What to Do When Your Disability Claim Is Denied
Your denial is not final — you have the right to challenge it
When Social Security or your private disability insurer denies your claim, the decision comes with a specific reason and a window to object. You do not need a lawyer to file an appeal, though many people find one helpful later in the process. The first step is always the same: read the denial letter carefully to understand why the agency said no, then decide which appeal path fits your situation.
The timeline matters. Social Security gives you 60 days from the date on the denial letter to request reconsideration. Private insurers have their own deadlines, usually 30 to 180 days depending on your policy and state — check your denial letter for the exact date. Missing the deadline closes that appeal route, so mark it on a calendar now.
Key Takeaways
- Social Security denials can be challenged through reconsideration, a hearing before an administrative law judge, or the Appeals Council, in that order.
- Private disability insurance denials go through the insurer's internal review process first, then to your state's insurance commissioner if you remain denied.
- The denial letter states the specific reason you were denied — read it carefully, because your appeal must address that reason directly.
- You have 60 days from the denial date to request reconsideration with Social Security, and 30 to 180 days with private insurers depending on your policy.
- New medical evidence is the most common reason appeals succeed, so gathering updated records from your doctors before you appeal strengthens your case.
Understanding why Social Security said no
Social Security denies disability claims for a few specific reasons, and your letter will state which one applies to you. The most common is that the agency does not believe your condition meets the medical severity threshold in their rules — meaning your symptoms and test results do not match the definition of disability they use. A second reason is that the agency thinks you can still work, even with your condition. A third is incomplete medical evidence, meaning you did not provide enough records for them to make a decision.
Read the "Reason for Denial" section word by word. If it says your condition does not meet the listing, your appeal needs to show either that it does meet the listing or that your combined conditions prevent substantial work. If it says you can work, your appeal needs medical evidence that you cannot. If it says evidence is incomplete, you need to submit the missing records before you appeal. Do not assume you know why you were denied — the letter tells you.
The Social Security appeal process: three levels
Social Security has three appeal stages, and you must go through them in order. You cannot skip to a hearing just because you want one.
Reconsideration is the first step. You request it by completing Form SSA-561, which you can print from ssa.gov or get at your local Social Security office. Mail it to the address on your denial letter, or file it online through your my Social Security account if you have one set up. Reconsideration means a different Social Security examiner reviews your file from scratch. You can include new medical records with your request. This stage takes 3 to 6 months.
Hearing before an administrative law judge is the second stage, and it is where most people's cases are decided. You request it on Form HA-501, again available at ssa.gov or your local office. At a hearing, you sit across from a judge (usually by video now, sometimes in person) and explain why you cannot work. Your doctors can testify, or you can submit their written statements. You can bring a representative — a lawyer, a non-lawyer advocate, or a family member. This stage takes 6 to 18 months depending on your area's backlog.
Appeals Council review is the third stage. You request it if the judge denies you. The council reviews the judge's decision for legal errors, not to re-weigh the evidence. This stage takes 3 to 6 months. If the council denies you, you can then file a federal lawsuit, which is rare and requires a lawyer.
Private disability insurance appeals work differently
If your denial is from a private insurer — through your employer, a policy you bought yourself, or a group plan — the appeal process is faster but more limited. Most private policies require you to request an internal review within 30 to 180 days. Check your denial letter for the exact deadline and the address to send your appeal.
For the internal review, send a letter to the address listed in your denial, stating that you are requesting reconsideration and why you believe the denial was wrong. Include any new medical records, test results, or statements from your doctors. The insurer will assign a different reviewer to look at your case. This usually takes 30 to 60 days.
If the insurer denies you again, you can file a complaint with your state's Department of Insurance (the name varies by state). The department can investigate whether the insurer followed state law and your policy terms. This does not overturn the denial directly, but it can pressure the insurer to reconsider or reveal that they made a procedural error. You can also pursue a lawsuit, which typically requires a lawyer and is expensive.
Gathering medical evidence that strengthens your appeal
The single most important thing you can do before appealing is get updated medical records from your doctors. Social Security and private insurers make decisions based on medical evidence — test results, imaging, doctor's notes, and specialist reports. If your file is thin or outdated, your appeal will fail no matter how compelling your story is.
Contact each doctor or clinic you see and ask for records from the past year. Specifically request: office visit notes, test results (blood work, imaging, nerve studies), medication lists, and any functional capacity evaluations or work restrictions they have written. If you see a specialist — a rheumatologist, neurologist, cardiologist, or psychiatrist — their records carry extra weight because they are experts in your condition.
Ask your doctor directly: "Based on my condition, can I work full-time?" If they say no, ask them to write a brief statement saying so and why. A doctor's statement that you cannot work is far more powerful than your own description of your symptoms. If your doctor is reluctant to write a statement, ask what information they need from you to do so — sometimes they want a list of your symptoms or a description of what a typical day looks like.
Whether to hire a lawyer for your appeal
You do not need a lawyer to request reconsideration or to file for a hearing. Many people handle reconsideration on their own — it is a straightforward form and a request to review your file again. For a hearing, you can represent yourself, bring a family member, or hire a non-lawyer advocate (often cheaper than a lawyer).
Most people benefit from a lawyer or advocate by the hearing stage. A representative knows how to present your case, what questions the judge will ask, and how to respond to the judge's concerns. They also handle the paperwork and deadlines, which matters because missing a deadline can close your case.
Social Security lawyers work on contingency, meaning they take payment only if you win. The fee is capped at 25 percent of your back pay (the money owed from when you became disabled), up to $7,200. You pay nothing upfront. Non-lawyer advocates charge hourly fees, usually $50 to $150 per hour, and you pay as you go. If cost is a barrier, contact your local legal aid office — they sometimes represent people in disability cases for free.
What happens while you wait for your appeal decision
If you are working and your claim was denied, you can continue working while you appeal. Your appeal does not affect your job or your income.
If you are not working and your claim was denied, you have no income from disability during the appeal. Some people return to part-time work or rely on family support. If you are in genuine financial crisis, contact your local social services office to ask about emergency assistance, food programs, or housing help while you wait.
Do not stop seeing your doctors while you appeal. Gaps in medical care hurt your case because they suggest your condition improved or is not serious. Keep going to appointments, follow your treatment plan, and keep records of any changes in your symptoms or ability to function.
Frequently Asked Questions
Can I appeal if I missed the 60-day deadline with Social Security?
You can request a "late reconsideration" by explaining to Social Security why you missed the deadline. The agency will grant it if you have "good cause" — meaning a reason beyond your control, like a serious illness or a mail delay. You must request it as soon as you realize you missed the deadline. There is no may provide it will be approved, so do not rely on this option.
What if I get new medical evidence after I file my appeal?
Send it immediately to the address handling your appeal. For Social Security, include a cover letter stating that this is new evidence for your pending reconsideration or hearing. For private insurers, send it to the claims department with your claim number. Do not wait to submit evidence — the sooner the reviewer sees it, the sooner they can consider it.
Do I have to go through reconsideration before requesting a hearing with Social Security?
Yes. You must request reconsideration first. Only if reconsideration is denied can you request a hearing. The only exception is if you are in a state where Social Security has waived the reconsideration step, which is rare — ask your local Social Security office if this applies to you.
What if my private insurer says my condition is not covered under my policy?
Request an internal review and argue that your condition is covered. Include your policy document and highlight the language that covers your diagnosis. If the insurer still denies you, file a complaint with your state's Department of Insurance, which can investigate whether the insurer correctly interpreted your policy. You may also need a lawyer to review your policy and advise whether you have grounds for a lawsuit.
Can I work part-time while appealing a disability claim?
Yes, but be careful. If you earn more than $1,550 per month (the 2024 limit; it changes yearly), Social Security may use that income as evidence that you can work. If you do work part-time while appealing, keep records showing that the work is limited by your condition — for example, that you can only work a few hours a week or that you need frequent breaks. Tell your doctor about the work and ask them to note any impact on your symptoms.