Why Claims Get Denied and What That Decision Means

A denial does not mean you are not disabled. It means the Social Security Administration (SSA) found that your medical evidence did not meet the rules for SSDI or SSI at the moment they reviewed your file. The most common reasons are: your condition does not match a listed impairment closely enough, your remaining work capacity is higher than SSA calculated, your medical records lack detail or are too old, or you did not provide enough work history.

When SSA denies your claim, they send you a written decision letter that names the specific reason. That letter also tells you how long you have to request reconsideration — usually 60 calendar days from the date on the letter. If you miss that window, you lose the right to challenge that particular denial and must file a new claim instead, which restarts the clock.

Key Takeaways

  • You have 60 calendar days from your denial letter to request reconsideration, and missing this important date means you must file a new claim instead.
  • Reconsideration is a free second review by a different SSA examiner, and you should submit new medical evidence or clarifications that address the specific reason for denial.
  • If reconsideration is also denied, you can request a hearing before an Administrative Law Judge, which is where most people who eventually win their cases succeed.
  • The Appeals Council can review a hearing decision, but only if the judge made a legal or procedural error — not straightforward because you disagree with the outcome.
  • At every stage, you can represent yourself, but many people hire a disability lawyer or representative once they reach the hearing stage.

The Reconsideration Process: Your First Appeal

Reconsideration is a free, informal second look at your claim by a different examiner. You do not attend a hearing or speak to anyone in person. Instead, you submit a written request and any new information you want SSA to consider. This is your chance to address the specific reason SSA gave for the denial.

To request reconsideration, contact your local SSA field office, call 1-800-772-1213, or submit Form SSA-561-U2 (Request for Reconsideration). Include a cover letter explaining why you believe the decision was wrong and attach any new medical records, test results, or statements from your doctors that clarify your condition or its severity. If your first denial was partly based on old medical records, updated records from the past few months carry more weight.

Reconsideration typically takes 3 to 6 months. SSA will mail you a new decision letter. If you are denied again, you move to the next level: a hearing before an Administrative Law Judge (ALJ). This is where the majority of people who eventually win their cases succeed, so do not lose hope after a second denial.

Requesting a Hearing Before an Administrative Law Judge

If reconsideration is denied, you have another 60 calendar days to request a hearing. You can submit Form SSA-561-U5 (Request for Hearing by Administrative Law Judge) in person, by mail, or online through ssa.gov. At a hearing, you sit across from an ALJ who reviews your entire file, listens to your testimony, and can question your doctors or vocational experts.

A hearing is more formal than reconsideration but still less rigid than a courtroom. You can bring documents, medical records, and witnesses — including your doctor if they are willing to attend. Many people find it helpful to have a representative present, whether a lawyer, non-lawyer advocate, or family member who knows your case well. If you cannot afford a lawyer, you can still request a hearing and represent yourself; the judge will explain the process.

Hearing wait times vary by region and current caseload, typically ranging from 6 to 18 months. During this wait, continue treating with your doctors and keep detailed records of your symptoms, limitations, and any work you attempt. This documentation strengthens your case at the hearing.

Working with a Representative or Lawyer

You can hire a disability lawyer or non-lawyer representative at any stage, but many people wait until after the second denial because the hearing is where representation makes the biggest difference. A representative can gather medical evidence, prepare you for testimony, cross-examine SSA's vocational informed, and file motions on your behalf.

Disability lawyers work on contingency, meaning they take no fee unless you win. If you win, the lawyer's fee is capped by federal law at 25% of your back pay (the money owed from the date you filed to the date SSA approves you), up to a maximum of $7,200. You also pay out-of-pocket costs for medical records and informed reports, though many lawyers advance these costs and deduct them from your award.

To find a lawyer, contact your state bar association, ask your doctor for referrals, or search the National Organization of Social Security Claimants' Representatives (NOSSCR) directory. Interview at least two or three before deciding; a good representative will explain the process, be honest about your chances, and answer your questions without pressure.

The Appeals Council: When to Request Review

If the ALJ denies your case at the hearing, you can request that the Appeals Council review the decision. The Appeals Council is a panel within SSA that looks at whether the judge made a legal mistake or ignored important evidence. They do not re-weigh the medical evidence or decide whether you are disabled — they only check whether the judge followed the rules correctly.

You have 60 calendar days to file a request for Appeals Council review, using Form SSA-561-U6. Include a written explanation of what the judge got wrong and cite the specific rule or evidence they overlooked. The Appeals Council receives thousands of requests and grants only a small percentage — roughly 10 to 15% — so this stage is not a second chance to present your case differently, but rather a check on the judge's legal reasoning.

If the Appeals Council denies your request or affirms the judge's decision, you can file a federal lawsuit in U.S. District Court. This is rare and requires a lawyer; it is also expensive and time-consuming. Most people at this stage either accept the decision or file a new claim if their condition has worsened significantly.

Filing a New Claim After Denial

If you let the 60-day appeal window close without requesting reconsideration, or if you exhaust all appeals and lose, you can file a new claim. A new claim restarts the process from the beginning and resets the 60-day clock for appeals. However, SSA will look at your entire medical history, including the old denial, so straightforward refiling without new evidence rarely succeeds.

File a new claim only if your condition has genuinely worsened, you have significant new medical evidence, or you have worked and earned enough to restart your work history. If you file too soon after a denial with no new information, SSA may dismiss it as a duplicate. Your local field office can tell you whether a new claim makes sense in your situation.

What Happens to Your Back Pay and Ongoing Benefits

If you win at any stage — reconsideration, hearing, or Appeals Council — SSA pays you back to the date you originally filed your claim. This lump sum is called back pay. If you hired a representative, their fee and costs come out of the back pay first, then you receive the remainder.

Once approved, you begin receiving monthly SSDI or SSI payments. If you were approved for SSDI, you become covered by Medicare after 24 months of payments (or when ready if you have end-stage renal disease or ALS). If you were approved for SSI, you may be covered by Medicaid depending on your state's rules. These programs continue as long as you remain disabled and follow the work rules.

Frequently Asked Questions

Can I work while my appeal is pending?

Yes. You can work and earn money while appealing, but if you earn more than the substantial gainful activity (SGA) limit — currently $1,550 per month for non-blind individuals — SSA may use that as evidence that you can work and deny your claim. Keep your earnings below SGA if possible, or document that the work is part-time, temporary, or accommodated for your disability.

What if I disagree with the reason SSA gave for the denial?

Submit a written response at reconsideration explaining why you believe their reasoning is wrong, and attach medical evidence that contradicts their conclusion. For example, if they said your condition is not severe, provide recent test results or a detailed letter from your doctor describing your limitations. Be specific and reference the exact statements in the denial letter.

How much does it cost to appeal?

Reconsideration and hearing requests are free. You pay nothing to SSA. If you hire a lawyer, you pay their contingency fee only if you win, and the fee is capped at 25% of back pay up to $7,200. You may also pay out-of-pocket costs for medical records or informed reports, though many lawyers advance these.

Can I request a hearing by phone or video instead of in person?

Yes. You can request a video hearing or phone hearing when you file your request for hearing. Video hearings are now common and work well for most cases. Ask your representative or the ALJ's office about the options available in your area.

What if I miss the 60-day important date to appeal?

If you miss the important date, you lose the right to appeal that specific denial. You must file a new claim instead, which starts the process over. However, if you have a good reason for missing the important date — such as serious illness or a postal delay — you can request a late appeal by explaining the reason in writing to your local field office.