Most people with long-term disability coverage assume their policy will pay out if they cannot work. For women, that assumption carries more risk than they realize. Research confirms that women with genuine, work-limiting disabilities are denied benefits more often than men with the same conditions — not randomly, but for specific, structural reasons that appear at predictable points in the claims process.
Women pay more for coverage and get denied more often
Individual disability insurance premiums run significantly higher for women than men. Insurers charge more because women file more claims and are out of work longer. The market acknowledges that women are more likely to become disabled. But what happens after they file tells a different story.
Peer-reviewed research by economists Hamish Low of Oxford and Luigi Pistaferri of Stanford found that women with genuine, work-limiting disabilities are 12.8 percentage points more likely to be wrongfully denied than men with comparable health conditions and demographics. Critically, the disparity did not arise at the point of determining whether a disability existed. It arose at the next question: can this person still do some kind of work? When evaluators looked at that question, they consistently concluded that women — even women with the same conditions as men — had more ability to keep working than the evidence supported. That assumption, applied systematically, is what drove the higher denial rate. Although this research examined Social Security Disability Insurance, not LTD benefits, the same reasoning appears throughout private and ERISA-governed claims.
The consequences for women are severe: those denied disability insurance despite being unable to work have very few alternatives to support themselves and their dependents long-term.
Three specific ways the process works against women
1. The conditions women most often claim are the hardest to prove
Insurers are more comfortable approving claims with objective, measurable findings. A tumor, a fracture, a documented cardiac event — these are straightforward to document. Autoimmune disease is not.
70-80% of autoimmune disease patients are women. Conditions like lupus, rheumatoid arthritis, and multiple sclerosis are serious and often profoundly disabling — but they fluctuate, they can be invisible on standard imaging, and they depend substantially on what a patient reports about her own experience. Women also file at higher rates for mental health conditions, which most group LTD policies limit to 24 months under “mental/nervous” provisions, and for musculoskeletal conditions, where imaging routinely understates actual loss of function.
An executive with lupus, an attorney with a debilitating autoimmune condition, a surgeon whose rheumatoid arthritis prevents her from operating — these are not borderline cases. They are exactly the kind of claims that can get denied because the disability is real, but the proof is complicated.
2. Women’s symptoms are more likely to be undertreated — and underrecorded
Under ERISA, which governs most employer-sponsored long-term disability plans, claimants must exhaust the insurer’s full internal appeal process before filing a lawsuit. By the time a case reaches federal court, the administrative record is often fixed. A judge is not evaluating the disability from scratch — she is asking whether the insurer’s decision was reasonable based on what the record already contains. This makes the quality of medical documentation critical from the very first appointment.
Women face a well-documented disadvantage here. A 2022 study published in the Journal of the American Heart Association found that women presenting with chest pain waited an average of 11 minutes longer than men before being evaluated, were less likely to be triaged as urgent, and were less likely to receive basic cardiac testing. Research consistently shows that women’s pain is assessed as less severe and treated less aggressively than equivalent symptoms in men. The 2001 analysis The Girl Who Cried Pain, published in the Journal of Law, Medicine & Ethics, documented that physicians attributed women’s reported pain to emotional factors even when clinical findings pointed elsewhere — a pattern that has been replicated in studies since.
When a treating physician minimizes or dismisses what a patient reports, that enters the medical record and, in turn, the claim file.
3. Continuing to function at home can be used against you
When you file an LTD claim, your insurer will ask detailed questions about your daily activities and may conduct surveillance. A claimant who appears to be functioning — driving, cooking, attending school events — can have those activities used as evidence that her limitations are not as significant as claimed.
According to 2024 American Time Use Survey data, women consistently spend more time than men on housework and caregiving activities. That gap does not fully close when a woman becomes ill. Women who are genuinely disabled are more likely to push through pain and fatigue to manage a household, care for children, or look after aging parents — not because they can return to work, but because those responsibilities do not stop for illness. An executive who can no longer sustain a full workday but still manages her household and gets her kids to school is not demonstrating that she is able to work. She is demonstrating that she is a mother. Insurers do not always draw that distinction, and the consequences can be serious. Knowing what information insurers collect and how they use it before you file — not after — matters.
Under ERISA, courts reviewing LTD denials often apply a deferential standard of review. The question is not whether the insurer was wrong — it is whether the insurer was unreasonable. That is a meaningful distinction, and it means that by the time a case is in litigation, your options may be significantly shaped by what is already in the record.
Why the appeal may be your most important opportunity
The internal appeal is the last real opportunity to introduce evidence, correct gaps in medical documentation, and directly challenge the insurer’s reasoning. What happens — or does not happen — at the appeal stage can be very difficult to undo.
If your claim has been denied
A denial is not final, but the timeline to respond is short, and the process is unforgiving. If you are a physician, executive, attorney, or other high-earning professional whose LTD claim has been denied or is at risk, call us at (215) 645-5955 or contact us online to discuss your options. Our initial consultation involves no charge and no commitment. If you are an attorney, financial advisor, or CPA with a client in that situation, we would be happy to support you and your client.