Denied Disability Benefits by Sun Life in Ontario
It is not uncommon to hear from workers who hold a Long Term Care or Disability Insurance policy with Sun Life that their long-term disability benefits claim has been denied, or cut-off by the insurer after 6 to 12-months or at the 2 year mark, when the definition of disability changes. They are typically surprised, distressed and wondering the reason of the denial, feeling helpless about their options. Some stated the reasons for refusals were insufficient medical evidence, or a claim they could hold another type of work because total disability tests had changed.
As we’ve helped many of our clients face this exact situation, we totally understand the stress such an event creates for you and your family.
For various reasons, most people will not challenge Sun Life’s initial decision to deny or cut-off long-term disability benefits mentioned in their policy; Insurance companies typically count on their customers to not appeal their decision, for their own financial benefit. Often, people don’t know how to successfully appeal after receiving the LTD denial letter.
Here is what you need to know when a disability insurance company such as Sun Life denies your long-term disability claim, and what you can do using the Sun Life appeal process.
Common Reasons Why Sun Life Could Deny Your LTD Claim
Regardless of the reason mentioned in Sun Life’s denial, you can still get the decision reversed using their appeal process if you build a winning case and a court decides in your favor. You will most likely need the help of a seasoned Toronto-area LT disability lawyer who has previously challenged Sun Life’s denials to prove your case and navigate the legal system efficiently.
About Sun Life: the Canadian company’s origins date back more than 150 years, initially starting with the sale of insurance, then adding health and financial solutions to their range of products and services. Sun Life is among the top 5 Canadian Health Insurance companies in terms of total policy values. Sun Life offers Long Term Care and Disability insurance policies, and is considered a leader in Group benefits in Ontario and Canada in general.
5 Tips for Appealing a Denied LT Disability Insurance Claim by Sun Life
A denied LTD insurance claim by Sun Life is not the end of the game. Long-term disability claims are routinely denied by insurance companies. In most instances, you should use the appeal process to fight your case. However, it’s important to do it right to preserve your credibility and build a winning case. A Toronto-area long-term disability lawyer from Himelfarb Proszanski can help.
Timing your appeal is crucial for success: there is a 2-year window to file a claim in court, which starts when the applicant receives a “clear and unequivocal denial” of the claim from Sun Life. There is also an internal appeal timeline to obey, which can vary depending on your Sun Life disability insurance plan. Most appeals are no successful, meaning the insurance company will not reverse their denial. The appeal, therefore, has just wasted time. It is important to have your matter reviewed by our lawyers right away before you appeal as we will be able to advise you if you are wasting your time with the appeal and that you should head straight to litigation.
It’s important to gather as much evidence and information as to why your claim has been denied. You can also ask Sun Life to see your insurance claim file and any other documentation your insurance company may have about your claim.
Each disability insurance plan has its own particularities and terms for coverage. It’s important to understand how the terms relate to your situation so you can provide the right evidence to back your claim.
After Sun Life denies your long-term disability benefits, you have 2 options to ask the insurer to reconsider their decision: an internal appeal process within Sun Life, and a court action decided by a judge . It’s critically important to choose the right process, which depends on your specific situation. An LTD lawyer who has challenged Sun Life’s denial decisions successfully can help you make that choice.
There are many hurdles when you try to challenge an insurance company’s denial of your LTD benefits. Without the help of an experienced disability lawyer these hurdles become major obstacles between you and your benefits. HIMPRO’s team has recovered long-term disability benefits for many clients, after they’ve been denied by Sun Life. We can help you achieve the same.
