SSDI Payments: Denial Appeal Guide for Colorado, Colorado

SSDI Denial and Appeal Guide for Colorado, Colorado

Receiving a denial on a Social Security Disability Insurance (SSDI) claim can be discouraging, but it is not the end of the process. For residents of Colorado, Colorado, federal law provides a structured appeals system with strict deadlines and clear rights for claimants. This guide explains what a denial means, why it happens, how the appeals process works, and what practical steps you can take right now to protect your claim. While this article slightly favors protecting the rights of disability claimants, it stays closely grounded in authoritative rules and procedures from the Social Security Administration (SSA), the Code of Federal Regulations (CFR), and the Social Security Act.

Colorado residents—whether you live in Denver, Colorado Springs, Aurora, Fort Collins, Pueblo, Grand Junction, or anywhere in between—typically interact with the SSA through local field offices for initial filings and reconsiderations, and through hearing offices for Administrative Law Judge (ALJ) hearings. You can locate the correct office for your ZIP code using the SSA’s official Office Locator (linked below). Appeals are largely federal and standardized across states, but local logistics, such as where you submit documents in person or where a hearing may be scheduled, will depend on the Colorado office that serves your county.

Importantly, you have a right to appeal within specific time limits following most SSDI denials. Missing a deadline can force you to start over or risk losing benefits, including potential back pay. The SSA has published regulations that define every stage of the process—reconsideration, ALJ hearing, Appeals Council review, and federal court review—and the Social Security Act guarantees due process in these proceedings. With the right documentation and timely action, many claimants successfully overturn denials on appeal. This guide will help you take the next steps, understand the rules that govern your case, and find legitimate resources in Colorado to move your appeal forward.

Understanding Your SSDI Rights

What SSDI is and who qualifies

SSDI is a federal insurance program for workers who have paid Social Security payroll taxes and who become unable to engage in substantial gainful activity (SGA) due to a medically determinable impairment expected to last at least 12 months or result in death. The foundational statutory definitions appear in section 223 of the Social Security Act (42 U.S.C. § 423), and the SSA’s five-step sequential evaluation process for disability is codified in the regulations (see 20 C.F.R. § 404.1520 for adult claims). In short, to qualify you must:

• Be insured for SSDI based on your work history and earnings.
• Have a severe medically determinable impairment or combination of impairments.
• Meet or equal a listed impairment, or show that your residual functional capacity prevents you from doing past work and any other work that exists in significant numbers in the national economy.
• Not be engaging in SGA as defined by SSA regulations (see 20 C.F.R. §§ 404.1571–404.1576).

Your duty to submit evidence and cooperate

Claimants carry a duty to submit all evidence known to them that relates to whether or not they are disabled, and to cooperate with the SSA’s requests (20 C.F.R. § 404.1512). This includes medical records from all treating providers, diagnostic test results, imaging, functional assessments, and statements from employers or caregivers if relevant. The SSA may also request that you attend a consultative examination if the existing medical evidence is insufficient (20 C.F.R. §§ 404.1517–404.1519t). Failure to cooperate or attend examinations can lead to denials.

Core appeal rights

Federal law requires the SSA to provide notice and an opportunity for a hearing on adverse determinations (Social Security Act § 205(b), 42 U.S.C. § 405(b)). SSA regulations establish a four-level administrative and judicial review framework: reconsideration, ALJ hearing, Appeals Council review, and finally federal district court review (20 C.F.R. § 404.900(a)). In most situations, you have 60 days from the date you receive a notice of determination or decision to file the next appeal step. The SSA presumes you receive the notice 5 days after the date on the notice unless you show you did not receive it within that time (20 C.F.R. § 404.901).

Common Reasons SSA Denies SSDI Claims

Insufficient medical evidence

One of the most frequent reasons for denial is a lack of objective medical documentation to substantiate the severity, duration, or functional impact of the impairment(s). SSA decision-makers rely on medical signs, laboratory findings, and longitudinal treatment records to assess whether your condition meets or equals a Listing or otherwise prevents gainful work (20 C.F.R. § 404.1520; 20 C.F.R. § 404.1513). If your records are sparse, outdated, or inconsistent, you are at higher risk of a denial.

Earnings above Substantial Gainful Activity (SGA)

If you are working and your earnings average above SGA thresholds defined by regulation and adjusted administratively, SSA may find you are not disabled regardless of medical conditions (see 20 C.F.R. §§ 404.1571–404.1576). Some unsuccessful work attempts and sheltered work may be evaluated differently, but earnings at or above SGA typically preclude entitlement.

Failure to follow prescribed treatment

Generally, if an impairment can be effectively controlled with treatment that your medical provider prescribes and you fail, without good cause, to follow that treatment, SSA can deny the claim based on failure to follow prescribed treatment (see 20 C.F.R. § 404.1530). Good cause exceptions may apply depending on the facts.

Duration requirement not met

SSDI requires that the impairment is expected to last at least 12 months or result in death (42 U.S.C. § 423(d)(1)(A)). Claims may be denied if SSA determines the impairment is not severe enough or not expected to meet the duration requirement.

Not enough work credits or coverage

SSDI is based on insured status. If you do not have enough recent work credits, or your date last insured passed before disability began, SSA will deny your SSDI claim. This is distinct from Supplemental Security Income (SSI), which is means-tested and not insured-status dependent.

Missed appointments or deadlines

Not attending a consultative examination or missing a deadline to appeal can lead to denial or dismissal. Because appeals deadlines are short, it is critical to track your mail, keep copies of everything, and confirm submissions.

Federal Legal Protections & Regulations

Core appeals framework

SSA’s appeals process is governed primarily by Subpart J of Part 404 in Title 20 of the Code of Federal Regulations. The regulation at 20 C.F.R. § 404.900(a) outlines the four levels of review. Specific rules and deadlines include:

• Reconsideration: 20 C.F.R. § 404.909 sets the procedures and time limits for requesting reconsideration (generally 60 days from receipt).
• ALJ Hearing: 20 C.F.R. § 404.933 governs requests for a hearing before an Administrative Law Judge (generally 60 days from receipt of the reconsideration determination).
• Appeals Council Review: 20 C.F.R. § 404.968 addresses how to request Appeals Council review (generally 60 days from receipt of the ALJ decision).
• Judicial Review: Judicial review is authorized by section 205(g) of the Social Security Act (42 U.S.C. § 405(g)); regulations regarding civil actions appear at 20 C.F.R. § 422.210. The deadline is generally 60 days from receipt of the Appeals Council’s denial or decision.

The rule defining when a claimant is presumed to have received SSA notices is at 20 C.F.R. § 404.901 (5-day presumption), which matters for calculating deadlines. Claimants can request extensions of time if they have good cause for missing a deadline, as described in 20 C.F.R. §§ 404.909(b), 404.933(c), and 404.968(b).

Evidence submission and hearing procedures

When preparing for a hearing with an ALJ, claimants must inform the ALJ about or submit written evidence at least 5 business days before the hearing (with specified exceptions for late submission) per 20 C.F.R. § 404.935. The ALJ will evaluate the case under the five-step sequential evaluation process (20 C.F.R. § 404.1520) using all relevant medical and vocational evidence, including treating source opinions and vocational expert testimony, where applicable. The claimant’s duty to submit all evidence known to them that relates to disability is reiterated in 20 C.F.R. § 404.1512.

Right to representation and fee control

Claimants are entitled to representation at all stages (20 C.F.R. § 404.1705). Representatives’ fees must be approved by SSA and are subject to the fee agreement or fee petition process (20 C.F.R. § 404.1720 et seq.). SSA’s fee-approval system is designed to protect claimants by ensuring that fees are reasonable and tied to results, particularly when the representative obtains past-due benefits.

Due process and the Social Security Act

The Social Security Act requires the SSA to provide notice and an opportunity to be heard before adverse decisions (42 U.S.C. § 405(b)), and grants claimants the right to seek judicial review after exhausting administrative remedies (42 U.S.C. § 405(g)). These protections apply equally to claimants in Colorado, Colorado.

Steps to Take After an SSDI Denial

1) Read the denial letter carefully

Your denial notice explains the reason(s) for the decision and the next deadline. It may cite insufficient evidence, work activity at SGA levels, a conclusion that you can perform other work, or other issues. Note the date on the letter and calculate your appeal deadline using the 5-day receipt presumption in 20 C.F.R. § 404.901.

2) File a reconsideration within 60 days

If your initial SSDI claim is denied, you can request reconsideration generally within 60 days of when you receive the denial (20 C.F.R. § 404.909). You can submit this online through SSA’s iAppeal portal or by filing Form SSA-561 and related forms (Disability Report – Appeal, and medical releases). Reconsideration involves a new review by an examiner who was not involved in the initial decision.

• Tip: Add any new or missing medical records from Colorado providers and provide a detailed report on any worsening conditions or new diagnoses since your initial application.

3) Request a hearing with an Administrative Law Judge (ALJ)

If reconsideration is denied, you can request an ALJ hearing within 60 days of receipt of the reconsideration decision (20 C.F.R. § 404.933). Hearings are typically conducted in person, by video, or occasionally by telephone. Before the hearing, you must submit or identify all evidence you want considered at least 5 business days in advance unless an exception applies (20 C.F.R. § 404.935).

• Prepare a clear timeline of symptoms, treatment, and functional limitations aligned with Colorado medical records.
• Ask treating providers for functional assessments explaining specific work-related limitations (e.g., sitting, standing, lifting, attendance, pace).
• Be ready to explain gaps in care, financial barriers, or other good-cause reasons for missed treatment.

4) Seek Appeals Council review

If the ALJ denies your claim, you may request review by the Appeals Council within 60 days (20 C.F.R. § 404.968). The Appeals Council may grant review, deny review (making the ALJ decision final), or remand the case back to an ALJ. Arguments here often focus on legal errors, significant evidentiary omissions, or new and material evidence that relates to the period on or before the ALJ decision and shows a reasonable probability of changing the outcome.

5) File a federal court case if necessary

If the Appeals Council denies review or affirms the ALJ, you generally have 60 days to file a civil action in the United States District Court (42 U.S.C. § 405(g); 20 C.F.R. § 422.210). For claimants in Colorado, this case would ordinarily be filed in the U.S. District Court for the District of Colorado. This stage is a review of the administrative record; new evidence is generally not admissible. The court can affirm, reverse, or remand the case back to SSA for further proceedings if legal error occurred or the findings are not supported by substantial evidence.

When to Seek Legal Help for SSDI Appeals

Why representation can help

SSDI appeals involve strict procedural rules, evolving medical-vocational guidance, and detailed evidence requirements. An experienced representative can ensure deadlines are met; that evidence is complete, relevant, and timely; and that arguments are framed to match the SSA’s five-step evaluation and vocational grids. Representatives can cross-examine vocational or medical experts at the hearing and identify legal errors for Appeals Council or federal court review. SSA permits both attorney and certain qualified non-attorney representatives to appear on your behalf (20 C.F.R. § 404.1705). Fees must be approved by SSA and are regulated under 20 C.F.R. § 404.1720 et seq.

Colorado-specific licensing context

If you choose an attorney, practicing law in Colorado generally requires a Colorado law license issued under the authority of the Colorado Supreme Court. For federal court litigation in an SSDI case, your attorney must be admitted to practice before the U.S. District Court for the District of Colorado. If your representative is a non-attorney approved by SSA, they can represent you at the administrative levels but cannot practice law in Colorado courts unless authorized. Always confirm your representative’s status and scope of services.

Local Resources & Next Steps in Colorado, Colorado

Finding your local SSA office in Colorado

Colorado residents can locate their nearest SSA field office using the SSA’s official Office Locator by ZIP code. This tool will provide the correct office for filing, in-person questions, or document submission. Many services can also be handled online, including appeals through SSA’s iAppeal portal.

Use the SSA Office Locator: Find Your Local SSA Office

Hearings and Appeals information

ALJ hearings for Colorado claimants are scheduled by the SSA’s Office of Hearings Operations (OHO). Hearings may be in person, by video, or by telephone. The SSA’s centralized hearings and appeals page explains procedures, representative appearance, and what to expect.

SSA’s Appeals Overview: How the SSDI Appeals Process WorksHearings and Appeals: SSA Hearings and Appeals

Key federal rules and where to read them

For in-depth, authoritative rules that govern SSDI appeals, you can consult the Code of Federal Regulations. Subpart J of Part 404 covers administrative review and appeals steps, including reconsideration, hearings, and Appeals Council review. The 5-day evidence submission rule for hearings is in § 404.935.

eCFR for SSDI Appeals: 20 C.F.R. Part 404, Subpart J

Colorado federal court filing (if needed)

If your appeal reaches the federal court stage, you will file in the United States District Court for the District of Colorado. Attorneys must be admitted to this court to represent you in that proceeding.

Attorney Admission, District of Colorado: U.S. District Court for the District of Colorado – Attorney Admission

Practical Timeline and Deadlines

While each case is unique, the appeals structure is consistent. Keep these general deadlines in mind (confirm the date on your own decision notices):

• Reconsideration: 60 days from receipt of the initial denial (20 C.F.R. § 404.909). Receipt is presumed 5 days after the notice date unless you prove otherwise (20 C.F.R. § 404.901).
• ALJ Hearing: 60 days from receipt of the reconsideration denial (20 C.F.R. § 404.933).
• Appeals Council: 60 days from receipt of the ALJ decision (20 C.F.R. § 404.968).
• Federal Court: 60 days from receipt of the Appeals Council’s final action (42 U.S.C. § 405(g); 20 C.F.R. § 422.210).

If you need more time, you may request extensions for good cause, but do not rely on extensions unless absolutely necessary and well-supported (see 20 C.F.R. §§ 404.909(b), 404.933(c), 404.968(b)).

Building a Strong Colorado SSDI Appeal

Collect complete, Colorado-based medical evidence

Ask every Colorado provider who has treated you for records covering the entire period of alleged disability. Include:

• Office visit notes showing symptoms, diagnoses, and response to treatment.
• Diagnostic testing (MRI, CT, bloodwork, EMG).
• Hospitalizations, ER visits, surgeries, and therapy notes (physical, occupational, mental health).
• Functionality assessments from treating providers that describe specific work-related limitations.

Be sure to promptly upload or deliver evidence to SSA, keeping the § 404.935 hearing evidence deadline in mind if you are at the hearing stage.

Demonstrate consistency and credibility

Decision-makers look for consistency between your testimony, your daily activities, and the medical record. If you have good-cause reasons for gaps in medical care (e.g., financial barriers), document them. If you made attempts to work that failed, explain why they were unsuccessful and provide evidence so SSA can evaluate whether they were unsuccessful work attempts rather than SGA (see 20 C.F.R. §§ 404.1571–404.1576).

Address vocational issues early

For claimants over certain ages, medical-vocational rules (the "grids") can be outcome-determinative. Even when the grids do not direct a finding of disabled, vocational evidence about the erosion of the occupational base due to non-exertional limitations can be persuasive. Prepare to question vocational expert testimony at the hearing and submit third-party statements where relevant.

Frequently Asked Questions for Colorado, Colorado Claimants

Do I need a Colorado-based representative?

You may choose any qualified representative permitted by SSA (20 C.F.R. § 404.1705). Local familiarity can help with medical evidence gathering and hearing logistics. If your case goes to federal court, your attorney must be admitted to practice in the U.S. District Court for the District of Colorado.

Can I submit new evidence after the ALJ decision?

Yes, but it is limited at the Appeals Council stage. New evidence must be material, relate to the period on or before the ALJ’s decision, and show a reasonable probability of changing the outcome. If accepted, the Appeals Council will consider it or remand. Otherwise, the Council may deny review.

What if I miss a deadline?

Request an extension as soon as possible and explain your good cause. SSA may grant extensions, but they are not guaranteed (e.g., 20 C.F.R. §§ 404.909(b), 404.933(c), 404.968(b)). If your appeal is dismissed, you may need to file a new application and could lose potential back benefits.

How long will the process take?

Processing times vary and are not guaranteed. While SSA publishes general information about workloads, each case’s timeline depends on multiple factors including evidence volume and hearing scheduling. Focus on meeting deadlines and submitting complete records to avoid preventable delays.

How to Use Colorado Resources Without Losing Time

Local SSA office logistics

Each Colorado county is served by a designated SSA field office for initial claims and reconsiderations. Use the Office Locator to confirm your office and operating hours. If you prefer in-person assistance, call ahead to verify what documents to bring and whether appointments are required. For many tasks—including filing reconsiderations and uploading evidence—online options can be faster.

Coordinating with Colorado medical providers

Ask providers about their record request process and timelines. Some providers prefer HIPAA releases; others work with the SSA’s forms. Keep a checklist of every Colorado clinic, hospital, or specialist you have seen and confirm that SSA has received records from all of them. If cost is a barrier, note that SSA can order consultative exams when necessary (20 C.F.R. §§ 404.1517–404.1519t), but it’s best to submit treating-source records whenever possible.

Tracking your case status

Create or use your my Social Security account to track appeal status, upload documents, and confirm SSA has your current address. Retain time-stamped receipts for all online or mailed submissions and keep a personal calendar of every deadline derived from the dates on SSA notices.

Checklist: Responding to an SSDI Denial in Colorado, Colorado

• Note the date on your denial notice; calculate the 60-day deadline using the 5-day receipt presumption (20 C.F.R. § 404.901).
• Start your reconsideration or next-level appeal immediately; use SSA’s iAppeal when available.
• Request and submit complete medical records from all Colorado providers, and provide functional opinions where possible.
• If heading to a hearing, calendar the 5-day evidence deadline (20 C.F.R. § 404.935) and prepare testimony.
• Consider retaining a qualified representative; confirm fee procedures under 20 C.F.R. § 404.1720.
• If the Appeals Council denies review, consult counsel about filing in the U.S. District Court for the District of Colorado within 60 days (42 U.S.C. § 405(g)).

Key Terms

• SGA (Substantial Gainful Activity): Work activity and earnings level used to determine if a claimant is working at a disqualifying level (20 C.F.R. §§ 404.1571–404.1576).
• ALJ (Administrative Law Judge): The impartial judge who conducts your hearing and issues a decision.
• Appeals Council: The SSA body that reviews ALJ decisions for legal and procedural errors, among other issues (20 C.F.R. § 404.967 et seq.).
• Residual Functional Capacity (RFC): The most you can do despite your impairments, used at steps four and five of the sequential evaluation (20 C.F.R. § 404.1545).

SEO Notes for Claimants

If you are searching online for help, this phrase may help you find resources relevant to where you live: SSDI denial appeal colorado colorado. You can also explore terms like social security disability, colorado disability attorney, and SSDI appeals for more information about the process in Colorado.

Authoritative Resources

SSA: How the SSDI Appeals Process WorkseCFR: 20 C.F.R. Part 404, Subpart J (Administrative Review Process)SSA: Hearings and AppealsSSA Office Locator (Find Your Colorado Field Office)U.S. District Court for the District of Colorado – Attorney Admission

Disclaimer

This material is for informational purposes only and is not legal advice. Laws and regulations change, and the application of law to your situation may vary. Consult a licensed Colorado attorney about your specific circumstances.

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