Reasons Why Sun Life May Deny Your Long-Term Disability Claim

You’ve been paying into your long-term disability policy for years, trusting that if something ever happens and you’re unable to work, your insurance provider will step up and help you through tough times.

You probably chose Sun Life because of their reputation and their promise to provide the support you need. But now, when you need them the most, they’ve denied your long-term disability claim. It feels like a betrayal, and you’ll most likely be left feeling frustrated, confused, and wondering what went wrong.

How can they just turn their backs on you after all those years of paying premiums? It’s not only disheartening, but it also leaves you in a difficult financial and emotional position.

Let’s try to understand why Sun Life may deny a claim.

The Medical Evidence You Provided Was Insufficient

One of the most common reasons insurance companies deny disability claims is insufficient medical evidence. Sun Life is going to want to see proof, lots of it, that you’re truly disabled and can’t work.

It’s not enough to just tell them you’re injured or sick; they’ll need detailed medical records, doctor’s notes, diagnostic tests, and more. If they feel like the evidence you’ve provided doesn’t clearly show your disability, they’ll deny your claim.

Your Health Problem Isn’t Covered By Insurance

Another reason for denial can be policy exclusions or limitations. Every insurance policy has a lot of fine print, and Sun Life is no different. There are likely things written in your long-term disability policy that outline certain conditions or circumstances under which they won’t pay out.

For example, some policies exclude pre-existing conditions, so if your disability is related to an illness or injury you had before you signed up for coverage, they might use that as a reason to deny your claim.

And then, mental health conditions or chronic pain syndromes, like fibromyalgia, are often subject to stricter rules. Sun Life might argue that your condition falls under one of these categories.

Failure To Meet The Definition Of “Disabled”

There’s also the issue of failure to meet the definition of “disabled” as laid out in your policy. This is one of those areas where insurance companies get pretty technical.

Your policy will define what it means to be disabled in their eyes, and if Sun Life doesn’t believe that you meet this definition, they won’t approve your claim.

For instance, some policies define “disabled” as being unable to perform the duties of your specific job, while others require that you be unable to perform any type of work.

If Sun Life thinks that you can still perform some kind of work, even if it’s not your usual job, they may deny your claim.

Lack of Cooperation

Another big reason for denial is a lack of cooperation. If you’re not fully playing along with Sun Life’s requests for documentation, medical evaluations, or rehabilitation programs, they might deny your claim because you’re not cooperating. They might ask you to go to an independent medical examination (IME), and if you refuse or don’t show up, that can be used against you.

Even if you’re genuinely trying to follow their process, any perceived lack of cooperation can result in a denial.

What to Do After Sun Life Denies Your Long-Term Disability Claim

So, what do you do if Sun Life denies your long-term disability claim? It’s not the end of the world, even though it might feel like it.

Here’s what you should do: Hire a lawyer who specializes in long-term disability claims. These lawyers know exactly how these companies operate and what it takes to get them to pay out.

You might be thinking, ‘Why do I need a lawyer? Can’t I just appeal the decision myself?’ Sure, you could, but here’s the thing: insurance companies like Sun Life have teams of experts working to protect their interests.

Their lawyers know the ins and outs of their policies, and they’re banking on the fact that most people don’t.

If you try to tackle this on your own, there’s a good chance you might miss something important, which could result in a failed appeal. A lawyer knows the process inside and out, and they’ll ensure that every ‘I’ is dotted and every ‘T’ is crossed.

If necessary, your lawyer might even file a lawsuit against Sun Life. While not every case goes to court, sometimes it’s the only way to get the insurance company to take your claim seriously.

Insurance companies are more likely to settle or reconsider their decision when they know there’s a legal expert in your corner, pushing back on their tactics.