If Lyme disease prevents you from continuing at your job, you may be eligible for disability benefits. Some employers offer long‑term disability (LTD), which is private insurance with its own rules. In contrast, Social Security Disability Insurance (SSDI) is a federal program, which covers a much larger portion of the work force. In the following article, two specialists in disability law explain the differences between the two.

By Jennifer Manger and Jennifer Hess

It is possible for someone with Lyme disease to be approved for long term disability benefits and denied Social Security Disability Insurance (SSDI). The opposite can happen too.

That can be hard to make sense of. The person may have the same diagnosis, the same doctors, and the same symptoms in both claims. But the two systems look at disability differently.

Long term disability insurance is governed by the terms of the policy. SSDI follows federal rules. The two systems also differ in how they look at work, what happens after a denial, how often an approved claim is reviewed, and how the benefits can affect each other financially.

For people with Lyme disease, those differences matter. Fatigue, brain fog, pain, dizziness, headaches, and worsening symptoms after activity can make regular work difficult even when a person can still do some everyday things.

The best place to start is with the criteria each system uses.

Long term disability usually starts with your own occupation

Most employer-sponsored long term disability policies begin with an “own occupation” definition of disability.

The exact wording varies, but the insurer generally considers whether your medical condition prevents you from performing the important duties of the occupation you were doing when you became disabled.

That can matter a lot for someone with Lyme disease.

Consider a financial executive whose job involves long days, detailed analysis, frequent meetings, quick decision-making, and hours of computer work. She develops significant fatigue, cognitive slowing, headaches, joint pain, and worsening symptoms after mental or physical activity. She can still drive short distances. She can prepare meals. She can use a computer for a while. She may even meet a friend for dinner on a good day.

But she can no longer follow complex discussions for hours, work through a full day of meetings, process large amounts of information quickly, or maintain that pace five days a week.

Under an own-occupation LTD policy, the question is not whether she can do anything. The question is whether she can still perform her occupation.

Then the LTD definition may change

Many long term disability policies change the definition of disability after a set period, often around 24 months. The policy may then move to an “any occupation” standard.

At that point, the insurer may look beyond your former occupation and ask whether you could perform some other occupation based on factors such as your education, training, experience, and sometimes your prior earnings.

This can be a major turning point in a Lyme disease long term disability claim.

Someone may receive benefits for two years and then face a new medical and vocational review, even if their health has not improved.

SSDI uses a different set of rules

SSDI does not use the same own-occupation-to-any-occupation structure.

Social Security uses a five-step process. Among other factors, it looks at whether the person is working at a substantial gainful level, whether there is a severe medically determinable impairment, whether the condition meets certain medical criteria, whether the person can perform past relevant work, and, when necessary, whether the person can adjust to other work.

That last step is important.

Being unable to return to your former job does not necessarily mean Social Security will find you disabled. Social Security may still consider whether there is other work you could perform despite your limitations. This is especially relevant if you are under the age of 50 at the time of your onset date as addressed below.

That is one reason an individual may qualify for long term disability benefits due to Lyme disease under an LTD policy while being denied SSDI benefits.

Age can matter in an SSDI claim

Age is also part of Social Security’s vocational analysis.

When Social Security considers whether someone can adjust to other work, it looks at age together with functional limitations, education, and work history.

In general, Social Security treats people under 50 as younger individuals, ages 50 through 54 as closely approaching advanced age, and age 55 or older as advanced age.

Turning 50 or 55 does not automatically qualify someone for SSDI. However, age can affect Social Security’s analysis of whether an individual can adjust to other types of work. As a result, a 42-year-old and a 58-year-old with similar medical and functional limitations may be evaluated differently when Social Security considers their ability to transition to other work.

Most LTD policies do not use Social Security’s age-based framework. The LTD insurer applies the terms of the policy.

Lyme disease can be difficult to fit into either system

Despite the differences, SSDI and long term disability claims have one major issue in common: A Lyme disease diagnosis by itself does not tell the decision-maker whether someone can work.

Two people can have the same diagnosis and function very differently. One may continue working full time. Another may have severe fatigue, cognitive problems, dizziness, pain, headaches, or worsening symptoms after activity that make regular employment unrealistic.

That is why disability claims often come down to function.

How long can the person concentrate?

How much activity causes symptoms to increase?

How often are there bad days?

Does the person need to rest during the day?

Can the person maintain a regular schedule without excessive absences and unscheduled breaks?

Those details often matter more than the diagnosis alone.

Doing something once is not the same as being able to work

This is especially important in Lyme disease disability claims.

A person may still grocery shop, drive to appointments, attend an occasional family function, or go out to dinner. That does not necessarily mean they can work full time. Someone may be able to grocery shop for 30 minutes and then need to rest for several hours. Someone else may attend an important event and spend much of the next day recovering. A person with cognitive symptoms may be able to answer a few emails but be unable to concentrate effectively for an eight-hour workday.

Work requires consistency. The better question is: Can the person perform work activities reliably, repeatedly, and on the schedule an employer expects?

For many people with Lyme disease, that is where the real difficulty lies.

Good days do not erase bad days

Lyme symptoms can fluctuate.

A person may look relatively well at one appointment and be struggling a few days later. Brain fog may be manageable one morning and much worse that afternoon. Physical activity may feel tolerable at the time but cause increased symptoms later.

A fair disability assessment should look at the overall pattern.

How often do the bad days occur?

How long does recovery take?

Would the person miss work, leave early, or need unscheduled breaks?

Could the person maintain normal productivity throughout the week?

Those questions help show whether someone can function reliably enough to work.

Medical records do not always tell the whole story

Doctors appropriately focus on diagnosis and treatment rather than documenting restrictions and limitations for the purpose of disability claim paperwork.

That means a medical chart can contain pages of information about symptoms, medications, testing, and treatment plans without saying much about work capacity. In a disability claim, that can leave an important gap between documenting the medical condition and demonstrating its functional impact. A doctor may understand that a patient’s cognitive fatigue prevents sustained work but never write that down.

Or the doctor may describe the patient as “stable,” meaning the condition has not changed much. A disability insurer may read the same word and take it to mean the patient is doing well.

For Lyme disease disability claims, medical records are often most helpful when they explain not only what the diagnosis is, but what activities the symptoms actually prevent the person from doing.

A statement such as “patient remains disabled due to Lyme disease” gives very little detail. A stronger explanation might say that the patient cannot sustain concentration for prolonged periods, needs unpredictable periods of rest during the day, or experiences increased symptoms after extended mental or physical activity.

That helps connect the medical condition to the work problem.

The appeal processes are very different

The difference between SSDI and long term disability becomes even clearer after a denial.

Long term disability claims are generally handled on paper. The insurance company reviews medical records, claim forms, occupational information, testing, and other written evidence. It may also obtain reviews from its own doctors or vocational consultants.

For many employer-sponsored LTD plans governed by ERISA, the claimant has an administrative appeal process after a denial. There usually is no live hearing where the claimant sits down with the insurer and explains what happened. That makes the written record especially important.

SSDI has a different process.

After an initial denial, a claimant can generally request reconsideration of their claim. If the claim is denied again, the claimant can request a hearing before a federal administrative law judge.

That hearing gives the claimant an opportunity to testify directly about symptoms and limitations.

For someone with Lyme disease, that can be meaningful. It may be easier to explain in testimony that a short errand causes hours of increased symptoms than to hope that point is obvious from a medical chart.

The timing can be different too

Neither process is necessarily quick.

Long term disability claims and appeals generally operate under contractual and regulatory time deadlines, although insurers may request additional information or extensions.

SSDI cases can take longer than LTD claim reviews, particularly when an SSDI claim proceeds through an initial denial, reconsideration, and ultimately a hearing. Unlike LTD claims, the Social Security disability process does not generally operate under strict, stage-specific deadlines requiring a decision to be issued within a particular period of time.

That means someone with Lyme disease may have an LTD claim and an SSDI claim moving at the same time, but on very different schedules.

LTD insurers usually ask for more ongoing updates

An LTD approval usually does not end the process.

The insurance company continues managing the claim and may periodically ask for updated medical records, new physician forms, claimant questionnaires, treatment information, or additional examinations.

For someone receiving Lyme disease long term disability benefits for years, those requests can become a regular part of the claim.

Social Security also reviews approved claims, but usually through periodic and typically less frequent Continuing Disability Reviews rather than the same kind of ongoing private claim management.

So someone receiving both LTD and SSDI may hear from the LTD insurer much more often.

Why does my LTD insurer want me to apply for SSDI?

The answer often comes down to money.

Many long term disability policies allow the insurer to reduce its payment by certain other income, including SSDI benefits. This is commonly called an offset.

Suppose the LTD benefit is $6,000 per month and the person is later awarded $2,500 per month in SSDI.  Depending on the policy, the LTD insurer may be allowed to reduce its payment by some or all of that amount.

That explains why an LTD insurer may encourage, or sometimes require, someone to apply for SSDI. The insurer may benefit financially if Social Security approves the claim.

Be careful with retroactive SSDI benefits

SSDI awards can also include past-due benefits. That can create another issue for someone already receiving LTD.

If the LTD insurer paid full benefits while the SSDI claim was pending, and Social Security later awards retroactive benefits covering some of those same months, the insurer often treats the overlapping amount as an overpayment and will seek reimbursement under the terms of the LTD policy.

That can come as a surprise.

A large SSDI payment may arrive, but some of it may ultimately be owed back to the LTD insurer depending on the policy.

Does an SSDI approval help a Lyme disease long term disability claim?

It can.

An SSDI award means Social Security reviewed the claim under its rules and found the person disabled, which can often be a more stringent standard than the standard under an LTD policy. That can be important evidence in an LTD claim.

But it does not automatically require the LTD insurer to approve benefits.

The reverse is also true. An LTD approval does not automatically mean Social Security will approve SSDI.

It is often more useful to look at why the person was approved.

Did Social Security accept cognitive limitations?

Did it accept physical restrictions?

Did it find that the person could not perform past work?

Those findings may still be useful in the LTD claim even though the standards are different.

What evidence can help both claims?

Although SSDI and LTD are different systems, much of the underlying evidence can overlap.

Helpful evidence may include:

• Medical records showing symptoms over time
• Detailed statements from treating providers
• Cognitive or functional testing when appropriate
• Documentation of fatigue or worsening after exertion
• Medication side effects
• Evidence of failed attempts to keep working or return to work
• Information about the actual demands of the person’s occupation
• Evidence addressing concentration, stamina, attendance, pace, and reliability

The goal is not to create the biggest possible file. It is to create one that makes sense.

Someone reviewing the claim should be able to understand the connection between the illness, the symptoms it causes, and the problems those symptoms create in a work setting.

Which is harder: SSDI or long term disability for Lyme disease?

There is no single answer.

Someone in a demanding profession may have a strong own-occupation LTD claim even if Social Security believes the person could adjust to other work.

For SSDI, age and other vocational factors may become important.

An LTD claimant may have to deal with policy exclusions or limitations that do not exist in SSDI.

An SSDI claimant may have to go through several levels of review before getting a hearing.

And after an LTD claim is approved, the insurer may continue asking for updated medical evidence for years.

So it usually does not help to think of one system as easier than the other. They are different systems asking different questions.

The bottom line

Lyme disease LTD claims and SSDI claims often involve the same person, the same doctors, and much of the same medical evidence.

But they are not the same claim.

Many LTD policies begin by asking whether the person can perform their own occupation and later change to an any-occupation definition.

SSDI uses federal rules and, when appropriate, considers whether the person can adjust to other work based on factors that include functional capacity, age, education, and work history.

The procedures differ too. LTD appeals usually depend heavily on a written record. SSDI claimants can eventually have a hearing before an administrative law judge. LTD insurers also tend to request more ongoing documentation after approval, while Social Security uses periodic reviews.

But both systems eventually come back to the same practical question: What can this person actually sustain?

For someone with Lyme disease, the answer may not be obvious from a diagnosis or a single medical test.

It may be found in the pattern of fatigue after activity, the difficulty maintaining concentration, the need for rest, the frequency of symptom flares, or the difference between being able to do something for an hour and being able to do it day after day.

That is why good disability evidence does more than show that someone has Lyme disease. It helps explain how Lyme disease affects that person’s ability to function reliably at work.

This article is for informational purposes only. It is not legal advice and does not create an attorney-client relationship. Disability insurance policies vary, and anyone dealing with a claim should consider seeking guidance based on their specific policy, medical condition, occupation, and claim history.

Jennifer Hess and Jennifer Manger are attorneys at Riemer Hess LLC, a New York City law firm focused on disability insurance claims. Riemer Hess attorneys have contributed other educational pieces for LymeDisease.org, including Filing a Lyme disability claim? Here’s what you need to know (2026) and 10 tips for Lyme disability insurance claims (2022). Additional information about evidence used in Lyme disease disability claims is available in Riemer Hess LLC’s educational FAQ, Lyme Disease and Long Term Disability: What Evidence Matters.