Sun Life LTD Claims: What You Need to Know About Their Policies and Practices

Your Sun Life long-term disability policy was there, you believed, to provide a potential financial safety net. Before your health took such a dramatic turn for the worse, you hadn’t paid too much attention to the details of how that safety net would work in Ontario, Canada. To you, your long-term disability was very much like your homeowner’s or rental or even auto insurance — until and unless something happened, there was no point delving into all the small print.

Now something has, indeed, happened — your condition has deteriorated to the point that, not only have you been unable to support yourself, your doctors are saying that your condition is not likely to improve, at least not for many years into the future. Following months of working with your medical professionals to fill out paperwork, after months of interviews, of lengthy conversations with your Sun Life case manager, months of suffering the indignity of surveillance  — you’ve received a letter informing you that your Sun Life Long-Term Disability Claim has been denied.

The language in the denial letter is not only upsetting – It’s confusing.  You’ve spend all those hours and hours filling out paperwork, hours and hours sending emails and making phone calls, making sure every single form had been completed by every medical professional who ever treated you or prescribed medication for you. Now, you’re being told that there is “insufficient evidence” and that you meet the policy’s definition of total disability”.

While the letter includes instructions on how to request a copy of your claim file, no specific steps are being recommended for you to take in order to get your case re-evaluated.

Sun Life’s practices — some uncomfortable truths:

• All long-term disability insurance providers are in business to make a profit. Yes, they are obligated by contract to pay all legitimate claims. But they are in business, and, like all business owners, their goal is to minimize payouts, thereby increasing their profit. Learn more about The Hidden Traps in Long-Term Disability Applications: What Insurance Companies Don’t Want You to Know.
• Although this remains an allegation rather than a “truth”, some attorneys have accused Sun Life and other insurers of purposely denying legitimate claims — or threatening to deny claims —  in order to pressure claimants into accepting low settlements.
• The long-term disability claims forms you submitted were completed by the doctors and therapists who actually saw you in person. When Sun Life has its own medical consultants review the paperwork; (people who never examined you or processed your test results), they may disagree with the conclusions reached by your own medical providers.
• Sun Life consultants will have examined your social media posts, purposely interpreting things you’ve shared with friends to mean you are not as “disabled” as you have claimed.
• Sun Life’s definition of disability changes after two years, going from “own occupation to “any occupation”, The company will often claim that, because (they believe) you are able to work, even if that work is not in the field in which you specialized training and experience, they are not obligated to honor your claim of being  totally disabled.

Your claim file includes all medical treatments since the onset of your condition, but Sun Life investigators may have uncovered some long-past medical appointment or recommendation that was inadvertently not included in the paperwork you submitted.