What to Do When Your Long Term Disability Claim Is Denied

Getting a long term disability denial feels like a door slamming shut. But for many claimants, it's actually the beginning of a longer process — not the end of one. Understanding why denials happen, what options exist, and how different situations produce different outcomes can help you figure out where you actually stand.

Long Term Disability and SSDI Are Not the Same Thing

Before going further, it's worth clarifying a critical distinction.

Long term disability (LTD) insurance is typically a private policy — either purchased individually or provided through an employer. These claims are governed by your policy's specific terms, and if your employer's group plan is involved, federal law under ERISA (the Employee Retirement Income Security Act) controls the appeals process.

SSDI (Social Security Disability Insurance) is a federal program administered by the Social Security Administration. Eligibility depends on your work history, the work credits you've earned through payroll taxes, and whether your medical condition meets SSA's definition of disability.

The two systems are entirely separate. A denial from a private LTD insurer does not affect your SSDI claim — and vice versa. Many people pursue both simultaneously, and the outcome of one doesn't determine the other.

This article focuses primarily on SSDI denials — how they happen, and what claimants can do at each stage.

Why SSDI Claims Get Denied

The SSA denies the majority of initial applications. That's not a signal that claimants don't have real disabilities — it reflects how the review process is structured. Common reasons for denial include:

• Insufficient medical evidence — SSA needs detailed, consistent documentation from treating physicians. Gaps in treatment or sparse records make it harder to establish the severity and duration of a condition.
• Not meeting the duration requirement — SSA defines disability as a condition expected to last at least 12 months or result in death. Short-term impairments don't qualify.
• Earning above the SGA threshold — If you're working and earning above the Substantial Gainful Activity (SGA) limit (which adjusts annually), SSA may determine you aren't disabled under their rules. In 2024, the SGA threshold for non-blind individuals is $1,550/month.
• Insufficient work credits — SSDI requires a certain number of work credits based on your age at the time of disability. If you haven't worked enough, or recently enough, you may not be insured for SSDI at all.
• RFC assessment disagreement — SSA evaluates your Residual Functional Capacity (RFC) — what work you can still do despite your impairment. If their assessment concludes you can perform some type of work that exists in the national economy, they will deny the claim.

The SSDI Appeals Process: Four Stages 📋

A denial at any stage is not final. The SSA has a structured appeals process, and approval rates generally increase as claims move through it.

The ALJ hearing is where many denials are reversed. You have the opportunity to appear before a judge, submit updated medical records, and — in many cases — have a representative present your case. Approval rates at the ALJ level have historically been higher than at initial or reconsideration stages, though they vary by judge, hearing office, and the specifics of each case.

What Changes Between a Denial and an Approval

The same medical condition can result in denial for one person and approval for another. The variables that shape outcomes include:

• Strength and consistency of medical documentation — Detailed treating physician notes, diagnostic imaging, lab work, and specialist opinions all carry weight. A well-documented record is significantly harder for SSA to dismiss.
• Age — SSA's Medical-Vocational Guidelines (the "Grid Rules") consider age as a factor. Older claimants, particularly those 50 and above, may qualify under rules that wouldn't apply to younger applicants, even with similar conditions.
• Past work and transferable skills — SSA evaluates whether your RFC allows you to perform your past work or any other work. Someone with highly specialized physical labor experience may have fewer transferable options than someone with an office background.
• Onset date — The established onset date affects both eligibility and back pay. Disputes over onset dates are common and can significantly affect what a claimant receives if approved.
• New evidence submitted on appeal — Many successful appeals hinge on updated records, a new treating physician opinion, or a detailed RFC assessment from a doctor who has examined the claimant — not just the SSA's own review.

If Your Private LTD Claim Was Denied

If the denial came from a private insurance company, the process is different. Under ERISA, employer-sponsored LTD plans must provide a written explanation for the denial and offer at least one level of internal appeal. The timeline for filing that appeal is usually spelled out in your denial letter — often 180 days.

⚠️ Missing the ERISA appeal deadline can eliminate your right to challenge the denial in court. The administrative record built during the appeal stage often becomes the only evidence a federal judge can consider — which means submitting strong documentation during the internal appeal matters enormously.

The Missing Piece Is Your Situation

How these rules apply depends entirely on what's in your file: your medical records, your work history, your age, your specific policy language if this is a private LTD claim, and which stage of the process you're currently in. A denial at the initial stage with strong medical evidence looks very different from a denial at reconsideration with sparse records. Someone with 30 years of physical labor and a back condition at age 58 faces a different analysis than a 35-year-old with the same diagnosis.

The process has structure — but the outcome is shaped by details that are specific to you.