Sun Life Approves Disability Benefits to Surgical Services Director

Prior to filing for disability our client worked as a Surgical Services Director for a large hospital system. Her occupation came with an incredible amount of responsibilities relating to the efficient and safe operation of the surgical department of a hospital- requiring her to not only have to be mentally alert, but also physically available on a moment’s notice throughout the hospital. This was a tall order for anyone, let alone someone with a long history of cervical and lumbar spine conditions with associated radiculopathy, arthritis, migraines and neuralgias. Eventually the pace of her job and the continued deterioration of her health left her unable to adequately perform her duties, which in turn left her with little choice but to file for disability benefits under her employer’s policy with Sun Life.

The Initial Denial of Benefits

Despite overwhelming support from her doctors and from her supervisors at work, Sun Life determined that our client was not eligible for benefits under the policy. The basis of the denial is due in large part how Sun Life often interprets its own policy, with specific attention to the definition of disability and “own occupation.†Our client’s policy had very standard language as it relates to disability- the inability to perform the Material and Substantial Duties of your Own Occupation. However, instead of reviewing one’s ability to perform the actual duties required of her job, Sun Life only took into consideration the physical demand level associated with our client’s occupation as set forth by the Department of Labor- or more commonly argued, the “national economy standard.†In this case, Sun Life stated that there was a lack of medical information to support our client’s inability to perform “Sedentary†work without any real consideration to her actual occupational duties.

The Administrative Appeal

Following the denial of her claim our client reached out to Attorney Stephen Jessup as he had previously represented and successfully secured disability benefits for a friend of hers. In reviewing Sun Life’s claim file Attorney Jessup’s attention was initially drawn to the concerns relating to Sun Life’s occupational review, which he felt created an unfair standard of disability that was not contained in the policy. However, knowing that Sun Life’s review of our client’s appeal would be heavily dependent on evidence with respect to her physical ability to work Attorney Jessup had her undergo a Functional Capacity Evaluation. The purpose of the FCE was to draw a correlation between our client’s diagnosis and her functional restrictions and limitations as they relate to work based on same. The results of the FCE did indicate our client retained some ability to work at a Sedentary demand level, but not on a full time basis or with reasonable continuity. In light of these findings Attorney Jessup gathered additional statements and letters of support from our client’s attending physicians to further undermine Sun Life’s doctor’s opinions. Armed with an abundance of additional objective medical evidence of disability Attorney Jessup submitted an appeal that was over 1000 pages of argument and medical information on our client’s behalf.

Following an appeal review that included Sun Life exercising its right to an extension of time to make a decision, Sun Life, faced with overwhelming evidence of disability and argument as to entitlement of same, overturned its denial of our client’s benefits. However, like many insureds, our client is not out of the woods yet as her policy contains a change in definition to the inability to perform the duties of “any occupation†after 24 months of long term disability benefits. Attorney Jessup continues to represent our client to best ensure that Sun Life will not be able to terminate her benefit at that time.


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Sun Life Reviews
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Showing 8 of 42 Reviews
Sun Life

Unscrupulous Tactics

Reviewed by Misseekayy on December 19th 2023   Verified Policyholder | May 2023 date of disability
Sunlife uses unscrupulous tactics in order to prevent payment of claims. They wait until it is close to the 30 day mark and then they ask for another form of information o... read more >
Sun Life

What a mess

Reviewed by Unknown on September 12th 2023   Verified Policyholder | July 2020 date of disability
This place has no idea what day it even is. First they attach my claim to my previous claim in which was a new claim. They messed up and denied me then made me wait yet ag... read more >
Reply
Sent on September 12th 2023 by Attorney Gregory Dell

I am sorry to hear what you are experiencing. Make sure you deal with Sunlife writing and follow up every day. If you would like assistance please contact us.

Sun Life

They leave you unable to fight

Reviewed by Kara on May 1st 2023   Verified Policyholder | July 2014 date of disability
I received LTD from Sunlife since 2014 until 2021. I still tried fighting in 2022. Somewhere they changed my claim from physical to mental but nothing in my medical histor... read more >
Reply
Sent on May 1st 2023 by Attorney Gregory Dell

Kara:
Thank you for submitting a review about your experience with Sun Life. If you appealed your denial, then you may still have time to file a lawsuit to obtain... read more >

Sun Life

Sun Life is a real pain

Reviewed by Chris K. on May 20th 2022   Verified Policyholder
Sun Life is a real pain. I just want them to buyout my long term disability policy, but they keep playing around and around. I just to be left alone and given my lump sum ... read more >
Reply
Sent on May 20th 2022 by Attorney Rachel Alters

Chris, you can contact me at Rachel@diattorney.com and we can set up a call to discuss your buy out options.

Sun Life

Everytime SunLife receives my information they ask for another 7 to 10 business days

Reviewed by Joe M on May 31st 2021   Verified Policyholder
Told Sunlife I’m getting an attorney since my claim was filed April 16, 2021, still pending a decision and everytime they ask for more information and they receive it, t... read more >
Reply
Sent on May 31st 2021 by Attorney Jay Symonds

Joe, I assume this is a short term disability claim pursuant to a group policy issued to your employer. If so, the relevant federal claims regulations allow the carrier... read more >

Sun Life

I have lost everything due to non payment of my claim.

Reviewed by Lester H. on November 2nd 2020   Verified Policyholder
I have lost everything due to non payment of my claim.
Sun Life

SunLife said if I don't apply for SSI they will lower my payments

Reviewed by Jeffrey R. on July 26th 2020   Verified Policyholder
Sun Life is trying to get me to apply for ssi. Have long term disability though them been on it for 9 months. Live in PA. Telling to apply or they are lowering my payments... read more >
Reply
Sent on July 26th 2020 by Attorney Rachel Alters

Jeffrey, you are required under the policy to apply for Ssdi. If you don’t they will take an estimated offset and decrease you benefit by that amount.

Sun Life

I don't understand SunLife's overpayment letter

Reviewed by Gina L. on July 15th 2020   Verified Policyholder
My name is Gina and I have been collecting LTD from my previous employer through Sun Life for almost 2 years. I am currently easing back into the work force and I work a p... read more >
Reply
Sent on July 15th 2020 by Attorney Rachel Alters

Gina: I suggest you contact our office and speak with one of the attorneys to discuss the specific questions you have. At that point you can send along the letter.

Answered Questions by Our Lawyers
(29)
Showing 8 of 29 Answered Questions

Q: Can SunLife offset dependent social security benefits received on account of my wife's disability?

Answered on May 8th 2020 by Attorney Stephen Jessup
A: Dominick, unfortunately, employer provided disability policies contain language that allows for the offset of ... Read More >

Q: Does SunLife have a required time to make a decision? Can they request medical records that have nothing to do with my illness?

Answered on February 19th 2019 by Attorney Gregory Dell
A: Megan, in an ERISA governed claim Sun Life would have 45 days to make a decision and have the option of taking... Read More >

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Answered on July 14th 2018 by Attorney Rachel Alters
A: Rachael, if the policy does not mention a COLA then that usually means that the insurance company does not off... Read More >

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Answered on June 15th 2018 by Attorney Alex Palamara
A: Scott, the policy governing your claim will define what is a pre-existing condition. If you were having sympto... Read More >

Q: Can I sue SunLife if I signed a Settlement & Release Agreement?

Answered on June 4th 2018 by Attorney Jay Symonds
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Q: Can I still get my short term disability benefits if I'm terminated?

Answered on January 26th 2018 by Attorney Stephen Jessup
A: C. Freeman, even if you are terminated you would still have legal rights under your policies. Your rights unde... Read More >

Q: Can I sue SunLife for pain and suffering?

Answered on January 12th 2018 by Attorney Stephen Jessup
A: Jim, under ERISA governed policies there are no actions for pain and suffering, only unpaid benefits. Read More >
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Can Sun Life deduct Veterans' Benefits from a monthly disability insurance benefit payment?

The case of Marco Martinez v. Sun Life Assurance Company of Canada (Sun Life) provides guidance in determining whethe... Read More >

California Court Reverses Sunlife Disability Denial for Woman with Fibromyalgia

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Most long-term disability policies require a claimant not only be unable to perform the material and substantial duties of his or her occupati... Read More >

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When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-698-9159 or by email. Lawyers and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.