I Won Social Security Disability. Why Did My LTD Insurer Deny Me?
A Social Security disability award does not bind your long-term disability insurer. The two programs use different definitions of disability, and an insurer may reach a different conclusion. But it may not simply ignore the award. For disability claims filed after April 1, 2018, the denial must explain why the insurer disagrees with a Social Security determination you gave it. Courts have repeatedly found denials unreasonable when the insurer required you to apply for Social Security, took a credit for your award, and then never explained why it reached the opposite conclusion.
What decides your case is less whether you won Social Security than when the award was made, whether the insurer actually had it, and what the denial letter says about it.
Why your insurer is allowed to disagree
The Supreme Court explained the basic difference in Black & Decker Disability Plan v. Nord, 538 U.S. 822 (2003). In a Social Security case, the agency “measures the claimant’s condition against a uniform set of federal criteria.” An ERISA disability claim, by contrast, turns largely on the terms of your particular plan. Employers have “large leeway” to write those terms as they choose.
So courts consistently hold that a Social Security award is evidence of disability, not a ruling the insurer must follow. In Pari-Fasano v. ITT Hartford Life & Accident Insurance Co., 230 F.3d 415 (1st Cir. 2000), the First Circuit upheld Hartford’s termination even though the claimant had a Social Security award, noting that the agency’s criteria are “substantively different” from those of many insurance plans.
The differences are real, and an honest assessment of your claim starts with them:
| Issue | Social Security disability | Typical group LTD policy |
|---|---|---|
| What you must be unable to do | Any “substantial gainful activity” in the national economy, under 42 U.S.C. § 423(d). | Usually your own occupation for the first 24 months, then “any occupation” as the policy defines it, often tied to a percentage of your prior earnings. |
| Your age | Counts. From age 50, the agency’s rules treat age, together with a severe impairment and limited work experience, as potentially affecting the ability to adjust to other work. From 55, age “significantly affects” it (20 C.F.R. § 404.1563). | Usually not a factor unless the policy says so. |
| Duration | The impairment must have lasted, or be expected to last, at least 12 months, or to result in death. | Set by the policy: an elimination period, typically measured in weeks or months, then continuing proof of disability. |
| Your doctors’ opinions | For claims filed on or after March 27, 2017, no automatic controlling weight (20 C.F.R. § 404.1520c). | No special deference required (Nord). |
| The date that matters | The onset date and the period the agency reviewed. | The dates in the insurer’s decision, which may be years after the agency’s award. |
One older explanation insurers give, that Social Security defers to treating physicians and plans do not, carries less force for awards on claims filed on or after March 27, 2017, when the agency stopped giving treating-source opinions controlling weight.
Why your insurer still can’t ignore the award
Federal regulations require more than a bare statement that Social Security is different. For disability claims filed after April 1, 2018, a denial must include “a discussion of the decision, including an explanation of the basis for disagreeing with or not following” a disability determination by the Social Security Administration that you presented to the plan (29 C.F.R. § 2560.503-1(g)(1)(vii)(A)). When the Department of Labor adopted the rule, it explained that a plan does not have to defer to the agency, but “a discussion of the actual differences would be necessary.”
The courts had been heading the same way for years. The pattern that draws the most scrutiny is one many claimants recognize: the policy reduces your benefit by any Social Security award, the insurer requires you to apply or refers you to an advocate to help, it collects the offset or the back-benefit overpayment, and then it decides you can work after all.
“[T]he court found questionable the fact that MetLife had encouraged Glenn to argue to the Social Security Administration that she could do no work, received the bulk of the benefits of her success in doing so (the remainder going to the lawyers it recommended), and then ignored the agency’s finding in concluding that Glenn could in fact do sedentary work.”
Metropolitan Life Insurance Co. v. Glenn, 554 U.S. 105, 118 (2008)
The Supreme Court said that sequence was “an important factor in its own right” because it suggested procedural unreasonableness. The federal circuits have applied the same reasoning:
Montour v. Hartford Life & Accident Insurance Co. (9th Cir. 2009) Benefits reinstated
The plan required Montour to apply for Social Security, and Hartford took a dollar-for-dollar offset. Hartford acknowledged the award but did not explain why the agency might have reached a different conclusion. The Ninth Circuit held Hartford abused its discretion. 582 F.3d 933, amended, 588 F.3d 623.
Salomaa v. Honda Long Term Disability Plan, 642 F.3d 666 (9th Cir. 2011) Benefits awarded
The plan never addressed the Social Security award. “Weighty evidence may ultimately be unpersuasive, but it cannot be ignored.” Id. at 679.
Calvert v. Firstar Finance, Inc., 409 F.3d 286 (6th Cir. 2005) Judgment for claimant
Liberty sought and received reimbursement from the award, but its file reviewer did not mention the award “at all, even to discount or disagree with it.” The award, the court said, “though certainly not binding, is far from meaningless.” Id. at 294, 296.
Ladd v. ITT Corp., 148 F.3d 753 (7th Cir. 1998) Judgment for claimant
MetLife encouraged the application and provided a lawyer for it, then denied the claim. The insurer had “repudiated the basis of their first victory in order to win a second victory.” Id. at 756.
Bennett v. Kemper National Services, Inc., 514 F.3d 547 (6th Cir. 2008) Sent back for new review
The plan’s administrator referred Bennett to a Social Security advocacy firm and told her LTD benefits would be reduced by any award. The administrator’s silence about the award weighed against it, and the case was remanded for a full and fair review.
None of these courts held that the award required payment. Each held that an insurer with the award in front of it, especially one that benefited from it, has to address the award and explain why it reached a different conclusion.
Pick the situation closest to yours
The same Social Security award can carry real weight in one case and almost none in another. Timing and the record usually decide which.
Select a situation to see what courts have done and what to do next.
This is where an award carries the most weight
What courts have doneWhen the insurer had the award and did not engage with it, courts in Montour, Salomaa, and Calvert treated that silence as evidence of an unreasonable decision. It counts for more if the insurer required the application or took the offset (Glenn). In Zayn v. Unum (D. Or. Sept. 15, 2026), the court reviewed the claim de novo, treated a Social Security award that continued through the relevant period as “probative evidence” of disability, and ordered benefits reinstated.
What to doRead what the denial actually says about the award. If the claim was filed after April 1, 2018 and the letter offers no real explanation, or only says the insurer is “not bound,” that gap belongs in the appeal. So does any offset or overpayment the insurer collected.
A mention is not evidence
What courts have doneIn Germana v. Hartford (D. Mass. Sept. 21, 2026), Hartford’s denial letter invited the claimant to send his Social Security information. The appeal referred to the award but did not include the decision. Hartford’s appeal reviewer explained that the standards differ, and the court entered judgment for Hartford.
What to doIf your appeal is still open, send the complete decision, not just the award letter, along with the medical and vocational evidence the agency relied on. The regulation’s duty to explain applies to a determination you presented to the plan.
An old award still counts, but it needs current support
What courts have doneIn Young v. Aetna (D. Minn. Sept. 24, 2026), Social Security had found the claimant disabled in 2018. Aetna terminated benefits in 2023. The court gave the award “some weight,” but noted the agency had not revisited it since 2018 and likely had not seen the evidence Aetna relied on. The termination was upheld.
What to doPair the award with current evidence: recent treatment records, updated functional assessments, and anything showing your condition has not improved since the agency decided. If Social Security has reviewed and continued your benefits since, get that record.
Timing can keep the award out of the case
What courts have doneCourts usually review the record the insurer had when it decided. In Cusson v. Liberty Life Assurance Co. of Boston, 592 F.3d 215 (1st Cir. 2010), the award came after Liberty’s decision, and the First Circuit found nothing suspicious in Liberty’s not crediting it. Some courts will consider later evidence for good cause, but that varies by circuit and standard of review.
What to doCheck whether your appeal is truly final, and whether the plan offers a voluntary further appeal. Have the lawsuit deadline calculated now. Whether the award can be used in court is a question to answer before filing, not after.
Building an appeal around a Social Security award
Our Litigation Back Approach starts from what a federal judge would need to see, then builds the appeal to contain it. Courts usually decide ERISA cases on the administrative record, so evidence left out of the appeal may never be considered. For a claimant with a Social Security award, that means:
Get the whole Social Security file, not just the award letter
The decision, the evidence list, and any consultative examination reports show why the agency found you disabled. That reasoning is what forces the insurer to answer on the merits.
Find out why the agency ruled for you
If the award rested on your medical limitations, it speaks directly to the insurer’s question. If it rested mainly on age under the agency’s vocational rules, the insurer will argue it doesn’t, so the appeal needs its own vocational evidence.
Line up the dates
Compare the agency’s onset date and the period it reviewed with the insurer’s elimination period, the 24-month own-occupation period, and the termination date. A mismatch is the insurer’s easiest answer; close it with evidence.
Show what the insurer gained from the award
Document any requirement to apply, any referral to an advocate, the offset, and any overpayment collected. Under Glenn, that history bears on whether the denial was reasonable.
Hold the denial to the regulation
For claims filed after April 1, 2018, ask whether the letter actually explains the disagreement. Point out what is missing in the appeal, while there is still time for the insurer to fix it or for its failure to become part of the record.
If Social Security paid you back benefits, expect your insurer to claim that the same months were overpaid under the policy’s offset provision. Read the policy’s overpayment and reimbursement terms before you spend or move that money, and get advice before signing any reimbursement agreement.
Why claimants bring these denials to Dorian Law
- This is the whole practice. Long-term disability, life, and accidental death insurance denials and ERISA benefit disputes are all Dorian Law does. Brent Dorian Brehm has represented claimants since 2006 and has resolved more than 500 benefit disputes.
- Claimants with a Social Security award are a regular part of our disability practice. We obtain the Social Security file, compare the agency’s findings with the policy’s definition and dates, and build the appeal around the gap the insurer has to explain.
- We take cases to federal court. In Cobb v. Chevron (N.D. Cal. 2025), we won de novo review by showing the plan never properly delegated discretion to its claims administrator.
- A free consultation, then contingency. Send the denial letter and your Social Security decision. We tell you what the record shows and whether we can help. Accepted disability matters are handled on a contingency fee under a written agreement.
To check the rest of your denial letter against federal requirements, use our denial letter checklist.
Frequently asked questions
No. Courts hold that a Social Security award does not bind an ERISA plan, because the agency applies uniform federal criteria while your claim turns on your plan’s terms (Black & Decker Disability Plan v. Nord, 538 U.S. 822 (2003)). The award is evidence of disability, and courts have found denials unreasonable when the insurer ignored it, as in Salomaa v. Honda Long Term Disability Plan, 642 F.3d 666 (9th Cir. 2011).
For disability claims filed after April 1, 2018, yes, if you presented the Social Security determination to the plan. 29 C.F.R. § 2560.503-1(g)(1)(vii)(A) requires a discussion of the decision, including the basis for disagreeing with or not following the Social Security Administration’s disability determination. The Department of Labor said a plan need not defer to the agency, but must discuss the actual differences.
The insurer may still disagree with the agency, but courts scrutinize that sequence closely. In Metropolitan Life Insurance Co. v. Glenn, 554 U.S. 105, 118 (2008), the Supreme Court said that encouraging the application, taking most of the back benefits, and then ignoring the agency’s finding suggested procedural unreasonableness. The Ninth Circuit in Montour v. Hartford (2009) and the Seventh Circuit in Ladd v. ITT Corp. (1998) ruled for claimants on similar facts.
The programs ask different questions. Social Security considers age, education, and work experience, and its rules give increasing weight to age from 50, and more from 55, in deciding whether you can adjust to other work (20 C.F.R. § 404.1563). Most LTD policies instead apply their own definition of disability, often own occupation for 24 months and then any occupation, and the insurer may be deciding a different time period than the agency did.
Yes, and send the full decision and the evidence behind it, not just the award letter. Courts usually decide ERISA cases on the record the insurer had. In Germana v. Hartford (D. Mass. Sept. 21, 2026), the appeal mentioned the award but did not include the decision, so the record held no specific information about it. The court entered judgment for Hartford.
It can, but a court may give an older award less weight when the insurer relies on newer evidence the agency never saw. In Young v. Aetna (D. Minn. Sept. 24, 2026), the court gave a 2018 award some weight but upheld a 2023 termination, noting the agency had not revisited its decision. Pair an older award with current medical and functional evidence.
Most group LTD policies reduce benefits by Social Security disability payments, so a retroactive award often produces an overpayment claim for the same months. Your rights depend on the policy’s offset and reimbursement terms and on how the money has been held. Review those terms before spending the back pay or signing a reimbursement agreement.
Dorian Law P.C. represents long-term disability claimants nationwide in ERISA appeals and federal lawsuits, including claimants whose insurer denied or terminated benefits despite a Social Security award. Brent Dorian Brehm has represented claimants since 2006. The firm builds appeals using its Litigation Back Approach. Free consultations: dorianlaw.com/contact or (747) 297-7409.
Send us the denial letter and your Social Security decision
We’ll compare what the agency found with what your insurer decided, check the denial against the federal requirements, and tell you whether we can help. Disability appeals have deadlines, usually at least 180 days from when you receive the denial for an ERISA-governed disability plan, so start early.
This article is general information, not legal advice, and reading it does not create an attorney-client relationship. Outcomes depend on the policy language, the evidence, the standard of review, and the governing law. Case descriptions reflect the linked opinions as of October 2026 and do not report later history. Past results do not guarantee a similar outcome.