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The long-term disability process can be complex and overwhelming, especially after a denied claim. Sun Life is a prominent provider of long-term disability insurance, and understanding how its denial and appeal process works is critical for policyholders.
When Sun Life denies a claim for long-term disability benefits, it can leave individuals uncertain and financially distressed. Knowing how to navigate the appeals process is key to potentially overturning the denial and securing the benefits you deserve.
A long-term disability attorney like Nick Ortiz understands the Sun Life appeals process and how to challenge wrongful denials. If you’ve already tried to appeal on your own, we may still be able to file a lawsuit against Sun Life.
Time is of the essence here as there are short deadlines. Call us now at (888) 321-8131 or request a free case review.
About Sun Life Long-Term Disability Insurance
Sun Life Financial Inc. is a global insurance company that provides life and disability insurance, including short-term and long-term disability coverage through employer-sponsored group policies.
What Is Sun Life Long-Term Disability Insurance?
Sun Life long-term disability insurance is typically offered through your employer as a group benefit. These policies are designed to replace a portion of your income—usually between 50% and 70%—if you are unable to work due to illness or injury.
Most Sun Life group disability policies are governed by the Employee Retirement Income Security Act (ERISA), a federal law with strict rules and deadlines that often favor insurance companies.
How Sun Life LTD coverage typically works:
- Coverage through your employer: Eligibility and policy terms are outlined in your benefits package.
- Filing a claim: You must submit detailed medical and employment documentation.
- Claim review: Sun Life evaluates the claim under the policy and ERISA standards.
- Denial and appeal rights: If denied, you must follow strict appeal procedures within limited timeframes.
Sun Life’s LTD applications are lengthy and complex. The process itself can feel overwhelming, and mistakes or omissions often lead to denials.
Bottom line: Sun Life has a track record of delaying or denying LTD claims and may attempt to settle claims for less than the policy promises. Do not accept any settlement or denial at face value before speaking with an attorney.
How ERISA Law Impacts Your Sun Life LTD Appeal
When your Sun Life LTD claim is governed by ERISA, the rules become far more rigid.
Critical Deadlines and Evidence Locks
- 180-day appeal deadline: Most denial letters allow exactly 180 days to appeal. Missing the deadline—even by one day—can permanently end your claim.
- One chance to submit evidence: Under ERISA, the appeal is usually your last opportunity to submit medical and vocational evidence. Courts generally will not consider evidence that was not included in the administrative appeal.
Because of these restrictions, ERISA appeals require careful planning and complete documentation from the start.
Why Sun Life Denies Long-Term Disability Claims
Sun Life denial letters are often long and technical. These letters can discourage claimants into believing an appeal is pointless. Understanding the real reasons behind the denial is essential.
Common Reasons Sun Life Denies LTD Claims
Sun Life’s Medical Consultant Says You Are Not Disabled
Sun Life frequently relies on internal or contracted medical consultants who may disagree with your treating physicians. These “peer reviews” often downplay symptoms and functional limitations.
Surveillance and Claims Investigations
Sun Life may use video surveillance or social media monitoring to challenge your credibility. Investigations can extend beyond the claimant to family members and daily activities.
Insufficient Medical Evidence
Claims are often denied because the medical records do not clearly connect the diagnosis to functional work limitations. Sun Life looks for inconsistencies or gaps and uses them to justify denial.
Overcoming these denials requires addressing each stated reason directly with strong, targeted evidence.
Navigating the Sun Life Long-Term Disability Appeals Process
Appealing a Sun Life LTD denial requires careful preparation and attention to detail.
Request Your Complete Claim File
Requesting your claim file allows you to see exactly what Sun Life relied on, including internal notes, medical reviews, and surveillance materials. This step is critical to building a focused appeal.
Gather Strong Supporting Evidence
Your appeal should include:
- Updated medical records and test results
- Physician statements explaining work-related limitations
- Functional capacity or specialty evaluations, when appropriate
Vocational Evidence and Witness Statements
Vocational experts can explain why your limitations prevent you from performing your occupation. Statements from coworkers, family, or friends can provide valuable real-world context.
Writing a Compelling Appeal Letter
Your appeal letter should directly address Sun Life’s reasons for denial and explain, with supporting evidence, why you meet the policy’s definition of disability.
Stay Ahead of Deadlines
Missing an appeal deadline can permanently bar your claim. We help ensure all deadlines are met and that your appeal is complete.
RELATED POST: How To Appeal Denial: Your LTD Appeal Guide
What Happens After You File Your Appeal?
After your appeal is submitted, Sun Life may:
- Conduct additional medical reviews
- Request vocational assessments
- Require an Independent Medical Examination (IME)
These evaluations can significantly affect the outcome of your appeal, and preparation is essential.
What If Sun Life Denies Your Appeal?
Filing a Second Appeal
In some cases, a second appeal may be available. This allows you to submit additional evidence and respond more fully to the denial.
Filing a Lawsuit Against Sun Life
If appeals are exhausted or unavailable, you may be able to file a lawsuit. This requires an attorney experienced in ERISA and LTD litigation.
Sun Life Case Summaries
The following cases are provided to illustrate how courts evaluate Sun Life LTD claims. Please review our case results and testimonials to learn more about claims we have handled.
- Wilkinson v. Sun Life
- Baker v. Sun Life
- Faciane v. Sun Life
- Christmas v. Sun Life
- Holmgren v. Sun Life
- Sobel v. Sun Life
Get Help With Your Sun Life LTD Denial
If Sun Life has denied your claim, our firm can help you understand the denial, build a strong appeal, and pursue litigation if necessary.
We represent claimants on a contingency fee basis. You pay no attorney’s fees unless benefits are recovered.
Call (888) 321-8131 to request a free case review.
Frequently Asked Questions
Why did Sun Life deny my LTD claim?
Common reasons include insufficient medical evidence, missed deadlines, or failure to meet policy definitions.
How long does Sun Life take to review an appeal?
Typically 45–60 days, though complex cases may take longer.
What if Sun Life denies my appeal?
You may be able to file another appeal or pursue legal action in court.
