your treating source opinions are well-supported by objective findings.

3) Appeals Council Review

What it is: A review of the ALJ decision for legal error, abuse of discretion, unsupported findings, or new and material evidence. You generally have 60 days to request review. See 20 C.F.R. § 404.968.

How to strengthen your case: Identify specific errors (e.g., improper symptom evaluation under 20 C.F.R. § 404.1529, failure to consider all impairments in combination, or mischaracterization of medical evidence). If you submit new evidence, explain why it is new, material, and why you could not submit it earlier.

4) Federal Court (U.S. District Court)

What it is: A judicial review of the final decision under 42 U.S.C. § 405(g). The court evaluates whether the Commissioner’s decision is supported by substantial evidence and based on proper legal standards.

How to strengthen your case: Federal court litigation is technical—briefing focuses on legal error and substantial evidence standards. Consider retaining a California-licensed attorney experienced in Social Security litigation.

Frequently Asked Questions for California Claimants

How long do I have to appeal my SSDI denial?

Generally, 60 days from receipt (with a five-day mailing presumption). See 20 C.F.R. §§ 404.909, 404.933, 404.968. The deadline to file a federal court action is also generally 60 days after the Appeals Council’s final action. See 42 U.S.C. § 405(g). Good cause may excuse late filing in limited situations. See 20 C.F.R. § 404.911.

Do I need a lawyer?

No, but many claimants benefit from representation. Fees must be approved by SSA and are generally contingent. See 20 C.F.R. § 404.1720. If you seek legal advice in California, consult a lawyer licensed by the State Bar of California.

Will California SDI or workers’ compensation affect my SSDI?

SSA is not bound by California SDI or workers’ compensation determinations. See 20 C.F.R. § 404.1504. Certain public disability benefits, including workers’ compensation, can reduce SSDI under federal offset rules. See 20 C.F.R. § 404.408; 42 U.S.C. § 424a.

What if I cannot obtain all my records in time?

Submit what you can and notify SSA of outstanding evidence. At the hearing level, if you miss the five-day deadline, explain good cause under 20 C.F.R. § 404.935 (e.g., unexpected events, delayed records despite diligent efforts).

What if I moved within California?

Update your address with SSA immediately so you receive all notices. Your hearing office assignment may change depending on your new location.

How to File and Track Your Appeal from California

Use SSA’s online appeal portal or visit a local office: Start at the official SSA appeals page: SSA Disability Appeals Overview. You can also visit your local office (verify location and hours via the SSA Office Locator).- Gather medical and vocational evidence: Include records, test results, provider opinions, work histories, and third-party statements. Be precise and consistent.

• File the appeal within 60 days: Preserve your rights at each stage: reconsideration (20 C.F.R. § 404.909), hearing (20 C.F.R. § 404.933), and Appeals Council (20 C.F.R. § 404.968).
• Prepare for the hearing: Comply with 20 C.F.R. § 404.935 and be ready to explain functional limitations that prevent sustained work. Consider a written pre-hearing brief.
• Escalate if needed: If the Appeals Council denies relief, discuss federal court options under 42 U.S.C. § 405(g) with a qualified representative or California-licensed attorney.

Avoiding Common Pitfalls

• Missing deadlines: Put every deadline on your calendar and submit appeals early. If late, explain good cause. See 20 C.F.R. § 404.911.
• Relying on diagnoses alone: SSA evaluates function. Connect symptoms to specific work-related limitations with objective support. See 20 C.F.R. § 404.1529 and § 404.1545.
• Underestimating vocational evidence: Be prepared to address transferable skills, exertional levels, non-exertional limitations, and job numbers.
• Not disclosing other benefits: Report California SDI or workers’ compensation to avoid overpayments and to address potential offsets (20 C.F.R. § 404.408).
• Submitting late evidence without explanation: Use the five-day rule (20 C.F.R. § 404.935) and explain good cause if necessary.

Where to Get Authoritative Information

SSA: How to Appeal a Decision (official overview of the appeal process from SSA)20 C.F.R. § 404.909 (reconsideration rules and deadlines)20 C.F.R. § 404.933 (requesting a hearing before an ALJ)SSA Office Locator (find your local California SSA office)

California Licensing, Representation, and Ethical Considerations

Legal advice about California law should be provided by a California-licensed attorney. If you hire an attorney to represent you in your SSDI matter and to provide legal services within California, confirm that the lawyer is in good standing with the State Bar of California. For representation before SSA specifically, both attorneys and qualified non-attorney representatives may appear, but all representatives are subject to SSA’s rules, including fee approval. See 20 C.F.R. §§ 404.1705–404.1720.

Bottom Line for California Claimants

If your SSDI claim has been denied in California, act quickly, build the strongest medical and vocational record possible, and consider professional assistance. The federal appeal framework gives you multiple opportunities to correct errors, submit additional evidence, and obtain a fair decision. Meeting deadlines, complying with evidence rules, and tying objective medical findings to functional limitations are the keys to success.

Disclaimer: This guide is for informational purposes only and does not constitute legal advice. Laws and regulations change. Consult a licensed California attorney for legal advice about 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.