If you’re filing a long-term disability (LTD) claim for depression, anxiety, PTSD, or another mental health condition, you may have heard that these claims are harder to win than physical ones. The reality is more nuanced — and more hopeful — than that common assumption suggests.
The 24-Month Rule You Need to Know
Before diving into how mental health claims are evaluated, there’s a critical policy feature to understand. According to the U.S. Department of Labor, only 1% of group disability policies sold in the U.S. do not have mental health and substance use disorder limitations, which typically limit the duration of benefit payments.
In practice, this means that under most employer-sponsored LTD plans governed by ERISA, benefits for conditions like anxiety, depression, and PTSD are capped at 24 months — regardless of whether your condition continues beyond that point. Physical disability claims, by contrast, generally pay benefits until retirement age.
This distinction matters enormously when planning your claim. Knowing your policy’s specific language before you file can shape your entire strategy.
How Disability Is Actually Defined
Most group LTD policies define disability as the inability to perform the material and substantial duties of your own occupation due to sickness or illness — typically for the first 24 months. After that period, the standard usually shifts to whether you can perform any occupation. This “own-occ vs. any-occ” distinction is central to how your claim will be evaluated.
Here’s the key insight that many claimants miss: the diagnosis itself isn’t what wins or loses your case. What matters is functional impairment — how your condition actually interferes with your ability to do your job.
Take a lawyer with severe anxiety disorder as an example. The relevant question isn’t simply “does this person have anxiety?” but rather: does that anxiety prevent them from concentrating on a client’s case, analyzing complex fact patterns, or sustaining the cognitive focus required to do their work? If the answer is yes, and that can be documented, the claim has merit.
The same logic applies to any occupation. A school teacher with severe anxiety who can’t maintain attendance, manage a classroom, deliver lessons, or grade tests may have just as strong a claim as someone with a physical injury preventing them from standing all day.
Mental Health Claims Can Win — with the Right Evidence
The good news is that mental health conditions can be just as disabling as physical ones under the law, and claims based on them can and do succeed. Strong medical documentation matters even more for mental health claims — treatment providers should document not just the diagnosis, but the functional limitations, including how the condition affects the ability to concentrate, interact with others, maintain a schedule, handle stress, and perform work-related tasks.
Useful evidence in a mental health LTD claim includes:
- A detailed letter from your treating physician explaining how your condition limits your ability to perform your job’s specific duties
- A completed functional capacity form — either one provided by the insurer or a customized version tailored to your condition
- Statements from colleagues or supervisors who have observed the impact of your condition on your work performance
- Your own written statement describing what you can no longer do and why
- Underlying medical records or a narrative summary prepared by your doctor
- Objective testing, such as cognitive function evaluations, where applicable
One Additional Caution
Insurers will often attempt to frame disabilities as mental illnesses rather than physical ones where there is some uncertainty around the true cause of the condition— precisely because the two-year cap works in their financial favor. If your disability involves both physical and mental health components, how your claim is characterized can have significant consequences for how long you receive benefits.
The bottom line: a mental health LTD claim is winnable, but it requires careful documentation of functional impairment — not just a diagnosis — and a clear understanding of your policy’s terms from the start.
RELATED POST: How to Avoid Being Misclassified Under a Mental Health Limitation
Was Your LTD Claim Denied? Ortiz Law Firm Can Help.
A denial isn’t the end of the road. At Ortiz Law Firm, we help people across the country fight back against wrongful long-term disability denials — including claims based on mental health conditions. Our team understands the tactics insurers use to limit or terminate benefits, and we know how to build the evidence-backed case you need to appeal.
If your LTD claim has been denied or your benefits have been cut off, contact Ortiz Law Firm today for a free consultation. You’ve paid for this coverage — let us help you fight for it.