Massachusetts Social Security Disability Lawyer Guides You Through the Modified SSDI Appeals Process
When the Social Security Administration (SSA) denies your Social Security disability claim, it can feel like a devastating setback. At Keefe Disability Law, we've helped countless Massachusetts residents successfully appeal their SSDI denials and obtain the disability benefits they deserve. The appeals process has evolved significantly since 2020, bringing both challenges and opportunities for disability claimants.
Understanding the Four Levels of SSDI Appeal
If the SSA denies your initial SSDI application, you have four opportunities to appeal. Each level has strict deadlines and specific requirements. In most cases, you must file for appeal within 60 days of receiving your decision from the previous level. Our experienced SSDI lawyers help ensure you meet all deadlines and submit appropriate documentation at each stage.
- Request for reconsideration. You can ask for a complete review of your claim by someone who didn't participate in the first decision.
- Administrative Law Judge (ALJ) hearing. If you don’t agree with the SSA’s response to your initial reconsideration, you can ask for a new review of your case by an Administrative Law Judge.
- Appeals Council review. The third level of appeal takes your case to the Appeals Council.
- Federal district court action. The highest level of appeal elevates your case to the U.S. District Court.
The appeals process can take months to complete. The Appeals Council can take up to a year or more to process requests, but you may be eligible for back pay if your application is eventually approved.
Recent SSA Policy Changes Affecting Appeals
The SSA has implemented several significant changes in the post-COVID era that could affect your claim. Many of these changes came into effect between Summer 2021 and Spring 2024.
Past Work Evaluation Changes
The SSA has significantly streamlined how it evaluates the relevance of your previous employment when determining disability eligibility:
- Relevant work history period is reduced to five years, down from 15 years.
- Work lasting less than 30 calendar days is no longer considered relevant.
- These changes help focus on your most recent abilities and skills, reducing processing times and improving customer service.
Housing Cost Changes
New policies make it easier for the SSA to evaluate your living situation and financial needs:
- Expanded In-Kind Support and Maintenance (ISM) rental subsidy exceptions nationwide
- Simplified determination of living arrangements, particularly with public assistance (PA) households
- May affect how the SSA evaluates your financial situation
Medical Evidence Timeline Changes
Recognizing ongoing healthcare challenges, including timely access to in-person healthcare, the SSA has extended timeframes for submitting medical evidence:
- Extended "close proximity of time" standard for musculoskeletal conditions through to May 2025
- Allows medical evidence within 12 months rather than four months
- Helps claimants who faced healthcare access barriers
Documentation Requirements
The SSA has reduced bureaucratic hurdles for proving financial hardship, including simplifying the dire need documentation process. The SSA has also streamlined medical opinion evaluation standards, adopting software that speeds up medical reviews.
Appeal Hearing Options Now Offer Greater Flexibility
The SSA now offers four ways to appear for your appeal hearing, all of which are considered standard manners of appearance:
- Agency video at an authorized SSA facility using their equipment
- Online video and audio, using your own private electronic devices and approved software
- Audio-only hearing by telephone in limited circumstances
- In-person
This increased flexibility means you can choose the hearing format that works best for your situation. You have the right to object to any manner of appearance except for an in-person hearing. Our attorneys can help you decide on the option that gives you the strongest chance of presenting your case effectively.
Preparing for Your Social Security Disability Hearing
The key to a successful SSDI appeals hearing is thorough preparation. Here's what to expect and how to get ready:
- Pre-hearing conference. The SSA may schedule a conference to discuss issues, evidence, and witnesses.
- Medical updates. Ensure all medical records are current within 90 days of your scheduled hearing.
- Work history details. Be prepared to discuss your past jobs in detail, including physical requirements and skills used.
- Daily activities. Document how your condition affects your activities of daily living, including specific examples.
- Witness testimony. Identify witnesses who can provide firsthand knowledge of your limitations.
Your hearing will likely take 45 to 60 minutes. During that time, the judge may ask about your medical conditions and symptoms, treatment history, ability to perform daily activities, past work experience, and your education and training. Come prepared to discuss all of these topics in great detail.
Current Wait Times Show Improvement After COVID-19
Recent data shows encouraging improvements in processing times for disability appeals following the COVID-19 pandemic:
- The average wait time for a hearing decision has dropped to 342 days in 2024, compared to 450 days in 2023.
- Critical cases involving terminal illness or dire financial need are being processed in about 201 days.
- The SSA's hearing caseload has reached a 30-year low of 262,000 in September 2024.
The SSA has implemented new technologies and procedures to reduce processing times, including expanded use of electronic records and streamlined case assignment procedures. The goal is to reduce the average processing time down to 270 days for the 2025 fiscal year.
Critical Need Cases Receive Priority Processing
You may qualify for expedited processing of your SSDI application. The SSA prioritizes cases involving:
- Dire financial need, including the risk of homelessness or eviction
- Terminal illness (TERI)
- Military service members with disabilities connected to their service
- Severe medical conditions that clearly meet disability criteria
Recent SSA policy changes have simplified the documentation requirements for dire need cases. You no longer need to provide extensive documentation of financial hardship. Your statement of dire need will be accepted unless there's evidence to the contrary.
Common Reasons for Denial and How to Address Them
Many initial applications are denied for technical reasons that can be corrected on appeal:
- Lack of medical evidence. We help gather comprehensive records from all your healthcare providers.
- Inadequate work history documentation. We ensure your employment record is complete and accurate.
- Failure to follow prescribed treatment. We can help you explain any barriers to compliance that prevent you from following treatment plans.
- Income exceeding limits. We review your work activity and earnings to confirm your income is lower than substantial gainful activity (SGA) thresholds.
Updated Qualifying Medical Conditions and Required Documentation
The SSA has updated several listings of qualifying conditions, including:
- Revised criteria for digestive disorders and skin disorders
- Updated standards for cardiovascular disorders
- Modified medical evaluation criteria for musculoskeletal disorders
- Expanded consideration of certain neurological conditions
Each condition requires specific medical documentation. Our team understands these requirements and ensures your medical evidence meets current SSA standards.
Strengthen Your Appeal With Help From Our Experienced SSDI Lawyers
The attorneys at Keefe Disability Law focus exclusively on helping clients obtain Social Security disability benefits. We understand the recent changes to the appeals process and how they can affect your claim. Our experienced legal team will:
- Review your denial notice and medical records
- Gather additional evidence to support your case
- Help you prepare for your hearing
- Present your case effectively to the judge
- Guide you through each step of the appeals process
There are strict deadlines for filing appeals, so don't wait to get the help you need. The appeals process can be challenging, but you don't have to handle it alone. Our experienced disability attorneys stay current with all SSA policy changes and can help ensure your appeal meets current requirements.
