Sun Life
Sun Life
Bartolic Law helps clients with long-term disability claims denied by Sun Life. In one case, our client suffered from Chronic Fatigue Syndrome and Sun Life denied the long-term disability claim and terminated short-term disability benefits after initially approving short-term disability. Sun Life conducted a background investigation of our client, including interviewing neighbors and contacting the fitness center where the client was a member regarding the frequency of attendance. It also demanded the client attend an Independent Medical Examination. We attended with the client to document the process. With photographs of the clock when our client began and ended the examination, and the client’s written explanation of the client’s inability to stay awake while waiting for the doctor, we got our client’s claim denial turned into an approval. In another case, Sun Life denied long-term disability benefits following a sudden cardiac death because the client had a pre-existing condition of heart disease. With considerable digging into medical causation and close work with the client’s doctors, we persuaded Sun Life the sudden cardiac death was an event not influenced at all by the heart disease, allowing our client to live an early retirement with financial dignity.
Sun Life Assurance Company of Canada
Sun Life Assurance Company of Canada is a large insurer of group long-term disability policies. It insurers groups of all sizes. Sun Life staffs a number of legally educated personnel in its claims and appeals departments, resulting in long explanations of its denials. We have seen 30–40 page claim and appeal denials. Sun Life requests more documentation from the insured than other insurers, telling you the information is necessary to decide the claim, when it often is not, or you cannot obtain it, and asserts it can “toll” its own deadlines until you comply. ERISA regulations only permit this act for necessary information a claimant failed to submit, which is often not the case. Bartolic Law knows how to handle this maneuver engaging the reviewer regarding why the information is necessary, or why it is not available, stopping Sun Life from delaying our clients’ claims.
ERISA regulations require an insurer to decide an appeal within 45 days unless “special circumstances” apply, preventing the insurer from being able to meet the deadline, allowing a single 45-day extension. For a discussion of what constitutes “special circumstances,” see our blog post.
When an insurer asserts its deadline is extended, make sure to ask why, and what steps it took to meet the 45-day deadline. The reasons given often do not meet the requirements of “special circumstances.”
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