What Your Social Security Disability Denial Letter Says and What to Do Within 60 Days

Which Social Security notice is the disability denial letter?

This page covers the first denial of a disability application, whether it was your first application or a later one. A reconsideration denial is a different letter: the next step after it is a request for a hearing. A notice ending disability benefits you already receive, because Social Security decided on medical grounds that you are no longer disabled, is also appealed by reconsideration, but it has its own rules, including a 10-day window to ask that payments continue during the appeal and the chance of a disability hearing in place of the usual case review. The first denial is a notice of an initial determination. Under 20 CFR 404.904, Social Security must mail it to your last known address and explain in simple and clear language what it decided, the reasons and the effect of the decision. When the decision on disability is unfavorable in whole or in part, the notice must also give a statement of the case setting out the evidence the decision rests on, and it must tell you about your right to reconsideration. SSI has the same rule in 20 CFR 416.1404.

Social Security's own forms carry the title Notice of Disapproved Claim. Its operations manual names three versions in POMS DI 26535.031: SSA-L443 for Social Security Disability Insurance (the Retirement, Survivors, and Disability Insurance notice), SSA-L444 for Supplemental Security Income, and SSA-L442, a single notice that may be used when both claims were denied for the same reason. When the reasons differ, you get two separate notices.

Two other parts can come with the letter. An SSI denial can carry added Medicaid or state supplement paragraphs, depending on your state. A denial notice also usually includes a paragraph that closes out the other benefit types the application covered, and SSI notices leave it off while a Social Security (Title II) claim, such as an SSDI claim, is still pending. Read every page, because the explanation can be on a separate page from the notice and its appeal instructions.

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The personalized explanation behind a medical denial

When the denial is medical, meaning Social Security looked at your health and decided you are not disabled under its rules, the state Disability Determination Services prepares a personalized disability explanation to go with the notice. POMS DI 26530.020 lists what it must contain. The items that depend on your claim appear only when they fit:

• A list of the medical and nonmedical sources that provided evidence. Medical sources are usually named with the date each report arrived; when several sources cannot be told apart, the list may say only Medical evidence that was submitted with your claim. Nonmedical sources, such as a vocational rehabilitation counselor, are listed by position and organization, and statements from family, friends or coworkers appear under the line Information from other people who know about your health.
• Sometimes, when a source did not answer, a note that other reports could not be obtained but the information on file was enough to evaluate your condition.
• A decision paragraph giving the basis for the denial, and a plain-language list of the impairments considered.
• A brief description of how severe the evidence shows your condition to be.
• For claims filed before March 27, 2017, how a treating source's medical opinion was considered.
• When the denial says you can still do work you did before, the job you can do. If you described that job differently from the way it is generally performed, the explanation says you can do it as it is generally performed.
• When the denial says you can do other work, a statement that, considering your age, education and work experience, you can do less demanding work or work needing less physical effort. The manual tells the agency not to name specific jobs.
• When the denial says your condition will not last long enough, the medical information on that point.

The manual adds one more item that matters for SSDI. When your insured status, the work-credit coverage SSDI depends on, ended before the decision date, the explanation covers the period considered and states the date through which you were insured.

A denial for a nonmedical reason, such as too few work credits, work above the earnings limit or SSI income and resources over the limit, comes without this explanation; the notice states that reason instead. Our guide to the most common reasons claims are denied sorts medical and technical denials.

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What to check on the letter before you appeal

Start with the date printed on the letter. Under Social Security's operations manual, the 60 days start the day after you receive the notice, and the agency presumes you received it 5 days after the date on it unless you show it arrived later. That usually puts the deadline 65 days after the date on the letter. If the last day falls on a Saturday, Sunday, legal holiday or other federal nonworkday, the period runs through the next full workday. Write down the day the letter actually arrived and keep the envelope. If you applied for both SSDI and SSI and received two notices, each one carries its own appeal rights, so check the date on both.

Next, read the list of sources line by line. A doctor, clinic or hospital missing from the list is the first thing to check, because it can mean Social Security decided the claim without that record. If the list uses only the general line Medical evidence that was submitted with your claim, it does not name each source. A source can also appear on the list even though it sent nothing, so a listed name does not prove the records arrived. Under 20 CFR 404.1512 you must tell Social Security about, or send it, all evidence you know of that relates to whether you are disabled, and the appeal is where you add what is missing. The date beside a medical source generally shows when Social Security received the report, not when you were treated, so check which treatment dates the records cover; the source list alone may not show whether newer notes reached the file.

Then read the reason. If the explanation names a past job you can still do, compare it with what that job actually required of you. Under Social Security Ruling 24-2p, the agency can find you able to do a past job either as you actually did it or as it is generally performed in the national economy, and either finding is enough for a denial at that step. Also check whether the job counts as past relevant work at all: the ruling limits it to work done within the past 5 years at the level of substantial gainful activity that lasted long enough to learn, and work you started and stopped in fewer than 30 calendar days does not count. For SSDI, when your date last insured is in the past, that 5-year period ends on that date. If it says you can do other, less demanding work, look at whether your age, education and work history are stated the way you would describe them. Our guide to residual functional capacity explains the limits that finding rests on.

Last, for SSDI, look for a date last insured. If the explanation says your insured status ended on a date in the past, the claim depends on showing you were disabled on or before that date, and the evidence you add should reach back that far.

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What to file after an initial disability denial

The next step after an initial denial is reconsideration, a complete review of the claim by someone who did not take part in the first decision: an examiner at your state's Disability Determination Services for a medical denial, or a Social Security employee for a nonmedical one. Under 20 CFR 404.909, the request must be in writing and filed within 60 days after you receive the notice, and SSI follows the same rule in 20 CFR 416.1409. You can file online, where Social Security has separate requests for medical and nonmedical denials, or on paper with Form SSA-561, the Request for Reconsideration. A paper appeal of a medical denial also needs Form SSA-3441, the appeal disability report, and Form SSA-827, which lets the agency request your records. Do not hold the request while you gather records or finish those forms. Social Security's manual treats any written document that clearly implies disagreement with the medical decision, such as a letter, as a request for reconsideration as long as it is filed on time, and it has steps to follow up when the appeal report or authorization is missing. Our reconsideration guide walks through the forms and what to add to the file.

If the 60 days have passed, you can still ask for more time in writing, explaining why the request is late. Social Security grants it only if you show good cause, so file as soon as you can rather than waiting to see whether an extension comes through.

A new application is a different thing from an appeal. Social Security's own notice paragraph on the subject, POMS NL 00725.125, says “filing a new application is not the same thing as appealing this decision.” It warns that if you disagree with the decision and file a new application instead of appealing, you might lose some benefits or not qualify for any, and that the agency could deny the new application using the earlier decision if the facts and issues are the same. If you disagree with the denial, the agency's own advice is to appeal within 60 days.

Our page on what to do after a disability denial covers how we take a case over at this stage.

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