• Sun Life Disability Lawsuit & Benefit Denial Tips

Sun Life Disability Lawsuit & Benefit Denial Tips

Canadian-based Sun Life provides group long term disability insurance policies throughout the United States, and like many disability insurance carriers, its disability insurance claimants tend to get their fair share of insurance benefit denial letters. But unlike some of the largest disability insurance carriers, Sun Life provides very thorough denial letters when it rejects a disability claim. Often weighing in at eight or nine pages to the more typical three or four, these letters can provide disability insurance claimants with a valuable roadmap to what they’ll need to prove to win a disability insurance lawsuit. Learn more about what happens after a Sun Life Disability insurance claimant has exhausted their disability insurance administrative appeals and is ready to sue this insurance carrier for disability benefits.

Sun Life Disability Lawsuits Are Usually Filed in Federal Court

Most Sun Life Disability policies are group policies paid by an employer, not individual policies purchased by a person. The Employee Retirement Income Security Act (ERISA) governs these policies and prescribes a strict set of procedures and rules that ERISA appeals must follow.

After a Sun Life Disability insurance claimant receives their denial letter, they’re required to appeal this denial (to, again, Sun Life) before they can sue. Filing a disability insurance lawsuit without appealing the disability insurance denial can prevent a claim from being litigated. If the administrative appeal results in a second denial, the claimant may file an ERISA lawsuit in federal court, applying federal law. This can be a double-edged sword; it can make it easier to predict how a particular case may go, but it can also present standards that can seem frustratingly rigid.

Discretionary Clauses Can Make Disability Claims More Challenging to Win

A discretionary clause provides the insurance carrier with the discretion to interpret the plan documents and deny a disability claim accordingly. This broad latitude can be a problem for ERISA claimants, who must not only show that they meet the policy’s definition of “disability,” but also that the disability insurance carrier’s denial was “arbitrary and capricious.” This is a much higher standard to satisfy than simply proving one is disabled, and when the insurance carrier has already been granted this broad discretion by the terms of the policy itself, meeting the “arbitrary and capricious” standard can require some significant evidence.

Most Common Ways a Long Term Disability Claim is Resolved

Because disability insurance litigation requires risk for both the claimant and the insurance carrier, most long term disability insurance  claims result in some sort of settlement. This can provide certainty and finality for both sides, even if neither party is getting precisely the outcome they wanted. In some rare cases, an ERISA claim will proceed all the way through litigation, but this can be expensive for an insurance carrier; avoiding this known cost in addition to the risk of being found liable for past-due disability benefits is often one of the major factors driving settlement.

Usually, when a Sun Life Disability claim settles, the insurance carrier will offer a lump sum buyout of the policy based on a percentage of the present value of future payments. Again, this can provide both parties with some greater certainty – Sun Life is able to terminate the claimant’s policy and close the case for good while the claimant has cash on hand to pay past debts or fund future expenses.

If you’ve recently received a denial letter from Sun Life Disability and are wondering about your next steps, the long term disability insurance attorneys at Dell & Schaefer can help. We serve clients all across the country and have years of experience in negotiating with Sun Life and other major carriers. Set up your FREE consultation today to discuss your case with us.

Comments (2)

  • Marketta, it’s important to ensure that if your claim is denied your Appeal be exhaustive, comprehensive, and contain not only all of your relevant medical records, but that your treating providers, particularly the ones who are in charge of your care for the condition(s) you are claiming disability from, address the limitations and restrictions produced by your conditions. Also, it may be important to consult additional experts and examiners who may be able to conduct testing that could show the extent of your functional limitations. This Appeal may be the only opportunity you will have to include additional support and evidence.

    Cesar Gavidia Feb 14, 2021  #2

  • I was denied once and appealed it. I believe they are going to deny me again.

    Marketta K. Feb 14, 2021  #1

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Questions About Hiring Us

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer 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.

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