Did Sun Life Deny Your Disability Insurance Claim?

Newfield Law Group frequently hears complaints about disability claims being denied or terminated by Sun Life Insurance.   Wrongful denials of disability claims by Sun Life are at direct odds with Sun Life’s receiving a top place to work from UA Today—or are they? Like so many disability insurance companies, Sun Life is a global financial behemoth, founded 155 years ago in Massachusetts as a life insurance company. It expanded and is now an international financial seller of group (ERISA) disability insurance products to companies worldwide.  Like others, COVID-19 had a negative impact upon earnings.

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If it’s so big, why is Sun Life denying my disability insurance claim? 

We have seen this time and time again—the larger the insurance company, the less likely it cares about anything but bottom line profits. Sun Life has a challenging appeal process, making it extremely important that your long term disability claim materials are presented in the correct manner from the start.

You will have to be careful as you navigate the Sun Life disability insurance claim process, whether your claim is for short-term benefits or long term benefits. Sun Life uses the short term claim process as a stepping stone for qualifying for long term disability insurance benefits, which is how most insurance companies manage their claims.   Often, Sun Life  will approve the claim for the short term, only to deny long term disability insurance benefits upon the same medical evidence upon which benefits were approved.  

What you will also need to watch for is the definition of disability, which varies from one policy to the next for Sun Life group LTD (ERISA) policyholders. More importantly, the tasks that you need to accomplish to perform your job may be considered different than what Sun Life thinks you need to do to get your job done. We have seen many individuals with serious disabilities whose claims were wrongfully denied because Sun Life claims representatives did not think they were unable to perform the tasks of their occupation.  They rely upon outdated resources to support their position and argue in litigation that it is appropriate to utilize occupational resources from the 1980s.

Our representation of clients includes creating a strong application for the initial claim. Founder Jason Newfield likes to say the work we do to prepare a claim is akin to preventing the spill so there is no mess to clean.  He finds that spotting issue of concern in advance helps to prevent having to fix something later.  It is a basic concept for life that works for disability claims as well. 

When we are brought into a matter after Sun Life wrongfully denies a disability claim, we work to create the most robust appeal we can. This is vital, as the materials used in an appeal are typically the only materials allowed if the case needs to go to court. 

Our appeal preparation is powerful, bringing in information from your own treating physician, ensuring you have the diagnostic tests used as the gold standard for your disability, and all possible occupational information. Our approach of integrating the medical, vocational factual and legal issues has formed the formula for success.  We leave nothing to chance, especially with Sun Life.

Sun Life says they do not have my records, but my doctor sent them in. What now? 

Telling claimants that they cannot find or have not received their records is standard operating procedure for Sun Life claims managers. We start our process by requesting your file from Sun Life, then analyze all of the information in great detail. Newfield Law Group knows we might receive a complete mess of a file, as the company seems to take pride in how poorly it manages claims and how disorganized a file is. We take the opposite approach, making sure every possible piece of information to support your Sun Life claim is in the file, in the correct order, and we create a narrative that outlines exactly why you are not able to work and why Sun Life should be accepting your claim and paying your disability insurance benefits.

How does Sun Life respond to Newfield Law Group representation?

Disability attorney Jason Newfield has represented many clients whose disability claims were wrongfully denied or terminated by Sun Life, and as a result of his experience, he knows what Sun Life claims managers are looking for when they review a claim. In many cases, the insurance company representatives tell him he has made it possible for claims to be paid because of the superior organization and preparation of the claims file.  Developing appropriate support, and cohesively bringing the issues together is the approach that brings success to our clients.

What other information does Sun Life want to accept my Disability Claim?

Demonstrating the occupational side of a claim is often where claimants find themselves in over their heads when they try to appeal a disability insurance claim denial or termination on their own. The tactics used by disability insurance companies to deny disability claims in general and ERISA group disability claims specifically include taking advantage of this specific part of a claim.  What you do and how Sun Life might view what you do might differ greatly, when it comes to analyzing your claim.

What does your occupation require? People underestimate the physical challenges of their jobs, until they are disabled by an illness or injury. If you work in an office, how grueling is your commute? If you need to travel by mass transportation, you probably need to be able to manage stairs, escalators, and crowds. Even if you work from home three days a week, if you have an orthopedic problem and can’t sit at a desk without experiencing pain, performing your job may not be possible.  

For surgeons, ER physicians, dentists, ophthalmologists and any medical professionals whose job requires them to stand for extended periods of time, use their hands in a precise and controlled manner and be completely cognizant of what they are doing, disabilities can do more than get in the way—they can cause serious harm to patients and lead to malpractice claims.   Sun Life insures many medical professionals through hospital policies.

Sun Life will not accept a simple description from you about the tasks and duties to perform your job. The requirement for a professionally prepared occupational description, combined with an equally credible evaluation of your physical and mental skills, will be needed in support of your claim. A vocational evaluation is something Jason Newfield can help you obtain, as he has worked with many experts and can make sure you are seen by an experienced and legitimate expert who can evaluate the issues and provide support.

Sun Life was paying my disability claim, then it stopped. What happened?

Sudden termination of payments are nothing new for Sun Life, often with a retroactive termination, but there are many complaints about how this disability insurance company conducts its business. If your claim was for a mental/nervous condition, your coverage period may have ended after 24 months. For some claimants, twenty four months is the time when coverage shifts from “own occupation” to “any occupation.” It would be reasonable to expect to be notified about this change, but this is not a concern for Sun Life.

Surveillance of Disability Claimants by Sun Life

Surveillance is a tool actively utilized by Sun Life in its claims management.  Surveillance by a Sun Life investigator happens without notice, and when on claim, you need to be prepared that this activity might occur. They then utilize benign activity as “evidence” of significant functionality, to deny or terminate your claim.

Why does Sun Life send field visit personnel to Disability Claimants?

Field visits of a disability claimant by an investigator may be one of the most intrusive actions taken by a disability insurance company like Sun Life.  If this is sought, it might be that they have surveillance and have video observations of you.  A field visit might be used to gather information that can be proven false.   This can be quite dangerous for a claimant.

Having an experienced disability claims attorney review your policy is the best way to prepare for this or any other form of denial or termination. Jason Newfield can review your policy, as he has for so many people, and give you insight into how your policy is structured, what you are likely to encounter along the time period of your claim, and how to best protect yourself.

You are invited to contact Disability Attorney Jason Newfield at 631-270-5090 to discuss your situation, review your policy and explore your options. The call is free, and you will learn what you can expect from Sun Life. 

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    Newfield Law Group does not handle Social Security Disability Claims