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Has Sunlife Denied your Long-Term Disability?

Our Hamilton Disability Lawyers have Recovered Millions for Claimants Nationwide

Has Sunlife Denied or Stopped Paying your Disability Benefits?

Don’t Panic. Lalande Personal Injury Lawyers are Hamilton Long-Term Disability Lawyers who serve all of Ontario. Call 1-844-LALANDE or Send us a Message Today. 

A disabling injury or illness can put your entire life on hold, from the personal to the professional, preventing you from enjoying your life as you had and leaving you unable to work and support your household as you had before the disability.

One relief is that a mental or physical disability that prevents you from working entitles you to long-term disability benefits to cover your lost earnings due to your condition. However, many people face an uphill battle when it comes time to seek disability benefits from Sunlife. When you receive a claim denial, it can put a halt on your ability to recover benefits and your ability to support your household.

Disability insurance should protect your ability to support yourself and your loved ones if you experience a health condition that makes you unable to work. When you are injured, you might think that it is automatic that your disability payments will kick in. While this is ideal, it is, unfortunately, not the case for everyone, and many Sun Life policyholders have found that collecting their disability benefits is not as simple as they had hoped.

Disability insurance is supposed to provide you with a safety net in your time of need, but when your claim receives a wrongful denial, your situation might be made significantly worse in the short term, with long-term financial implications.

If you’ve been denied long-term disability – call us today. Our Hamilton disability lawyers have been helping claimants who have been denied long-term disability and have recovered millions in compensation since 2003. For a free consultation with an experienced long-term disability lawyer in call Lalande Personal Injury Lawyers at 905333-8888 or fill out a free Consultation Form today. Alternatively, you can call us toll-free, no matter where in Canada you are located at 1-844-525-2633. Our long-term disability lawyers would be happy to schedule a no-obligation consultation with you and your family, and we would be happy to advise you of all of your legal rights and options.

What should I do if Sunlife Denied my Disability Benefits?

If Sunlife terminated your disability benefits, it’s important to take specific steps to address the situation effectively. Here’s a general guide on what you should do:

  1. Understand the Reason for Sunlife’s Termination: Review Sunlife’s termination letter carefully. It should state the reason for the termination of your benefits. Understanding the specific reason(s) is crucial for determining your next steps.
  2. Review Your Policy: Go through your disability insurance policy to understand the terms and conditions, especially those related to the termination of benefits. This will help you assess whether the termination aligns with the policy’s provisions or if there might be grounds for contesting it.
  3. Seek Legal Advice: Consider consulting our disability lawyers. We can provide guidance on your rights, help you understand the complexities of your policy, and advise you on the best course of action, whether that’s an internal appeal, filing a lawsuit, or other legal remedies. Remember – you still have options even though you’ve been denied your disability benefits. It’s important that you speak to a lawyer as soon as possible.
  4. Maintain Your Health Treatment: Continue with your prescribed medical treatments and follow your doctor’s recommendations. Consistency in treatment is important both for your health and as evidence of the ongoing nature of your disability.
  5. Document Communication: Keep a detailed record of all your communications with your Sunlife insurance adjuster. This can be important if there are disputes about what was communicated and when.
  6. Stay Organized: Keep all your documents, correspondence, and notes organized. Being able to quickly find and reference specific information can be crucial during the appeal process or legal proceedings.

Every case is unique, and the best course of action depends on the specifics of your situation, including the reason for the termination, the terms of your Sunlife insurance policy, and your medical condition. It’s strongly recommended to seek professional legal advice from our disability lawyers to navigate this process effectively.

Why did Sunife deny my Long-Term Disability?

Long-term disability claims can be denied by Sunlife for several reasons, some of which are as follows:

  1. Insufficient Medical Evidence: In Canada, long-term disability claims often require substantial medical evidence to support the claim. If the medical documentation is incomplete, vague, or does not sufficiently prove that the disability is severe enough to prevent the claimant from working, Sunlife may deny the claim.
  2. Pre-Existing Conditions: Many Canadian disability insurance policies have clauses related to pre-existing conditions within the first 12 months before obtaining a disability policy. Similarly, with an individually purchased policy, if the disability is due to or related to a condition that the claimant had before obtaining the insurance policy, and if this condition was not disclosed at the time of application, the claim may be denied.
  3. Non-Compliance with Treatment Plans: If a claimant does not follow prescribed treatment plans, Sunife may view this as non-compliance and deny the claim. They may argue that the claimant is not taking necessary steps to improve their health condition. You need to mitigate your disability.
  4. Definition of Disability: The specific definition of disability, as stated in your Sunlife insurance policy, plays a crucial role. The definition of disability may change after 2 years (e.g., from “unable to perform your own occupation” to “unable to perform any occupation”). If you do not meet the evolving criteria, their claim can be denied.
  5. Surveillance and Social Media: Sunife, like other insurance companies sometimes use surveillance tactics or monitor social media activities to gather evidence about the claimant’s activities. If they find evidence suggesting that the claimant is more physically capable than reported, they may use this as a basis to deny the claim.

It’s important for claimants to thoroughly understand their policy, gather comprehensive medical evidence, and adhere to their treatment plans to strengthen their long-term disability claims. Connecting with a Sun Life long-term disability insurance lawyer as soon as possible after your denial is the best thing you can do – do not waste time. The longer you wait, the longer you are delaying the recovery of your claim.

Should I file an Internal Appeal with Sunlife?

If your long-term disability benefits have been denied – Sunlife will offer you the option of an internal appeal. Do you have to do it? The answer is no – and we recommend you don’t.

Pursuing an internal appeal of denied disability benefits is not always advisable due to inherent biases and the limited scope of review within the insurance company. Here are several compelling reasons why filing a lawsuit might be a better option than an internal appeal:

Bias of the Insurance Company:

  • Financial Interests: The insurance company that denied the claim initially has a financial interest in maintaining that decision. This conflict of interest can influence the objectivity of the internal appeal process.
  • Institutional Inertia: Companies often have an institutional tendency to uphold previous decisions. The same personnel or departments involved in the initial decision may also handle the appeal, leading to a high likelihood of the original decision being reaffirmed.
  • Restriction on New Evidence: Internal appeals usually limit the review to the evidence already submitted. This can be detrimental if the initial submission lacks critical information or if new supporting evidence has emerged since the original claim.
  • Process Constraints: The review process and criteria in internal appeals are controlled by the insurance company, which might not be as thorough or fair as an independent review.

Advantages of Filing a Lawsuit:

  • Independent Judgment: A lawsuit brings the case before an impartial judge or jury, ensuring an independent review free from the insurance company’s internal biases and financial interests.
  • Broader Evidence Review: In a lawsuit, you can introduce new evidence and testimony that wasn’t part of the original claim or internal appeal. This allows for a more comprehensive review of the case.
  • Legal Precedents and Standards: Courts operate under established legal standards and precedents, which can offer a more favorable framework for claimants than the policies and procedures of an insurance company.
  • Potential for Greater Compensation: A lawsuit can result in not just the approval of benefits but also the possibility of receiving back pay, interest, and sometimes even punitive damages, depending on the jurisdiction and specifics of the case.
  • Legal Representation: In a lawsuit, claimants can be represented by attorneys who specialize in disability law, offering expertise and advocacy that can significantly increase the chances of a favourable outcome.

While a lawsuit can be more time-consuming and potentially more costly upfront, for many, the prospect of an impartial review and the potential for more careful consideration of their claim makes it a more attractive option than an internal appeal. It’s important for individuals to consult with legal professionals to understand their specific situation and receive tailored advice before deciding which route to approach after a Sunlife denial.

Sunlife Disability Benefits: What happens after two years?

When an individual is approved for long-term disability (LTD) benefits through Sunlife, it’s essential to understand that the definition of disability may change after two years. This change in definition is a crucial aspect of the policy and can significantly impact the claimant’s eligibility for continued benefits.

During the first two years of receiving LTD benefits, the policy typically defines disability under the “own occupation” provision. This means that the claimant is considered disabled if they are unable to perform the essential duties of their own specific job due to an illness or injury. The “own occupation” definition is generally more lenient, as it focuses solely on the claimant’s ability to perform their current job.

However, after two years, the definition of disability often shifts to the “any occupation” provision. Under this definition, the claimant is considered disabled only if they are unable to perform the duties of any occupation for which they are reasonably suited by way of education, training, or experience. This change in definition is significant because it broadens the scope of potential jobs the claimant may be expected to perform, making it more challenging to qualify for ongoing benefits.

Insurers pay close attention to this two-year mark because it allows them to reassess the claimant’s eligibility for benefits under the more stringent “any occupation” definition. From the insurer’s perspective, this shift in definition helps to control costs and ensures that only those who are truly unable to work in any capacity continue to receive benefits.

It’s important to note that while the two-year mark is a critical point in the lifecycle of an LTD claim, not all insurance adjusters are acutely aware of the legal nuances surrounding this change in definition. Some adjusters may not fully grasp the implications of the shift from “own occupation” to “any occupation” or may not be well-versed in the relevant case law that has shaped the interpretation of these provisions.

This lack of understanding can lead to mishandled claims, improper denials, or failure to thoroughly investigate the claimant’s ability to work in other occupations. As a result, claimants may find themselves unfairly denied benefits or faced with the daunting task of appealing the insurer’s decision.

To protect their rights and ensure they receive the benefits they are entitled to, claimants should familiarize themselves with the terms of their specific policy and seek the advice of experienced legal advice from Lalande Personal Injury Lawyers, who specialize in disability insurance claims. These experts can help navigate the complexities of the two-year mark, gather the necessary evidence to support the claim, and advocate on behalf of the claimant to secure the benefits they deserve.

In Ontario, Canada, the time frame within which a claimant must file a legal claim following the denial of long-term disability benefits is typically governed by a limitation period – which is two years. This means that a claimant usually has two years from the date they are first informed of the denial to initiate legal proceedings.

However, there are important nuances to consider:

  1. Date of Discovery: The two-year limitation period generally starts from the date the claimant first became aware, or ought to have become aware, of the facts upon which the legal claim is based. In the case of disability benefit denials, this is often the first date the insurer formally notifies the claimant of the denial – remember the term is “formally”.
  2. Exceptions and Extensions: In certain circumstances – although rare, the limitation period can be extended or delayed, such as in cases of disability or other factors that prevent the claimant from understanding their legal rights. However, these are specific legal exceptions and should be discussed with a lawyer.
  3. Impact of Appeals: If you are engaging in internal appeals with Sunlife, be aware that this process does not extend the limitation period for filing a lawsuit. Therefore, it’s crucial to keep track of the limitation period while undergoing any appeal process with the insurer.

Given the complexity of these matters and the significant impact of missing a limitation deadline, it’s highly advisable to consult with our disability lawyers, who specialize in disability insurance claims, as soon as possible after a Sunlife denial. Our legal professionals can provide advice tailored to your specific situation, including the relevant limitation periods and any actions you need to take.

Has Sunlife denied your Long-Term Disability Benefits? Our Hamilton Disability Lawyers can help.

If Sunlife has denied your long-term disability benefits, it’s crucial to seek the guidance of an experienced long-term disability lawyer to navigate the complexities of your claim and secure the compensation you deserve. At Lalande Personal Injury Lawyers, we understand the profound impact such a denial can have on your life and are committed to advocating for your rights.

Here’s what you can do:

  1. Contact Us Immediately: Time is of the essence in disability claims. Reach out to us for a free consultation to discuss your case. You can call us at 905-333-8888 without worrying about upfront fees.
  2. Gather Your Documentation: Prepare all relevant documents related to your disability claim, including any denial letters from the insurance company, medical records, and any correspondence that you have had regarding your claim.
  3. Meet with Our Team: We can meet with you in person at our Downtown Hamilton office or virtually via Zoom, Google Meet, Microsoft Teams, or Facetime, depending on what’s most convenient for you.
  4. No Upfront Legal Fees: We operate on a contingency basis, meaning you only pay if we are successful in recovering funds for you.
  5. Personalized Legal Representation: When you work with us, you get one-on-one attention. You will not be passed around; you will work directly with our dedicated team throughout your case.

If you’re ready to start, you can also send us a confidential email through our website and we will be happy to get right back to you. We are here to provide you with the personalized and effective representation that you need during this challenging time.

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