How to Appeal Denied Survivor Benefits in Massachusetts

A denial letter after your loved one dies feels like a door slamming shut at the worst possible moment. But in Massachusetts, most survivor benefit denials are not final — they're an invitation to prove your case through an appeal process. The catch is that these processes have strict deadlines, and missing one can permanently forfeit your right to benefits you're entitled to.

Here's what you need to know about appealing the most common types of survivor benefit denials in Massachusetts.

MassHealth Denials: The Fair Hearing Process

MassHealth (Massachusetts Medicaid) survivor benefit issues arise most often in two contexts: denial of a surviving spouse's application for their own MassHealth coverage after the deceased's death, or disputes related to MassHealth estate recovery claims against the deceased's estate.

When MassHealth issues a denial or takes an adverse action, you have 60 days from the date on the notice to request a Fair Hearing before the Board of Hearings.

This deadline is not negotiable. If you miss the 60-day window, you lose the right to challenge that specific decision through this process. Read every MassHealth letter carefully — the clock starts from the date on the letter, not the date you received it.

How to Request a Fair Hearing

You can request a Fair Hearing by:

• Calling MassHealth Customer Service at 1-800-841-2900
• Writing to the Board of Hearings directly
• Submitting a written request referencing the notice you received

Your request must state that you are requesting a Fair Hearing and identify the decision you are appealing. You do not need to have your full argument prepared at this stage — you just need to get the request in before the deadline.

What Happens at the Hearing

The Board of Hearings operates independently from MassHealth. A hearing officer reviews the evidence and hears from both you and MassHealth. You can represent yourself, bring a family member or advocate, or hire an attorney.

The Board must issue a written decision within 90 days of the hearing date. That decision either upholds or reverses the MassHealth determination. If you disagree with the Board's decision, you can pursue further appeal in the Massachusetts court system.

Key preparation steps:

• Get a copy of your complete MassHealth file (you're entitled to it)
• Document everything: dates, phone calls, names of representatives you spoke with
• Gather all medical, financial, and household documentation that supports your case
• If the denial involves estate recovery, consult an elder law attorney — the amounts at stake often justify the cost

DTA Funeral Payment Denials

The Department of Transitional Assistance (DTA) administers Emergency Assistance for Elderly and Disabled Individuals and may provide funeral assistance to families who cannot afford burial costs. If the DTA denies or reduces a funeral assistance payment, you can appeal that decision.

DTA denials can be appealed through the DTA appeals process, which also routes to a Fair Hearing. The appeal must be filed within the timeframe stated in the denial notice — read the letter carefully, as timelines can vary depending on the program.

Documentation matters enormously here. The DTA looks at the deceased's assets, household income, and the actual costs incurred. If the denial was based on incorrect financial information, gather bank statements, asset documentation, and funeral invoices to demonstrate the correct picture.

Appeals are complex. The Massachusetts Survivor Benefits Navigator maps out every benefit you may be entitled to — and how to claim them — so nothing falls through the cracks.

MTRS and MSERS Pension Survivor Benefit Disputes

Massachusetts public school teachers are covered by the Massachusetts Teachers' Retirement System (MTRS). State employees are covered by the Massachusetts State Employees' Retirement System (MSERS). Both systems provide survivor benefits, and both can be the subject of disputes.

Common disputes involve:

• Whether the surviving spouse qualifies for an Option C benefit (pension continuation)
• Calculation of the benefit amount
• Eligibility after a divorce or separation
• Who qualifies as a "dependent" for survivor allowance purposes

If the retirement board issues a determination you believe is incorrect, you have the right to appeal. Appeals from MTRS and MSERS determinations go through the retirement board itself in the first instance, and then to the Contributory Retirement Appeal Board (CRAB) if you are still dissatisfied.

The timeframe for filing depends on the specific determination and will be stated in the notice. Contact the relevant retirement system directly to confirm your deadlines and the steps for filing.

For municipal employees, the process is similar but routes through the local retirement board and then CRAB.

Social Security Survivor Benefits Denials

The Social Security Administration has its own multi-step appeal process, separate from Massachusetts state processes. If SSA denies a survivor benefit claim, you have 60 days from receipt of the denial notice to request reconsideration (plus 5 days mail time).

The full SSA appeal process has four levels:

1. Reconsideration
2. Hearing before an Administrative Law Judge
3. Appeals Council review
4. Federal court

Most survivors who appeal SSA denials and are ultimately successful do so at the ALJ hearing stage. Getting to that hearing requires completing reconsideration first, even if reconsideration is denied — skipping a step forfeits the right to the next level.

If the denial involves a surviving divorced spouse benefit, a child survivor benefit, or a lump-sum death payment, the same appeal process applies. Document the date you received the notice (SSA counts from that date for the 60-day window).

Free Resources for Appealing Denied Benefits

You do not necessarily need to hire an attorney to appeal a benefit denial in Massachusetts. Several free resources exist:

Massachusetts Court Service Centers: These centers, available in person and virtually, can help you understand the appeals process and navigate paperwork. While staff cannot give legal advice, they can explain procedures clearly. Find your local center at mass.gov/court-service-centers.

Volunteer Lawyers Project: Provides free civil legal assistance to low-income Massachusetts residents, including help with public benefits appeals. Call their intake line at 617-603-1700.

Mass Legal Help (masslegalhelp.org): A comprehensive online resource covering benefits appeals, probate, housing, and other legal topics. Search for your specific benefit type to find step-by-step guidance.

Greater Boston Legal Services and regional legal aid offices: If you are low-income, your regional legal aid office may provide direct representation in benefits appeals.

AARP Legal Counsel for the Elderly: For survivors 60 and older, AARP provides legal consultations and referrals.

The Three Rules That Win Appeals

Regardless of which system you're appealing in, three principles apply consistently:

1. Meet every deadline exactly. Not approximately. The day the notice is dated, calendar the deadline immediately. A day late is the same as not filing at all in most administrative appeal systems.

2. Document everything in writing. Phone calls with agency staff, conversations with benefits coordinators, statements made by representatives — confirm them in writing afterward. When you speak with anyone at MassHealth, DTA, or a retirement board, follow up with an email or letter saying "This confirms our conversation on [date] in which [representative] told me [specific information]."

3. Request your complete file before the hearing. Every agency must provide you with the documentation used to make the determination against you. Review it carefully. Denial letters are often based on missing information, outdated information, or administrative errors. Knowing what the agency has (and hasn't) considered is the foundation of any winning appeal.

A denial is not a final answer. It is the start of a process designed to ensure accuracy — but that process requires you to act quickly and precisely.

The Massachusetts Survivor Benefits Navigator provides a complete guide to survivor benefits in Massachusetts, including government benefits, pension systems, and the steps to claim what your family is owed.

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