Hi. I’m Nick Ortiz. I’m a board certified disability insurance attorney. Today I’m here to talk to you about Sun Life Insurance Company and the top reasons why Sun Life denies long-term disability claims. Just for reference, these are not presented in any particular order.
Number one, insufficient medical records. In other words, the insurance company requested medical records from your doctor or other medical provider and the doctor’s office never provided the records.
Number two, insufficient objective medical evidence. The insurance company may have medical records, but they don’t believe that the records are sufficient to show a disabling condition. Some of the types of objective records they’re looking for are X-rays, MRIs, CT scans, and the like.
Number three, the medical condition is non-verifiable or based primarily on self-reported symptoms.
Number four, your doctor’s didn’t return forms or questionnaires, also known as attending physician statements.
Number five, the peer review physician does not agree with your doctors. In other words, the insurance company has hired a doctor to review your records and they’re doctor says that your conditions are less limiting than your doctors say.
Number six, the insurance company may say that you’re exaggerating your symptoms to qualify for disability.
Number seven, the insurance company may have hired a private investigator to conduct video surveillance and the video footage is inconsistent with your reported limitations.
Number eight, your social media profile. The insurance company is likely tracking you on Twitter, Facebook, LinkedIn and the like and they’re going to argue that your postings are inconsistent with your disabilities.
Number nine, missed deadlines. For example, you didn’t file your initial applications for benefits in time or B, your proof of loss in time, or C, you didn’t file your appeal in time.
Number ten, there may be a pre-existing condition exclusion.
Number 11, there may be a specifically excluded condition listed in the policy that says you cannot qualify for benefits with that condition.
Number 12, you do not meet or satisfy the definition of disability under your specific plan or policy.
Number 13, there’s been a change in the definition of the term disability. For example, from own occupation to any occupation after six, 12, or 24 months.
Number 14, you may be partially disabled but not totally disabled under the policy.
Number 15, you are out of work due to your own choice but not do to your medical condition.
And, finally, ERISA. Most group plans, not all, but most are subject to ERISA and that law very heavily favors the insurance companies.
If you’ve been denied benefits for one or a combination of these reasons, then we encourage you to give us a call at 850-898-9904. Our office has experience in dealing with all these reasons why insurance companies deny claims. Also, if you’d like more information I encourage you to download a free copy of a book that I wrote called The Top 10 Mistakes That Will Destroy Your Long-Term Disability Claim. You can claim a free copy at www.FreeLTDbook.com. Thanks for listening.