Who is Sun Life Financial?
Sun Life Financial is a Canadian financial services company that also offers various insurance and investment products, including disability insurance. Sun Life Financial is one of the largest publicly traded financial companies in Canada. In the United States, Sun Life Assurance Company of Canada (Wellesley Hills, Massachusetts) is a major provider of disability benefits in all states except New York. In New York, Sun Life and Health Insurance Company (U.S.) (Lansing, Michigan) offers disability benefits to persons in New York.
Why did Sun Life deny my claim?
SunLife may deny your claim for many reasons that you believe is wrong. Below are some reasons. The list is not exhaustive:
Insufficient Evidence of Disability
To qualify for disability benefits, you must provide compelling evidence that clearly establishes your symptoms prevent you from performing your occupational duties.. Simply having a diagnosis or medical records may not suffice to secure long term disability benefits from your insurer. To strengthen your case, consider seeking evaluations from experts who can attest to how your medical symptoms illustrate why you cannot work.
Focusing on Medical Symptoms and Not Impairment.
If you are out of work due to symptoms of an illness that is made by a clinical diagnosis, your claim may get diagnoses for lack of objective proof. The insurance policy should be evaluated based on your symptoms impacting work functionality and not diagnosis, but sometimes insurance companies are looking for objective proof of a medical illness when the insurance company should not be.
Use of SunLife’s Own Medical Experts
Under most disability policies SunLife has the authority to use its own medical experts and examiners to assess you. Unfortunately, these “experts” who regularly perform services for Sun Life insurance companies and other insurance companies know that if they want repeat referrals, siding with the insured is not going to curry favor with the insurance company. Medical professionals who rely on repeat referrals for “independent medical exams” understand who is footing the bill and what outcome the insurance company desires. Some doctors have little interest in patient care. These doctors can be content, sitting in their home offices, reviewing medical files and passing judgment on people they never talk to or examine.
Missed Deadlines
Adhering to all deadlines is critical for the success of your claim. Failing to meet specified timelines could result in a denial of benefits or the loss of your rights to benefits.
Video Surveillance
Insurance companies, including SunLife, may use video surveillance to monitor your daily activities. They are on the lookout for any moments that could cast doubt on your disability claim. While most surveillance footage may not reveal anything significant, insurance companies may exaggerate minor details. It’s important to be truthful with your doctor about your disability, acknowledge your limitations, and maintain consistency to strengthen your case. Some insurance employees are looking for that “gotcha moment.” Insurance employees or their agents will look high and low for you online. Social media can be your downfall. If you are seeking disability benefits, or you are receiving disability benefits, the best advice we can give is stop posting. Social media posts get taken out-of-context all the time.
Occupation Policies
Some long-term disability plans provide benefits if you are disabled from performing your own occupation. That said, after a certain period, typically 24 months, the policy may transition to the any occupation definition of disability, which can pose challenges in proving your inability to work in any occupation. It’s crucial to understand that “any occupation” doesn’t necessarily mean menial tasks. A famous court case talks about selling pencils on the street corner. That is not the standard to qualify for “any occupation” benefits. It typically encompasses a broader range of job roles, but is still influenced by factors such as education, training, experience, station life, mental and physical health and age.
What are My Rights and Options if I Believe Sun Life Has Wrongfully Denied My Claim?
If your initial claim is denied and your claim is governed under the Employee Retirement Income Security Act of 1974 (ERISA), Sun Life must give you no less than 180 days to appeal. This is a minimum standard set by a US Department of Labor regulation. If your claim is under an individual insurance policy, or you work for a government employer, or religious organization (“Church Plan” in ERISA talk), Sun Life usually cannot make you appeal. The time period to file a suit is in the insurance policy or by statute. You may not need to file a presuit appeal. But appealing presuit is generally a good idea. Give Sun Life a chance to reach an accurate outcome based on your appeal. This is the best result for you and Sun Life.
Navigating the appeals process without the help of an experienced legal counsel is generally a bad move. The process is not complex. Some insureds have been advised by insurance companies, “Just write on a piece of paper, ‘I am appealing the claim denial by the insurance company,’ and send it in for a ‘fresh look.’” This is one way to guarantee your claim will get denied again.
Get an experienced ERIAS attorney or disability insurance attorney, involved early. Appealing on your own, and having Sun Life deny the claim again, is not a position you want to find yourself. ERISA is not simple. ERISA has often been described as one of the most complex statutes ever passed by Congress. It has been substantially amended over forty times since it was enacted on Labor Day in 1974, and it was subject to further amendment in the health reform bills passed by the House and the Senate during 2010, and other amendments under the Affordable Care Act and recently again during the COVID-19 pandemic. ERISA is regulated by both Internal Revenue Service and the United States Department of Labor. It’s been referred to by one federal judge as an acronym as Everything Ridiculous Since Adam.
If the ERISA appeals and litigation process was easy, you would expect to see many attorneys representing individuals in this area of the law. You may have struggled to find a knowledgeable ERISA attorney. That is because there are few.
How Can an Attorney Help?
A knowledge ERISA attorney has the skills to compile compelling medical evidence, engage with specialists to fortify your case, and maneuver through the appeals process. Enlisting the services of an ERISA attorney, such as Jonathan M. Feigenbaum, can help ensure fair treatment for both you and your disability claim. Make sure you retain an attorney who has a history of successfully litigating disability claims in court. This includes ERISA and individual disability insurance claims. Ask the attorney to show you a history of litigating cases. We have a great deal of experience in both. Throughout the disability claims process, we provide you with support, guidance, and advocacy. We can answer your questions, address your concerns, and advocate for your best interests to ensure that you receive the benefits you deserve.
Access to legal counsel not only raises the likelihood of a favorable outcome, but also eases the weight off your shoulders, enabling you to prioritize your well-being while pursuing your rightfully deserved benefits.
