1. Why Are SSDI Claims Medically Denied?

SSA issues medical denials if:

• Your medical evidence does not prove your condition is severe enough to prevent substantial gainful activity (SGA)
• Your condition does not meet or equal one of the listed impairments
• You have gaps in medical treatment or insufficient documentation of your symptoms and functional limitations
• SSA believes you can still perform past work or adjust to other work

2. First Step: Request Reconsideration

In North Carolina, the first appeal step is Reconsideration, where a different disability examiner reviews your case.

How to Request Reconsideration

• File a Request for Reconsideration (Form SSA-561-U2) within 60 days of your denial notice
• Submit the form online through your My Social Security account or at your local SSA office
• Include new or updated medical evidence, such as:
• Recent doctor’s visits
• Updated diagnostic tests (MRI, CT scans, lab results)
• Detailed treatment notes and functional assessments

Tips for Reconsideration

• Review your denial notice to understand why your claim was denied medically
• Address SSA’s specific concerns with targeted medical evidence
• Obtain letters from your treating physicians explaining how your condition limits your ability to work

3. Second Step: Request a Disability Hearing

If your reconsideration is denied, you can request a hearing before an Administrative Law Judge (ALJ).

How to Request a Hearing

• File a Request for Hearing by Administrative Law Judge (Form HA-501-U5) within 60 days of your reconsideration denial
• Submit additional medical evidence or documents showing:
• The progression of your condition
• Any new diagnoses or complications
• How your daily life and work capacity are impacted

Preparing for Your Hearing

• Review your entire claim file and denial reasons
• Prepare to testify clearly about your limitations, symptoms, and daily challenges
• Gather supporting testimony if possible, such as from family, caregivers, or vocational experts
• Have your treating doctor provide a Medical Source Statement detailing your inability to work

4. Third Step: Appeals Council Review

If the ALJ denies your claim, you can request review by the SSA Appeals Council. They will:

• Review whether the ALJ made an error in law or failed to consider critical evidence
• Either uphold the decision, send it back for a new hearing, or reverse the decision and approve benefits (rare)

Submit your Request for Review of Hearing Decision/Order (Form HA-520-U5) within 60 days of your hearing denial.

5. Fourth Step: Federal Court Appeal

If the Appeals Council denies your request, the final appeal option is filing a lawsuit in federal district court within 60 days. This is a formal legal action requiring:

• A disability attorney experienced in federal appeals
• Strong legal arguments showing SSA errors in evaluating your case

6. Strengthening Your Medical Appeal

a. Maintain Consistent Medical Treatment

SSA places high importance on consistent, ongoing medical care to confirm your disability. Avoid treatment gaps whenever possible.

b. Obtain Detailed Doctor Statements

Request that your treating physicians provide:

• Specific functional limitations (e.g. inability to sit for more than 20 minutes, need to lie down multiple times a day)
• Objective support from medical tests and clinical observations
• Statements focusing on how your condition prevents work, not just your diagnosis

c. Work With a Disability Attorney

Appealing medical denials is complex. An experienced attorney can:



• Identify weaknesses in your original application
• Gather targeted medical evidence to address SSA concerns
• Prepare you thoroughly for testimony at your hearing
• Handle procedural requirements to avoid missed deadlines