Denied Long-Term Disability? What Attorneys Do — and When They Matter

When a long-term disability (LTD) claim gets denied, most people don't know where to turn next. One common path is hiring an attorney who specializes in disability denials. But understanding what these attorneys actually do, how their role intersects with SSDI, and what shapes whether legal help makes a difference — that's where most guides fall short.

LTD and SSDI Are Not the Same Program

This distinction matters before anything else.

Long-term disability (LTD) insurance is a private benefit — typically provided through an employer group plan or purchased individually. It's governed by the terms of your policy and, for employer-sponsored plans, by a federal law called ERISA (Employee Retirement Income Security Act).

SSDI is a federal program run by the Social Security Administration. Eligibility, appeals, and benefits follow SSA rules — not insurance policy language.

A denied LTD claim and a denied SSDI claim involve different laws, different processes, and often different types of attorneys. Some claimants are dealing with both at the same time, especially since many LTD policies require you to apply for SSDI as a condition of receiving private benefits.

Why LTD Claims Get Denied

Insurance companies deny LTD claims for several reasons:

• Insufficient medical documentation — the file doesn't establish functional limitations clearly enough
• Policy exclusions — pre-existing condition clauses, mental health benefit limits, or "own occupation vs. any occupation" definitions
• Independent Medical Examinations (IMEs) — insurer-hired doctors who reach different conclusions than your treating physicians
• Surveillance — video or social media evidence the insurer interprets as inconsistent with claimed limitations
• Administrative errors — missed deadlines or incomplete claims submissions

Understanding why a claim was denied shapes what an attorney can actually do.

What Denied LTD Attorneys Do

Attorneys who handle denied LTD claims typically focus on one or both of two tracks:

1. ERISA Administrative Appeals (Employer-Sponsored Plans)

For employer group plans, ERISA requires claimants to exhaust the internal administrative appeal before filing a lawsuit. This is not optional — skipping it generally bars you from going to court.

An attorney working this stage will:

• Review the full claim file the insurer used to make its decision
• Identify gaps in medical evidence and work to strengthen the record
• Draft a formal appeal letter addressing the specific denial reasons
• Submit additional documentation — functional assessments, treating physician statements, vocational evidence

⚠️ The administrative appeal is often the most important stage under ERISA. Unlike many legal proceedings, courts reviewing ERISA denials are frequently limited to the record that existed during the administrative process. What gets added before the lawsuit is filed often determines what a judge can consider later.

2. Federal Litigation

If the internal appeal is denied, the next step for employer-plan claimants is federal court. ERISA litigation is specialized — it doesn't work like a typical personal injury case. Courts generally apply a deferential standard to insurer decisions unless the plan gives the claimant stronger rights, or the insurer demonstrated clear bias.

For individually purchased (non-ERISA) policies, state contract law applies, and litigation options may be broader.

How LTD Attorneys Are Typically Paid

Most denied LTD attorneys work on contingency — meaning they receive a percentage of recovered benefits if successful, and no fee if they don't win. Fee structures vary by attorney and by whether the case settles, goes through appeal, or reaches litigation.

Some attorneys charge flat fees or hourly rates for specific services, like reviewing a denial letter or drafting an appeal. The arrangement should be clearly spelled out in a retainer agreement.

Where SSDI Fits Into the Picture

If you're receiving LTD benefits — or pursuing them — your insurer may have required you to apply for SSDI. Here's why that matters:

If SSDI is also denied, that's a separate appeals process with its own deadlines — most critically, 60 days to request reconsideration after an initial denial, and another 60 days to request a hearing before an Administrative Law Judge (ALJ) if reconsideration fails.

Variables That Shape What Happens Next

No two denied claims look the same. What drives outcomes includes:

• The specific denial reason — a documentation gap is different from a policy exclusion
• The type of plan — ERISA employer plan, non-ERISA individual policy, or government-employee plan each follows different rules
• How far along the process is — an appeal at the administrative stage has different options than a case already in litigation
• The strength of the medical record — treating physician documentation, functional capacity evaluations, specialist opinions
• Occupation and age — LTD policies often shift their definition of "disabled" from "own occupation" to "any occupation" after 24 months, which changes what has to be proven
• State — non-ERISA claims follow state insurance law, which varies significantly

🔍 The Record Is the Foundation

Whether pursuing an LTD appeal, SSDI reconsideration, or both, the medical record carries most of the weight. Attorneys in this space spend significant effort building and presenting that record — not just arguing that someone is disabled, but documenting how a condition translates into functional limitations that prevent work.

The gap between "I have a serious condition" and "the record establishes I cannot perform substantial work" is where many claims are won or lost.

Whether that gap exists in your case — and what it would take to close it — depends on your medical history, your policy's specific language, the reason your claim was denied, and where you are in the process.