Long-Term Disability Questions and Answers

You usually file an LTD claim by notifying your employer’s HR department (for group policies) or your insurance agent (for individual policies). They will give you the required claim forms, which typically include an employee statement, an employer statement, and an attending physician’s statement.

Insurance companies often delay claims by requesting more information or extending their review time, which ERISA allows them to do. In our experience, delays are one of the most common tactics insurers use to push claimants back to work or frustrate them into giving up. A delay doesn’t mean your claim is doomed, but you should respond quickly to requests for records and keep copies of everything you submit.

You can appeal by gathering updated medical records, physician opinions, and any other evidence the insurer overlooked or misinterpreted. Your appeal letter should explain why the decision was wrong and include every piece of support you want in the claim file. In my experience, the strongest self-filed appeals follow a structured approach, which is why I offer a free step-by-step appeal guide.

Yes. Under ERISA, you have 180 days from the date of the denial letter to file your appeal. If you have an individual (non-ERISA) policy, the deadline will be listed in your denial letter and may be different. Missing this deadline is one of the costliest mistakes a claimant can make because it usually ends your right to challenge the denial.

You’re not required to hire a lawyer, but it can make a meaningful difference. The most common mistake I see claimants make is handling the appeal themselves without knowing what evidence the insurer expects. A well-prepared appeal can correct gaps, rebut bad medical reviews, and significantly strengthen your case before litigation ever begins.

Your health insurance pays for your medical bills, but what about your other monthly expenses if you are unable to work due to a disability? Disability insurance is meant to replace your wages and help with expenses if you cannot work due to a disability.

Group policies (usually obtained through an employer) are governed by ERISA, which limits your rights and protects insurers from bad-faith lawsuits. Individual policies are governed by state law and generally offer stronger legal remedies. In my experience, individual policyholders tend to have more leverage than group policyholders, especially when a claim is wrongfully denied.

ERISA is a federal law that controls most employer-provided disability plans. It limits the evidence courts can review, restricts damages, and requires strict adherence to internal appeal deadlines. The most common surprise for claimants is learning that they cannot sue for bad faith or punitive damages under ERISA—even when the insurer handles the claim unfairly.

Bad faith occurs when an insurer unfairly delays, mishandles, or wrongfully denies a claim. Examples include inadequate investigations or unreasonable delays. However, if your claim falls under ERISA (and most employer-provided LTD plans do) you cannot sue for bad faith or punitive damages. ERISA only allows you to recover the benefits owed, which is often surprising to claimants who expected broader legal remedies.

This is the legal standard most courts use when reviewing ERISA LTD decisions. It means the judge must uphold the insurer’s decision unless it was completely unreasonable. In our experience, this standard makes appeals and lawsuits much harder to win, which is why strengthening the administrative appeal file is critical.

A doctor’s letter can help, but it is never enough on its own. The insurers focus on specific functional limitations, not broad statements like “my patient is disabled.” The letters that make the biggest impact explain why you cannot safely perform the physical or cognitive duties of your job.

Yes. If multiple doctors treat you, each should provide a statement supporting your claim. Consistent opinions from multiple specialists strengthen your file. The best practice is to include at least two medical source statements.

Residual functional capacity (RFC) describes what you can still do despite your medical conditions. It outlines your physical and cognitive limits, such as how long you can sit, stand, concentrate, lift, or work without pain. RFC forms often make a major difference in LTD appeals because they translate your medical issues into functional restrictions insurers can’t ignore.

Yes. Insurers routinely deny claims when the file shows “non-compliance” with treatment. Missing appointments, ignoring medical advice, or stopping medications without explanation can all be used against you. The most common mistake I see claimants make is assuming the insurer will understand their reasons. Always document why you cannot tolerate or access certain treatments.

If your doctor says you cannot work, but your claim is still denied, ask your doctor to complete a residual functional capacity form. This will help outline the tasks that the doctor believes you are not able to do safely without injuring yourself further.

Ask your doctor to complete a residual functional capacity form. A statement simply saying “unable to work” isn’t enough—insurers want detailed descriptions of the specific activities you can’t perform safely or consistently. In our experience, a strong RFC form often turns a weak claim into a compelling one.

Generally, no. Medical providers should not release your medical records without your express written permission due to HIPAA privacy rules. In practice, insurers will pressure claimants for broad authorizations, but you have the right to limit what the insurer can request. Just be aware that refusing all access can lead to a claim denial.

If you’ve completed every appeal required under your policy, your next step is usually filing a lawsuit in federal court. At that point, the judge reviews the claim file to determine whether the insurance company acted unreasonably. Many cases settle, but insurers negotiate more fairly when your appeal record is strong. That’s why it’s critical to build the right evidence during the appeal stage.

The Social Security Administration’s decision does not control your insurance company. SSDI uses federal disability rules; LTD insurers rely on the specific terms of your policy. In my experience, insurers often discount SSDI awards by claiming they used “different criteria” even when the medical evidence is the same. A strong appeal explains why both decisions should align.

It depends on the type of policy. With group LTD policies, you must complete all required administrative appeals before filing suit. With individual policies, you may be able to sue immediately. The most common mistake I see claimants make is missing the appeal deadline or filing a weak appeal, which severely damages the later lawsuit.

If federal ERISA regulations govern your claim, your state’s insurance laws are “pre-empted,” meaning your state’s Department of Insurance has no jurisdiction.

Usually no. If your claim is governed by ERISA, your state’s Department of Insurance has no jurisdiction because federal law overrides state regulations. Complaints may help with individually purchased policies, but not with employer-provided LTD plans.

It depends on your policy. Many LTD policies limit certain conditions—especially mental health disorders, chronic pain, or self-reported symptoms—to 24 months. After two years, most insurers switch from the “own occupation” standard to the stricter “any occupation” standard. This is one of the most common points where insurers try to terminate benefits.

Most LTD policies pay between 50% and 80% of your pre-disability income. Some policies offer a fixed monthly amount instead of a percentage. The only way to know your exact benefit is to check your policy.

Long-term disability benefits do not reduce SSDI payments. However, most LTD policies reduce your LTD check by the amount of SSDI you receive. A common mistake I see claimants make is assuming their LTD benefit stays the same after an SSDI approval. In reality, insurers almost always apply an offset, and most will pursue reimbursement for past-due SSDI backpay.

You may be able to receive both, but it depends on your policy. With an “own occupation” policy, you can be disabled from your specific job yet still capable of performing other work, even if you can’t find it. In our experience, the biggest issue claimants face is that unemployment requires you to certify you’re ready and able to work, while LTD often requires proving the opposite. Your policy language determines whether these two benefits can coexist.

The best time to hire an attorney is at the appeal stage. This is the last chance to add medical and vocational evidence to your file before it becomes locked for litigation. The biggest mistake we see is claimants submitting a simple “I disagree” letter without adding meaningful evidence.

We represent long-term disability claimants nationwide. We focus heavily on building the strongest administrative record possible, because that’s where most LTD cases are won or lost. Our goal is simple: help you secure the benefits you deserve while providing compassionate, clear guidance throughout the process.