Sun Life Denies LTD Claims
Many employees participate in a group policy of long term disability insurance issued by Sun Life Assurance Company of Canada (Sun Life). Under a typical LTD policy, disability occurs when:
[D]uring the Elimination Period and the next 24 months, the Employee, because of Injury or Sickness, is unable to perform the Material and Substantial Duties of his Own Occupation. After Total or Partial Disability benefits combined have been paid for 24 months, the Employee will continue to be Totally Disabled if he is unable to perform with reasonable continuity any Gainful Occupation for which he is or becomes reasonably qualified for by education, training or experience.
A typical denial letter will say something to the effect that it is denying benefits because of “insufficient objective evidence to substantiate” a disability that keeps the claimant from performing his or her job duties. Other language used in the denial may state that the medical evidence does not document the presence of conditions physical, psychological, or cognitive in nature of such severity that the claimant could not continue to perform his or her occupation.
Top Reasons Why Sun Life Denies Claims
Sun Life May Cut-Off Benefits if You Do Not Accept a Low Ball Settlement Offer
Sun Life may offer a “low ball” lump sum settlement to “wash out” or “buy back” the policy. That means the claimant is offered a lump sum of money that is less than the total value of the claim in exchange for no more future payments. Many claimants who receive this offer decline because they would rather receive the full value of their benefits paid over a period of time. However, Sun Life has terminated benefits in the past when the claimant declined a lump sum settlement offer. Claimants have reported that after declining a lump sum settlement offer they received a letter from Sun Life advising that Sun Life was investigating the claim to determine if the claimant was still disabled under the terms and conditions of the policy. Sun Life has been known to be aggressive in claim terminations.
Unlike other major disability insurance companies, Sun Life seems to have hired very limited internal claims handlers, preferring instead to rely on cheap outsourcing of peer reviewers. At first glance, the reports issued by these peer reviewers appear to be credible. However, a closer look at the reports shows that these peer review facilities are basically insurance-paid “farms” that are generating shoddy graphs and narrative reports to support Sun Life’s denial of claims.
Sun Life Disability Denial Letters
Sun Life seems to like to write long denial letters, which can be more than 20 pages long. Our theory is that the long denial letter is being used to intimidate the claimant into thinking that the negative evidence is so overwhelming that the unfavorable decision must be the right one. The insured may be so disheartened or intimidated as to believe that an appeal of the denial would be useless. In other words, if the insurance company took twenty pages to deny the claim, Sun Life may be right after all.
Moreover, Sun Life’s claim investigation is extreme. The investigation often extends beyond the individual disability applicant. The claimant and his or her family members have been known to have been investigated by private investigators. Sun Life also directly attacks a claimant’s reputation and credibility to support the termination of a claim.
Sun Life does not seem to begin its evaluation of a claim with the presumption that a claimant is in fact disabled. Instead, Sun Life seems to begin its evaluation under the presumption the claimant is suspect and the insurance company engages in an investigative campaign to discredit the individual.
Sun Life’s medical “peer reviews” and “independent medical examinations” are so biased against claimants as to be absurd. Yet, Sun Life relies on the reports from its doctors to deny claims. The disability insurance company remains steadfast in its denials and forces all too many claimants to hire an attorney to file lawsuits in order to receive payments they should already be receiving.
If Sun Life is your long term disability insurance company, then pay particular attention to all of the paperwork the insurance company requires you to fill out for LTD claims. The applications are not designed to be easy to fill out. It would not be much of a stretch to say that the sheer length and difficulty of the application is by design to overwhelm claimants from the very beginning of the application process.
The bottom line is this: Sun Life does not like to pay long term disability claims. Claimants have to fight “tooth and nail” to collect LTD benefits under such policies.
Appeal a Sun Life Denial Letter
If you’ve been denied by Sun Life, you should hire an attorney to help you appeal the unfavorable decision. Nick A. Ortiz is an experienced long term disability denial lawyer and can help you determine what steps you should take to get the funds you are entitled to receive. In many cases, having a knowledgeable disability denial attorney from the beginning of an LTD claim will prevent or minimize abusive tactics used by insurance companies.
Contact Information for Sun Life
As of December 20, 2014, the contact information for Sun Life and Health Insurance company is as follows:
Sun Life and Health Insurance Company (U.S.)
Group Long Term Disability Claims
175 Addison Road
P.O. Box 725
Windsor, CT 06095
Phone: (800) 247-6875
Fax: (781) 304-5425
When you have suffered a disabling injury or have been diagnosed with chronic illness, worrying about how to pay the bills and how to take care of your family should not be an added concern. Florida disability denial attorney Nick A. Ortiz is here to take on that burden for you. Call us today at (888) 321-8131 to learn your rights and get the help you need to appeal your disability denial.