Denied Long-Term Disability? That Denial Does Not Decide Your SSDI Claim

Wanda Glenn worked for Sears. When a heart condition made it impossible to keep doing her job, she filed a claim under her employer’s long-term disability plan, and MetLife approved it.

Then MetLife pointed her toward a law firm and encouraged her to apply for Social Security disability. She did. The Social Security Administration agreed she could not perform her own job or any other job in the national economy, and awarded her benefits, including a retroactive payment.

That award entitled MetLife to an offset. Most of Glenn’s Social Security back pay went to the insurance company.

And then MetLife decided she could work after all, and cut off her benefits.

That sequence went all the way to the United States Supreme Court, which ruled in 2008 that an insurance company deciding claims it also has to pay is operating under a conflict of interest that courts must weigh. But the part of the story worth holding onto is simpler than the legal holding: two systems looked at the same woman and the same medical file, and gave opposite answers.

That happens every day. And it is why one denial should never be the end of the conversation.

Does a long-term disability denial affect your SSDI claim?

No. A private insurer’s decision has no controlling weight at Social Security.

This is written directly into federal regulation. Under 20 CFR § 404.1504, the Social Security Administration acknowledges that other entities — including the Department of Veterans Affairs, the Department of Labor, state agencies, and private insurers — decide disability and employability questions using their own rules. Because those decisions rest on someone else’s rules, the regulation says plainly that they are not binding on the SSA.

So when a disability insurer writes that you are capable of working, that letter does not travel to Social Security and settle anything. Social Security has to run its own analysis, under its own definition.

Why do two systems reach different answers on the same records?

Because they are not asking the same question.

Social Security applies one fixed standard set by statute. Under 20 CFR § 404.1505, you are disabled if a medically determinable impairment prevents you from doing any substantial gainful activity, and that impairment has lasted or is expected to last at least 12 continuous months, or is expected to result in death. In 2026, monthly earnings above $1,690 are generally treated as substantial gainful activity, or $2,830 if you are statutorily blind.

A long-term disability policy is not a statute. It is a contract, and the contract writes its own definition. Most employer-sponsored group policies start with an “own occupation” standard: you qualify if you cannot perform the material duties of the job you actually held. After a set period — typically 24 months — most of those same policies switch to an “any occupation” standard, asking whether you could perform some other work you are reasonably suited for by education, training, or experience.

Which means the two systems are genuinely out of sync. During the own occupation period, a policy can be easier to satisfy than Social Security. After the switch, the standards move closer together, but they still are not identical, and the insurer is still reading its own contract rather than the federal regulations.

What Each System Actually Asks

Does an SSDI denial end your long-term disability claim?

No. It runs the other direction too.

Your insurer is bound by the terms of your policy, not by a Social Security determination. A denial from the SSA does not automatically satisfy the policy’s definition of “not disabled,” and it does not relieve the insurer of its obligation to evaluate your claim on the evidence.

There is a wrinkle worth knowing, though, and it is the reason the Glenn case still matters. Many policies require you to apply for Social Security, because an award lets the insurer offset what it owes you. When an insurer pushes a claimant toward Social Security, collects the financial benefit of an award, and then brushes past the agency’s findings, courts have treated that inconsistency as a problem. It is not an automatic win. But it is a crack worth examining, and most claimants never think to look for it.

What happens to the evidence behind a long-term disability denial?

It follows you, and that is a good thing.

The same regulation that strips a private insurer’s decision of any binding effect says something else in its second half. For claims filed on or after March 27, 2017, Social Security will not analyze the other entity’s decision — but it will consider all of the supporting evidence underlying that decision.

Read that carefully, because it changes how a denial should be handled. The insurer’s conclusion is irrelevant to Social Security. The medical records, functional testing, treating physician opinions, and vocational evidence assembled during that claim are not. A file built for one system can become the foundation for another.

How long do you have to appeal each decision?

Both clocks start when the denial arrives, and they do not run at the same speed.

For most employer-sponsored plans governed by ERISA, federal regulation requires the plan to give you at least 180 days after you receive an adverse benefit determination to file an internal appeal. That appeal is not optional paperwork. It is usually where the record gets built, and skipping it can cost you the right to go to court at all.

Social Security is far shorter: generally 60 days at each level, from reconsideration through the hearing stage and the Appeals Council.

Two points people miss. First, the 180-day figure comes from ERISA, and not every policy is an ERISA plan — individually purchased policies, church plans, and many government plans fall outside it, so the deadline comes from the policy itself. Second, an “adverse benefit determination” is not just a flat rejection. A reduction or a termination of benefits already being paid counts too, which means a cutoff at the 24-month mark carries the same appeal rights as an initial denial.

What other benefits stay open after a denial?

More than most people assume. Depending on your work history, your policy, and your service record, the paths still available may include Supplemental Security Income, a state temporary or short-term disability program, waiver of premium coverage buried in a life insurance policy, workers’ compensation, disability provisions inside a pension or retirement plan, and, for veterans, benefits through the VA.

None of these are decided by the system that just told you no.

Where claimants get hurt moving between systems

Two things cause real damage, and both are avoidable.

The first is inconsistency. What you tell an insurer about your work capacity, what you report to Social Security, and what your medical records say all need to line up. Contradictions surface later, and they surface at the worst possible time.

The second is the offset. If your policy required you to apply for Social Security and you later win a retroactive award, the insurer will typically expect repayment for the period it already covered. That bill can arrive as a lump sum and catch people completely off guard. It is manageable when it is anticipated, and painful when it is not. You can read more about this by clicking on our article LTD and SSDI at the Same Time.