Sun Life Overturns Its Previous Denial of LTD Benefits for Massachusetts Teacher

Our client, Ms. L, formerly worked as a Technology Teacher for a public high school in Massachusetts. For many years Ms. L suffered from chronic debilitating effects of multiple physical conditions and ailments, including most notably severe degenerative joint disease and osteoarthritis, which left her with debilitating physical pain and occupational impairments. Ms. L was unwilling to give up his career and worked as long as she possibly could. As a result of her serious medical conditions and associated restrictions and limitations, Ms. L was forced to stop working in January 2019 and apply for disability benefits under her employer’s Long Term Disability (LTD) Policy, which was administered and funded by Sun Life. However, Sun Life denied LTD benefits after it determined that the medical evidence does not support Ms. L’s claim that she was precluded from performing the material and substantial duties of her own occupation.

After receiving the denial, Ms. L contacted Dell Disability Lawyers and discussed her case with Attorney Jay Symonds, who identified several significant issues in Sun Life’s denial letter and in the evidence it relied on and agreed to prepare and submit Ms. L’s ERISA appeal with the assistance of his appeal team.

The appeal addressed all of Sun Life’s short-comings and reasons for denial. In particular, the appeal argued that Sun Life’s occupational analysis confirmed that Ms. L’s position as a high school teacher required standing and walking to a significant degree (6 hours in an 8 hour day) and was considered to be “light duty”. And review of the claim file confirmed that Sun Life had in their possession clear objective testing – an MRI – of Ms. L’s afflicted joint(s) that was positive for nondisplaced degenerative tear surrounding the soft tissue and an underling bone marrow edema; advanced tri-compartmental cartilage loss as well as a subsequent X-ray that was positive for advanced degenerative changes with joint space narrowing in the medial compartment. Clearly, the objective testing did not support the ability to perform light duty work requiring extensive standing/walking.

The appeal next argued the significant disparity in Sun Life’s medical reviews versus Ms. L’s treatment providers. Specifically, from a medical standpoint Sun Life’s denial relied exclusively on a “specialist review” completed by Sun Life’s own in-house nurse whose credentials and experience were unknown. Conversely, Ms. L’s claim was supported by all of her treatment providers, which included three (3) different board certified orthopedic surgeons, all of whom were clinical instructors at Harvard Medical School and maintained full-time clinical practices at Massachusetts General Hospital. What’s more, unlike each of these three experts, Sun Life’s nurse did not actually examine Ms. L or even speak with her.

Finally, the appeal noted that the record evidence clearly establishes that Sun Life operated under a significant financial conflict of interest in its purported investigation of and determination on Ms. L’s LTD claim. Sun Life’s attempt to avoid significant financial liability by claiming Ms. L could return to her light occupation by relying on unsupported and unreasonable medical record reviews by an in-house nurse consultant made clear that Sun Life operated under a significant and ongoing financial conflict of interest in deciding Ms. L’s claim.

Just over nine weeks after filing her appeal, and after reviewing hundreds of pages of exhibits and medical records, Sun Life overturned its decision to terminate benefits, paid full LTD back benefits and reinstated Ms. L’s LTD benefits. Attorney Symonds continues to represent our client to best ensure that Sun Life will not terminate her benefits again. Feel free to call our disability attorneys for a free consultation regarding any matter relevant to your disability claim.


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Sun Life Reviews
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Showing 8 of 41 Reviews
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.

Sun Life

SunLife screwed me one week after a C-section

Reviewed by Anna K. on February 17th 2020   Verified Policyholder
On maternity leave after cesarean section and told after my 1 week of wait time that I was only qualified for 7 weeks of short term pay. I understand waiting 1 week before... read more >
Reply
Sent on February 17th 2020 by Attorney Cesar Gavidia

Anna, you should appeal the decision made by the short-term disability insurer. Your denial of benefits letter should explain the timeframe in which you have to appeal ... read more >

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

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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?

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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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