Yes. You can qualify for long-term disability benefits for serious mental health conditions if those symptoms keep you from doing your job.
Mental health does not clock in and out. It does not care about a 9 a.m. meeting at Liberty Place or a packed ride on SEPTA. If you are fighting depression, anxiety, PTSD, bipolar disorder, or another serious condition, you already know how heavy a workday can feel.
This page explains how LTD claims for mental health work in Philadelphia, why insurers push back, and what actually moves the needle.
Why do mental health LTD claims get denied so often?
Insurers like problems they can see. A broken bone. A scan. A lab value. Mental health is different. There is no X-ray for panic. No blood test for flashbacks. That gap is where denials live.
Plenty of Pennsylvanians live with mental health conditions. Many still get told their symptoms are “not severe enough.” I have seen it for years. It is common. It is frustrating. It is also beatable with the right proof.
What conditions can qualify in Pennsylvania?
Not every rough patch at work qualifies. Serious, ongoing conditions can. For example:
- Major depression that wipes out focus and energy.
- Anxiety or panic that makes leaving the house feel impossible.
- PTSD that brings on nightmares, hypervigilance, or shutdowns.
- Bipolar disorder with cycles that derail routine.
- Schizophrenia or other psychotic disorders that impair daily life.
The label matters less than the impact. The question is simple. Can you perform your job duties reliably and safely?
What evidence actually helps in a mental health LTD claim?
You need a record that tells a true story. Neat charts with “patient stable” do not help. Honest notes do.
- Treatment records. Regular visits with a psychiatrist or therapist. Penn, Temple, Jefferson, or a trusted community clinic. The notes should show symptoms, side effects, and real-world limits.
- Testing when available. Neuropsych testing for memory and attention. Functional testing for stamina and pace. These are not perfect, but they give structure to your story.
- People who know you. A spouse who sees the hard mornings. A friend who drives you to therapy. A coworker who watched the decline. Short, specific statements beat generic praise every time.
- Work proof. Attendance. Performance drops. Write-ups. Schedule changes that did not work. Save what you can.
If you stopped treatment, explain why. Cost. Transportation. Side effects. Burnout. Do not leave a blank space. Insurers treat blanks like “I got better.”
What mistakes sink good claims?
Silence. Social media that looks like a highlight reel. Minimizing symptoms in the exam room because you do not want to sound dramatic. I understand why people do all three. Insurers use all three against you.
Be honest with your providers. Keep your posts private and plain. If there is a gap in care, write down the reason.
Why do insurers fight mental health claims so hard?
Money. Mental health conditions can last a long time. A long claim costs them more. Many people feel overwhelmed and do not appeal. Denials go out. Some claims go away. That is the business model.
Deadlines you cannot miss
Most employer LTD policies require notice and proof within 180 days of disability. Mental health makes the “start date” messy. Was it the first panic attack that kept you home. The month you could not get out of bed. Do not wait for the perfect date. If work is no longer sustainable, file and document why.
Can you work part-time and still receive LTD?
Sometimes. Some policies pay partial benefits when you can work fewer hours but not full time. If anxiety caps you at twenty hours a week at a hospital job or office role, the policy may allow a partial benefit. Read the policy. Then get advice before you change your schedule.
What if your claim gets denied?
You can appeal. You usually have 180 days. The appeal is not a quick call. It is your last chance to load the file with evidence. After that, if the case goes to federal court, you are often stuck with what is already in the record. Build the record now.
How does ERISA change the rules?
If your policy comes through an employer, ERISA likely applies. ERISA keeps these cases in federal court. The review is limited. The process is technical. Strategy matters. So does the paper trail.
A Philadelphia point that helps
Treatment at respected centers helps credibility. Penn Medicine. Temple. Jefferson. CHOP for younger claimants. Community providers can be excellent too. What matters most is consistency and detail. Who you see. How often. What changed. What did not.
The 24-month cap for mental health
Many LTD policies limit benefits for mental health conditions to 24 months. It is a common clause. It is harsh. Pennsylvania has not banned it. Plan ahead. If you also have physical conditions that meet the definition of disability, document those too. The wording of your policy controls.
Can you receive both SSDI and LTD?
Yes. Many people do. Most LTD policies offset SSDI, which means the LTD payment may go down if you win SSDI. It can still be worth it. SSDI can bring Medicare after 24 months, which matters for long-term care.
Choosing a lawyer for a mental health LTD claim
Look for real experience with mental health denials and ERISA. Look for someone who listens. You should feel heard. You should leave the call with a plan. No judgment. No shame.
The bottom line
You paid for coverage so you would not have to choose between your health and your paycheck. If your mind and body are telling you it is time to stop, listen. Then put a record together that proves it.
My team and I have helped many people in Philadelphia through this exact fight. If you are staring at a denial letter, or you are about to file and want to do it right, we are here.
Call 1-800-CANT-WORK. Visit 1800CANTWORK.com. Send an email to contact@ericshore.com. We will handle the insurer. You focus on getting better.
