Ryan Findlay | September 18, 2023 | Long-Term Disability
Has Sun Life Denied Your Long-Term Disability Benefits?
LTD Claim Denied by Sun Life?
If Sun Life has rejected your claim for long-term disability benefits, you undoubtedly feel angry and helpless. You have been contributing to your policy for years, and now when you need the protection most, the insurance provider informs you that you are ineligible.
Continue to hold onto hope! Denial of long-term disability payments is frequently just the beginning of a protracted appeals process. Like many insurance providers, Sun Life dislikes paying claims. In an effort to get policyholders to give up and leave, they frequently play hardball with them.
We approach the legal process as a team of personal injury lawyers. The collective medical expertise of our team, case managers, and lawyers is required to put together a compelling argument on your behalf. We’ll examine your letter of denial to see whether you have a case. If we think you do, we’ll develop a strategy that involves locating the required witnesses and medical data to back up your claim.
We have years of expertise working with insurance providers like Sun Life, and we are aware of how stressful this time may be. We are aware of their strategies and how to counter them.
You might be able to obtain the benefits you require and are entitled to with the aid of an experienced disability lawyer. If you would like more information about our fees and services, please call us at (905) 522-9799 or visit one of our locations.
Long-term Disability Claim Denied by Sun Life
In Ontario, the majority of legitimate long-term disability (LTD) applications are rejected by insurance companies. Statistics from the sector show that every year, close to 60% of all long-term disability claims are denied.
Normally, Sun Life will send you a letter informing you that your long-term disability claim has been rejected and encouraging you to challenge the insurer’s choice. This is done in the expectation that the insurance company can deal with the applicant immediately and avoid a drawn-out legal battle.
Knowing and understanding your rights is essential before moving on with the appeals process. Without legal representation, dealing with insurance companies may be difficult and is generally not recommended. You can challenge the insurance provider’s decision with the aid of a long-term disability claim lawyer, who will also assist you in bringing your case before a judge if required.
What Happens If My Long-Term Disability Claim Is Denied?
The insurance provider will ask for a lot of details about your medical history when you initially apply for long-term disability benefits. Additionally, the insurance provider will check your records with one of its own doctors. The insurance provider could even ask you to go to an independent medical examination (IME) with one of their physicians in specific circumstances.
The IME is crucial because it gives the insurance provider a chance to speak with a second doctor about your condition and how it impacts your capacity to work. It’s crucial to remember that the IME does not obligate the insurance provider. In other words, the insurance company may still reject your claim even if the IME doctor certifies that you are disabled.
Common Causes for Denial of a Long-Term Disability Claim with Sun Life
There are many reasons why an individual’s long-term disability claim may be denied by Sun Life. Some of the most common causes include:
1) Not Meeting the Definition Of “Disability” In Your Policy: The policyholder’s failure to fulfil the policy’s definition of “disability” is one of the most frequent grounds for denial. It’s crucial to thoroughly analyze your policy because each long-term disability insurance has its unique definition of impairment.
2) Pre-Existing Conditions: If the insurance provider says that your condition was present before, that is another frequent justification for denial. It’s crucial to have all of your medical information organized because this can be challenging to show.
3) Not Being “Totally” Or “Completely” Disabled: The majority of policies stipulate that you must be “totally” or “completely” handicapped in order to be eligible for long-term disability benefits. In other words, you must be unable to perform the duties of any employment, not just your own.
4) The Policy Has A “Cap”: There may be a “limit” on the amount of payments you can get under some long-term disability policies. This indicates that, regardless of how long you are disabled, there is a cap on the amount of money you can receive from the policy.
5) You Have Not Been Out of Work Long Enough: Before payments begin, the majority of long-term disability policies contain a waiting period. It can take three to six months. Your claim will probably be rejected if you haven’t been out of work for the required amount of time.
6) Your Illness or Injury Is Not Serious Enough: If your illness or injury is severe enough to keep you from working, you may be eligible for long-term disability benefits. The insurance provider may reject your claim if they don’t think your condition is serious enough.
7) You Were Working in A Hazardous Occupation: Some long-term disability insurance policies don’t cover illnesses or accidents that happen while you’re working in a dangerous job. This implies that your claim can be rejected if you have an injury while performing a hazardous job.
8) Submitting a Claim Late: You could only have a small window of opportunity to submit your long-term disability claim. Your claim can be rejected if you miss the deadline.
9) Failing to Communicate with Your Insurance Company: It’s critical to stay in touch with your insurance company. They may reject your claim if you cease answering their inquiries for details.
10) The Coverage Has Expired: If your long-term disability insurance policy has expired, your claim can be rejected.
It’s critical to contact legal counsel as quickly as you can if Sun Life has rejected your application for long-term disability payments.
Appealing A Denied LTD Claim with Sun Life
An appeal may be made for a variety of reasons. For instance, if Sun Life declined your claim on the grounds that the condition is not covered by the policy, you may appeal using the justification that the condition is, in fact, covered. Another common denial reason is that your condition is not “serious enough,” according to Sun Life. The definition of “severe” used by the insurance company is excessively narrow, and this can be used as the basis for an appeal.
It is your responsibility to demonstrate that you suffered a total disability during the qualifying period and the first 24 months or two years of long-term disability in order to be eligible for long-term disability benefits under the majority of individual or employee long-term disability policies.
The “Own Occupation” Clause
Most long-term disability policies include an “own occupation clause” for the first 24 months (2 years) of long-term disability, which states that even if you can perform other types of work, you will be considered disabled and eligible for long-term disability benefits if you are unable to perform the essential duties of your specific occupation or job.
However, the “own occupation” phase ends and is replaced by an “any occupation” provision once the first 24 or two years have elapsed. You must demonstrate your inability to carry out the responsibilities of any profitable activity for which you may be properly qualified by education, training, or experience in order to maintain your eligibility for long-term disability payments.
This is where long-term disability payments are frequently rejected by insurance companies like Sun Life. The insurance company will frequently engage a vocational expert to try to establish that there are alternative jobs you might perform, even if you are not currently certified to do them, even if you have a well-documented ailment that has stopped you from working in your specific occupation.
If Sun Life has rejected your request for long-term disability compensation, persist. There could be justification for an appeal. Consult a qualified disability lawyer to find out more about your legal rights.
The “Mental and Nervous” Clause
Sun Life uses a clause in its policies known as a “mental and nervous” clause as one means of avoiding paying claims.
This basically implies that if it is shown that your impairment was caused or contributed to by a mental or nerve disorder after 24 months of payments have been paid, your benefits would be terminated. Obviously, this may be very difficult and upsetting, adding stress to your mental health.
The “Benefits Offset” or “Zero-Sum Offset” Clause
A “benefits offset” clause is also included in the majority of plans. This implies that your long-term disability payments will be lowered by the amount of any other income you may be receiving, such as CPP Disability Benefits or Workers’ Compensation Benefits. With a family to support, this may make it very challenging to make ends meet.
The insurance company will not pay you anything if you receive benefits in addition to those that your insurance provider is providing for you and the total of those benefits exceeds the whole amount of the LTD payment. This clause is frequently referred to as the “zero-sum offset”.
Proving Total Disability
You must demonstrate your whole impairment in order to be eligible for long-term disability benefits. This means that despite having the necessary education, training, or experience, you are unable to carry out the obligations of your current job or any other productive career.
You must present in-depth evidence from your treating physicians describing the type and severity of your condition as well as how it impacts your capacity to work in order to demonstrate complete disability. You will also need to submit proof of your credentials and employment experience.
We can assist you if Sun Life denies your application for long-term disability payments on the grounds that your condition is not sufficiently “severe” or “totally disabled.” We handle long-term disability claims and appeals with a great deal of expertise, so we are aware of the procedures necessary to secure the benefits you require and are entitled to.
For a free consultation, get in touch with us today. We’ll examine your situation and go over your legal choices.
How a “Change of Definition” Might Affect a Sun Life Long-Term Disability Claim That Was Rejected
The definition of “total disability” generally changes in long-term disability benefit plans at the two-year mark, which disability insurance carriers frequently fail to appropriately disclose to subscribers.
Typically, a more strict definition of “total disability” is used when an insurance provider like Sun Life modifies what the term means after two years. If you are already coping with a significant illness or accident, these shifts can be incredibly perplexing and challenging to grasp.
For instance, changing “own occupation” to “any occupation” is a frequent alteration. To continue receiving long-term disability payments, you must demonstrate that you are unable to carry out the responsibilities of any gainful activity for which you may be properly qualified via education, training, or experience. The insurance company will frequently engage a vocational expert to try to establish that there are alternative jobs you might perform, even if you are not currently prepared to do them, even if you have a well-documented condition that has stopped you from working in your specific occupation.
Call us as soon as possible if Sun Life has rejected your long-term disability payments and you have questions concerning a change in definition. We have handled many long-term disability claims, and we are familiar with the appeals procedure.
What to Do If Your Sun Life Claim Is Denied
Don’t panic! There are options for you, and you are not alone. Every single day, people just like you are having their LTD claims rejected, but regrettably, many people choose not to seek legal counsel because they are unaware that they have the option.
If your claim has been rejected, the first thing you should do is ask for a copy of the decision letter from the insurance company (if you don’t already have one), as well as a copy of the actual policy. Call the Findlay Personal Injury Lawyer team as soon as you receive this information. Denial of benefits is frequently just the beginning of a protracted appeals process.
We’ll work with you to thoroughly evaluate your denial letter. The insurance firm needs to have provided a justification for their choice in it. When we are aware of the reasons your claim was rejected, we can begin to prepare an appeal.
Contact us right away if you need assistance understanding why your claim was rejected or are unsure of how to begin your appeal. We provide free consultations, and we would be pleased to go over your case and assist you in moving forward.
When appealing a denial of long-term disability benefits, you must move promptly. There are stringent deadlines, and if you miss one, your entire appeal may be in jeopardy.
You may appeal the judgement if your original claim is rejected. It is crucial to have an accomplished long-term disability lawyer on your side because the appeals process can be difficult and time-consuming. We will do all in our power to assist you in obtaining the benefits you require and deserve. We are knowledgeable about the ins and outs of the appeals procedure. For a free consultation, get in touch with us today. We’ll examine your situation and go over all of your legal choices.
Don’t delay! The faster we can begin working on your appeal, the better.
Disability Benefits Will Get Harder at the Two-Year Mark with Sun Life
Sun Life is one of the leading insurance companies in Canada, bringing in over $39 billion in premiums every year! You would assume that with that kind of cash, they could afford to pay the policyholders’ long-term disability payouts. Sadly, it does not always happen. In fact, when it comes to obtaining your long-term disability benefits, Sun Life has a reputation for being a challenging insurance provider to work with.
In addition to the already challenging process of applying for long-term disability benefits, policyholders frequently encounter additional difficulties when their benefits are set to expire beyond the two-year threshold.
When it comes to long-term disability insurance, the two-year (24-month) milestone is frequently a make-or-break moment for many claims. This is because the majority of long-term disability insurance policies have provisions that go into effect at this point and can make it very challenging to continue collecting payments.
After two years, Sun Life will review your condition and likely make it more difficult for you to qualify for LTD benefits. The criteria for what constitutes a “disability” are increasingly severe as documentation of your disease is proven.
Call us right away if you are approaching the two-year mark and are concerned that your long-term disability payments will be terminated. We can assist you with comprehending your coverage and any potential choices.
How a Lawyer Can Help with Your Sun Life Claim
It is usually advisable to have an experienced lawyer on your side when negotiating with insurance firms like Sun Life. Because they are in the business of making money, insurance firms frequently use any and all measures to avoid paying out claims.
Remember, you have choices if Sun Life rejects your long-term disability claim. The refusal can be challenged, and if required, you can go to court.
An experienced disability lawyer will be able to negotiate with the insurance provider and fight for the benefits you are entitled to. A disability lawyer will also be knowledgeable about the appeals procedure and be able to guide you through this complicated system.
Our team at Findlay Personal Injury Lawyers specializes in long-term disability claims. Check out how we can get you the full support you need from your insurance company.
The Difficulty Gathering Evidence for Unseen Conditions
Claims that include symptoms that physicians cannot see, such as exhaustion, mental health issues, chronic pain, fibromyalgia, anxiety, and depression, are frequently rejected by Sun Life. This is because obtaining proof of these kinds of illnesses may be challenging.
You can be denied due to “insufficient medical evidence,” which may be quite upsetting, especially if you are aware of how seriously your symptoms are affecting your life.
These invisible illnesses, particularly mental health problems, may be just as crippling as physical illnesses and are frequently very real. Call us immediately if you have been refused benefits despite having one of these ailments. We can assist you in gathering the evidence required to support your claim and obtain the benefits you are entitled to.
Frequently Asked Questions about Sun Life Denying Long-Term Disability Claims
Doesn’t Sun Life have my best interests in mind?
No, Sun Life does not have your best interests in mind. Since they are a for-profit insurance firm, making money is their primary objective. They frequently reject claims or attempt to persuade claimants to take less money than they are fully entitled to.
How do I proceed if my claim is rejected?
You have the option to challenge the decision if your claim is rejected. You can obtain assistance with this procedure and the best chance of receiving the benefits you are entitled to from an accomplished disability lawyer.
How long does the procedure for appealing take?
The appeals procedure can be drawn out, and it could take months or even years to reach a conclusion. You should always have an expert lawyer at your side and not attempt to handle this procedure on your own.
How likely is it that I’ll succeed in my appeal?
The particular facts of your case will determine your prospects of succeeding on appeal. An accomplished disability lawyer will be able to evaluate your case and provide you with a more accurate assessment of your prospects of success.
What if I am totally unable to work?
You may qualify for CPP Disability payments if you are totally unable to work. You may negotiate this procedure with the assistance of an expert lawyer, giving you the best opportunity of obtaining the benefits you require.
If my long-term disability benefits are going to expire, can I seek assistance?
If your long-term disability benefits are set to expire, you can most surely obtain assistance. Give us a call right away, and we’ll be happy to explain your policy and any potential choices to you.
Why is dealing with insurance companies so challenging?
Sun Life is one of the biggest insurance companies in the world. Despite this, they have a reputation for being difficult to work with when it comes to long-term disability benefits.
There are several reasons why this is the case. One explanation is that insurance firms are for-profit enterprises. They routinely deny claims or make an effort to get claimants to accept less money than they are entitled to under the law.
Working with insurance companies might be difficult since they are accustomed to the system. Teams of lawyers and claims adjusters are employed by them, and their exclusive focus is on finding ways to deny or minimize claims. As a result, it could be difficult for claimants to get the benefits they need and deserve.
We’re Here When You Need Us Most
It is crucial that you have a knowledgeable disability lawyer on your side while dealing with Sun Life. The Findlay Personal Injury Lawyers team can help you! We have dealt with insurance companies for years and know how to produce results.
We’re here when you need us most. Call us right away for a free consultation. We will examine your insurance, evaluate your situation, and inform you of your alternatives. There isn’t any commitment. Call us right away instead of waiting until it’s too late!
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