What happens when Social Security denies your SSDI claim
When Social Security denies your SSDI claim, you do not lose the right to challenge that decision. You have four separate chances to appeal, and each one follows a specific process with its own timeline and requirements. The first appeal is called reconsideration, and it is a complete re-review of your case by someone who did not make the original decision.
You must request reconsideration within 60 days of the date on your denial letter. Social Security counts this important date strictly — if your request arrives on day 61, it will be rejected. The 60 days starts from the date printed on the letter itself, not the date you received it. If you miss this window, you can ask Social Security to reopen your case for "good cause" — meaning you have a legitimate reason you could not meet the important date — but this is harder to win than a standard appeal.
During reconsideration, Social Security will review your medical records, work history, and any new evidence you submit. They may order a new medical exam. This stage takes roughly 3 to 6 months. If Social Security denies you again, you move to the next level: a hearing before an Administrative Law Judge (ALJ).
Key Takeaways
- You have 60 days from your denial letter to request reconsideration, the first appeal level, and this important date is strictly enforced.
- If reconsideration is denied, you can request a hearing before an Administrative Law Judge, which is where most people win their appeals.
- You can represent yourself at an ALJ hearing, but many people hire a lawyer or non-lawyer representative who works on contingency and takes a percentage of back pay only if you win.
- After an ALJ denies you, you can appeal to the Appeals Council, and then to federal court, though federal court review is limited to whether Social Security followed the law correctly.
- At every stage, you can submit new medical evidence, work records, or statements from doctors and people who know your condition.
Reconsideration: the first appeal level
To request reconsideration, you must file Form SSA-561-U2 (Request for Reconsideration) with your local Social Security office, by mail, or online through your my Social Security account. You can also call Social Security at 1-800-772-1213 and ask them to start the reconsideration process for you. When you request reconsideration, tell Social Security about any new medical evidence you have — recent test results, updated doctor's statements, or records from a specialist you have seen since you first applied.
Social Security will send you a notice telling you they received your request. During reconsideration, a different claims examiner will review your entire file. They may order a new Consultative Examination (CE) — a medical exam paid for by Social Security — to update your medical record. You will receive notice of this exam and the date, and you should attend. If you cannot attend, call Social Security when ready to reschedule.
Reconsideration takes 3 to 6 months on average, though it can take longer if Social Security orders a medical exam or if your case is complex. You will receive a written decision. If Social Security approves you, your benefits begin and you receive back pay to the date you first applied. If they deny you again, you have 60 days to request a hearing before an ALJ.
Requesting a hearing before an Administrative Law Judge
If reconsideration is denied, you can request a hearing before an Administrative Law Judge by filing Form SSA-561-U5 (Request for Hearing by Administrative Law Judge) within 60 days of your reconsideration denial letter. You can file this form at your local Social Security office, by mail, or through your my Social Security account. This is the stage where most people who eventually win their cases succeed.
An ALJ is an independent decision-maker who works for the Social Security Administration but is not part of the team that denied you. The ALJ will hold a hearing, usually by video or phone, where you can present your case. You can bring witnesses — a family member, a friend, a doctor, or anyone else who knows your medical condition or how it affects your ability to work. You can also submit written statements from your doctors or other medical providers.
You have the right to have a representative at your hearing. This can be a lawyer, a non-lawyer representative (called an "accredited representative"), or a family member or friend. Many representatives work on contingency, meaning they take a fee only if you win. The fee is limited by law to 25 percent of your back pay, or $7,200, whichever is less. If you cannot afford a representative, you can represent yourself, and the ALJ will explain the process.
The wait for a hearing varies widely by location — from a few months to over a year in some areas. Social Security will send you a notice with the hearing date, time, and location (or instructions for joining by video or phone). You should prepare by gathering all your medical records, writing down the dates you saw doctors, and thinking through how your condition affects your daily life and your ability to work.
What to expect at your ALJ hearing
An ALJ hearing is less formal than a court trial, but it follows a structure. The ALJ will ask you questions about your medical condition, your symptoms, your daily activities, your work history, and how your condition prevents you from working. Answer honestly and in detail — do not minimize your symptoms or your limitations. The ALJ needs to understand how your condition actually affects you.
If you brought witnesses, they will also answer questions. The ALJ may ask a Vocational informed (VE) — a specialist in job requirements — whether someone with your age, education, and limitations could perform any work in the economy. Your representative, if you have one, can cross-examine the VE and challenge their conclusions.
After the hearing, the ALJ will issue a written decision, usually within 2 to 4 months. The decision will explain the ALJ's findings about your medical condition, your credibility, and whether you meet the legal standard for disability. If the ALJ approves you, you receive back pay to the date you first applied (or the date your disability began, if that is later). If the ALJ denies you, you have 60 days to appeal to the Appeals Council.
Appeals Council and federal court review
If an ALJ denies you, you can request review by the Appeals Council by filing Form SSA-561-U6 (Request for Review of Hearing Decision/Order) within 60 days of the ALJ's decision. The Appeals Council is a panel within Social Security that reviews ALJ decisions for legal errors or new evidence. They do not hold a hearing; they review the written record.
The Appeals Council will approve your request for review only if you show that the ALJ made a legal error, that new evidence exists that could change the outcome, or that the ALJ's decision does not follow Social Security's own rules. This is a higher bar than the ALJ hearing. The Appeals Council takes 3 to 6 months to decide, and they may deny your request for review without issuing a new decision.
If the Appeals Council denies you or refuses to review the ALJ's decision, you can file a lawsuit in federal district court within 60 days. Federal court review is limited: the judge can only decide whether Social Security followed the law and whether the decision is supported by evidence in the record. The judge cannot order Social Security to approve you; they can only send the case back to Social Security for reconsideration. Federal court cases take 1 to 3 years.
Submitting medical evidence at each stage
At every appeal level, you can submit new medical evidence. This includes recent test results, imaging reports, lab work, updated statements from your doctors, records from specialists you have seen, and statements from people who know your condition. Do not wait until the hearing to submit evidence — send it as soon as you have it, so the decision-maker has time to review it.
When you submit medical evidence, include a cover letter explaining what the evidence shows and why it is important to your case. For example: "This MRI from Dr. Smith shows the herniated disc that causes my chronic pain and limits my ability to sit for more than 30 minutes." Be specific about how the medical findings connect to your inability to work.
If your doctor will not provide written statements, ask them to complete a Residual Functional Capacity (RFC) form — a questionnaire that asks about your physical and mental limitations. Social Security has forms for this, or your doctor may have their own. An RFC form from your treating doctor carries significant weight with decision-makers because it comes from someone who knows you and your condition over time.
Hiring a representative and understanding fees
You can hire a lawyer or accredited representative at any stage of your appeal, but most people wait until after reconsideration is denied and they are preparing for the ALJ hearing. Representatives who handle SSDI cases typically work on contingency: they take a fee only if you win, and the fee comes from your back pay, not from your pocket.
By law, a representative's fee cannot exceed 25 percent of your back pay or $7,200, whichever is less. Before you hire someone, ask them to explain their fee structure in writing. Some representatives charge a flat fee; others charge a percentage. Make sure you understand what you are agreeing to.
You can find representatives through the National Organization of Social Security Claimants' Representatives (NOSSCR), your state bar association, or legal aid organizations in your area. Legal aid may represent you for free if your income is low. Before you hire anyone, check whether they are authorized to represent you — Social Security maintains a list of accredited representatives on their website.
Timeline and what to do while you wait
| Appeal Stage | important date to Request | Average Wait Time |
|---|---|---|
| Reconsideration | 60 days from denial letter | 3 to 6 months |
| ALJ Hearing | 60 days from reconsideration denial | 3 months to 2 years (varies by location) |
| Appeals Council | 60 days from ALJ decision | 3 to 6 months |
| Federal Court | 60 days from Appeals Council decision | 1 to 3 years |
While you are waiting for your appeal decision, keep seeing your doctors and keep records of all appointments, medications, and treatments. Continue to document how your condition affects your daily life — what you can and cannot do, how pain or symptoms limit you, and any changes in your condition. This documentation becomes evidence if your case goes to a hearing.
If your financial situation is urgent, ask Social Security whether you may be may have access to to Supplemental Security Income (SSI) while your SSDI appeal is pending. SSI is a needs-based program for people with low income and resources, and you can receive SSI while your SSDI case is being decided. You can also ask about expedited review if your health has worsened significantly since your denial.
Frequently Asked Questions
What if I miss the 60-day important date to appeal?
You can still appeal if you have "good cause" — a legitimate reason you could not meet the important date. Good cause includes serious illness, lack of understanding of the important date, or relying on incorrect information. You must explain your reason in writing and submit it to Social Security. Good cause is evaluated case by case, and it is harder to win than a standard appeal, so do not count on it.
Can I work while my appeal is pending?
Yes. Working does not hurt your appeal, but your earnings may affect whether you receive benefits. If you earn more than the current Substantial Gainful Activity (SGA) limit — which changes each year — Social Security may conclude you can work and deny your case. Keep your representative informed about any work you do, and ask them how it might affect your case.
Do I have to attend my ALJ hearing in person?
No. Most ALJ hearings are now held by video or phone. Social Security will tell you the format when they send your hearing notice. If you need to appear in person for a specific reason, you can request it, but Social Security may deny the request. Video and phone hearings are just as valid as in-person hearings.
What happens if I win at the ALJ hearing?
If the ALJ approves you, you receive back pay from the date you first applied (or the date your disability began, if that is later), minus any representative fee. Your benefits begin the month after the ALJ's decision becomes final. You will receive a notice explaining your benefit amount and your first payment date.
Can I appeal if Social Security approves me at reconsideration?
No. If Social Security approves your claim at any stage, the appeal process ends and your benefits begin. You cannot appeal an approval. However, if you disagree with your benefit amount or your start date, you can contact Social Security to discuss those issues.