If you’ve become unable to work due to an illness or injury, you’ve probably encountered two very different types of disability benefits and the confusion between them is completely understandable. Social Security Disability Insurance (SSDI) and long-term disability insurance both exist to replace lost income when you can’t work, but they operate under entirely different systems, different rules, and require very different legal strategies when something goes wrong.
SSDI is a federal program administered by the Social Security Administration (SSA). It’s funded through the Social Security taxes deducted from your paycheck throughout your working life which is why eligibility is tied to your work history.
To qualify for SSDI, you generally must:
- Have worked long enough and recently enough to have earned sufficient “work credits” under Social Security rules
- Have a medical condition that meets the SSA’s definition of disability meaning it prevents you from doing any substantial gainful work and is expected to last at least 12 months or result in death
- File an application with the SSA and navigate a multi-step review process
The SSDI process is notoriously long. Initial applications are denied the majority of the time often for technical reasons that have nothing to do with how serious your condition is. Most approved claimants reach approval at the hearing level, which means going before an Administrative Law Judge (ALJ), sometimes years after their initial filing.
This is where having an experienced SSDI attorney in your corner makes an enormous difference. At Pisanchyn Law Firm, we’ve helped Pennsylvania residents fight through the SSDI process from initial applications through ALJ hearings and federal court appeals and we don’t collect a fee unless you win.
Learn more about our SSDI representation
What Is Long-Term Disability (LTD) Insurance?
Long-term disability insurance is private insurance either purchased individually or, more commonly, provided through an employer’s group benefits plan. Unlike SSDI, LTD is not a government program. It’s a contract between you and an insurance company.
LTD policies typically pay a percentage of your pre-disability income (often 60–70%) after a waiting period (called an “elimination period”) once short-term disability benefits are exhausted. The definition of “disability” under a private LTD policy varies significantly from policy to policy and insurer to insurer.
Common reasons LTD claims are denied:
- The insurance company disputes your medical evidence
- You no longer meet the policy’s definition of disability after an “own occupation” to “any occupation” shift (typically at the 24-month mark)
- Surveillance or social media evidence is used against you
- The insurer claims your condition is a pre-existing one
- Paperwork errors or missed deadlines
LTD disputes are governed by the terms of your specific policy, and in the U.S., employer-sponsored LTD plans are typically regulated under a federal law called ERISA (Employee Retirement Income Security Act), which has its own complex set of rules around appeals and litigation.
For those dealing with denied or terminated LTD benefits outside the United States particularly in Canada the legal framework is entirely different. Canadian LTD claimants operate under provincial law and deal with insurance carriers under a separate regulatory system. Firms like Pelz Law Group, an Ontario Disability lawyer, specialize specifically in helping Ontario residents fight denied, reduced, and terminated LTD claims under Canadian law.
Key Differences: SSDI vs. LTD Insurance
| SSDI | LTD Insurance | |
|---|---|---|
| Who runs it | Federal government (SSA) | Private insurance company |
| Who’s eligible | Workers with sufficient work credits | Policyholders / employees with coverage |
| Benefit amount | Based on earnings history | % of pre-disability income (policy-specific) |
| Definition of disability | Unable to do any substantial work | Varies by policy; often changes at 24 months |
| Appeals process | SSA reconsideration → ALJ hearing → federal court | Internal appeal → ERISA litigation (U.S.) |
| Attorney fees | Capped by federal law (typically 25% of back pay) | Varies by case and policy type |
| How long it takes | Often 2–3+ years to approval | Varies widely |
Can You Receive Both SSDI and LTD Benefits?
Yes and this is an important point that many people don’t realize.
If you have employer-sponsored LTD coverage and also qualify for SSDI, you can receive both. However, most LTD policies include an “offset provision” meaning the insurance company will reduce your LTD benefit by the amount of SSDI you receive. The net result is that your total income doesn’t necessarily increase, but the cost shifts partially from the insurance company to the federal government.
This is one reason LTD insurance carriers often actively assist (or pressure) claimants to apply for SSDI. It’s not purely out of generosity a successful SSDI award directly reduces what the insurer has to pay.
Understanding how these two systems interact is critical to making sure you’re not leaving money on the table or inadvertently harming one claim while pursuing the other.
What to Do If You’ve Been Denied
Whether it’s SSDI or a private LTD policy, a denial is not the end of the road. Both systems have formal appeal processes, and both are areas where having legal representation dramatically improves your odds.
For SSDI denials in Pennsylvania: The appeals process goes: Reconsideration, ALJ Hearing, Appeals Council, Federal District Court. Most claims that are ultimately approved are won at the ALJ hearing stage. Representation by an experienced SSDI attorney before your hearing is one of the highest-impact decisions you can make.
For LTD denials: If your plan is employer-sponsored, ERISA governs your appeal. This is particularly important because under ERISA, your administrative appeal record becomes the evidentiary record if you later sue — meaning what you submit during the internal appeal process matters enormously. An attorney should be involved before the appeal deadline, not after.
