Most people think disability is disability.
“If you’re approved for one, you’ll be approved for the other.” (That’s not true)
And once you win, the hard part is over. (That’s ALSO not true)
That assumption is dead wrong, and it’s one of the most expensive mistakes people make when dealing with disability benefits.
We’ve represented clients who were approved for Social Security Disability but denied long-term disability benefits. We’ve also seen the reverse.
When that happens, people ask the same question:
“How can I be disabled for one system but not the other?”
The answer is simple.
They are two completely different systems governed by different laws, different standards, and different procedures.
And confusing them can cost you your benefits.
What Is Social Security Disability?
Social Security Disability Insurance (SSDI) is a federal government program.
It is governed by federal statute and administered by the Social Security Administration.
To qualify, you generally must prove that you cannot perform any substantial gainful activity, not just your job, not just your profession, but any work that exists in the national economy.
That is a very high standard.
The process is formal:
- Applications
- Medical record review
- Administrative hearings
- Testimony
- Vocational experts
- Administrative law judges
It is a government-run system with structured procedural protections.
But that system is not the same as long-term disability insurance.
What Is Long-Term Disability (LTD)?
Most long-term disability claims come from private insurance policies offered through employers.
Even though you may live in Virginia, most employer-provided LTD plans are governed by a federal law called ERISA (the Employee Retirement Income Security Act).
That means:
- Virginia insurance law often does not apply
- The policy document controls everything
- Your rights are limited to what the policy allows
And this is where most people get blindsided.
The Most Important Difference: The Policy Controls
In an ERISA long-term disability case, the most important document is not a statute.
It’s the policy.
The policy defines:
- What “disabled” means
- How long benefits last
- What evidence is required
- How and when appeals must be filed
- Whether benefits can be offset
Many policies begin with an “own occupation” definition.
That means you’re considered disabled if you cannot perform the duties of your specific job.
But after a set period — often 24 months — the definition quietly changes.
Now you must prove you cannot perform “any occupation.”
That single change ends a huge number of long-term disability claims.
Different Standards of Disability
Here’s how the standards typically compare:
Social Security Disability
You must prove you cannot perform any substantial gainful activity in the national economy.
Long-Term Disability (Early Phase)
You must prove you cannot perform your own occupation.
Long-Term Disability (Later Phase)
You must prove you cannot perform any occupation for which you are reasonably suited by education, training, or experience.
They sound similar.
They are not.
And the wording inside your specific policy matters more than anything else.
How ERISA Cases Are Decided
Another major difference:
Social Security cases often involve live hearings and testimony. ERISA long-term disability cases usually do not. Most ERISA cases are decided on paper.
There is no jury or live testimony.
There is no second chance to explain yourself in court.
Once your administrative appeal closes, the record is usually locked. If key evidence is missing at that stage, you may never be able to add it later. That is why so many ERISA appeals fail before a judge ever sees the case.
Why a Social Security Approval Does Not Guarantee LTD Benefits
This is one of the biggest misconceptions in disability law.
People assume:
“If Social Security approved me, my long-term disability insurer has to approve me too.”
That is not true.
ERISA insurers are not bound by Social Security’s decision.
They will argue:
- Social Security uses a different legal standard
- Social Security evaluates evidence differently
- The policy language is different
At the same time, insurers will often selectively use parts of your Social Security file against you if it benefits them.
It’s a one-way street.
The Offset Trap Most People Never See Coming
Here’s another surprise.
Many long-term disability policies require you to apply for Social Security.
If you are approved, your LTD benefit is often reduced dollar-for-dollar by your Social Security award.
So after going through a long federal process, you may discover that your total income did not increase at all. You simply shifted payment sources. This is written directly into most ERISA policies.
Why Confusing These Systems Is So Costly
Social Security and long-term disability overlap.
But they do not protect each other.
- An approval in one does not guarantee approval in the other.
- A denial in one does not automatically defeat the other.
- The rules governing them are fundamentally different.
The evidence needed for each system is different.
The appeal process is different.
The legal standards are different.
And the deadlines are different.
Making assumptions about one system based on the other is how people lose benefits they otherwise could have protected.
The Bottom Line
If you are dealing with disability benefits, you need to know:
- Which system applies to you
- What definition of disability controls your case
- Whether ERISA governs your claim
- When your appeal deadline expires
- Whether your policy contains offsets
These are not small technicalities. They determine whether you keep your income.
If your long-term disability claim has been denied, or if you’re unsure how your Social Security claim interacts with your private disability policy, get guidance early.
Because in ERISA cases especially, mistakes made at the claim or appeal stage often cannot be fixed later.
If you want help to know what Long-term disability options you may have, Schedule a FREE strategy session.
