Riemer Hess regularly wins long term disability benefits from SunLife for our clients, whether filing a claim, appealing a denial, or litigating in court. SunLife is a well-known disability insurer, and many of our clients come to Riemer Hess after SunLife denies or terminates their long term disability claim. That isn’t surprising since, like all disability insurers, SunLife is operates under an inherent conflict of interest that motivates it to deny benefits. See Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 115 (2008). Each denial can help increase SunLife's profit margin.
Below we’ll discuss common tactics SunLife uses to deny disability claims and how Riemer Hess can help you win your disability benefits from SunLife.
What common tactics does SunLife use to deny disability claims?
SunLife relies on many tactics to deny long term disability claims. In our experience, some tactics SunLife commonly employs include:
- Hiring private investigators to surveil you: SunLife may conduct surveillance on you and use the resulting footage as a basis to deny your claim, even if the surveillance footage is inconclusive and taken out of context.
- Failing to consider all relevant medical evidence: SunLife may “cherry-pick” from your medical records to selectively acknowledge evidence that supports their denial and ignore evidence that supports your claim for disability.
- Dismissing your subjective symptoms: If you report symptoms that are difficult to prove with objective evidence (such as chronic pain or headaches), SunLife may reject these symptoms out of hand without any sound rationale for doing so.
- Failing to consider the impact of your medication side-effects: SunLife may neglect to take into account how the side-effects of your medication affect your physical and cognitive functioning; and/or
- Attacking your credibility without any sound reason for doing so: For example, SunLife may claim you are exaggerating your complaints of chronic pain or fatigue, even when medical evidence substantiates your symptoms.
What common excuses does SunLife use to deny long term disability claims?
SunLife denies disability benefits for a number of reasons, oftentimes unreasonably. Reasons SunLife will deny long term disability claims may include:
- Missed deadlines for filing;
- Your medical records are not “supportive” enough of disability;
- Pre-existing condition clauses in your policy that rule out your medical condition;
- SunLife’s medical and vocational consultants declared you are able to work, despite the evidence to the contrary; and/or
- SunLife conducted video surveillance and used this unreliable, out-of-context footage to deny your benefits.
The disability attorneys at Riemer Hess are well-versed in SunLife’s tactics and can help you avoid these pitfalls when filing for long term disability, appealing your denial, or litigating your claim.
What are the best strategies for filing a disability claim with SunLife?
Before filing your claim with SunLife, it’s important to understand what evidence you may include to increase your chances of benefit approval. It’s also recommended you speak with an experienced ERISA attorney who can assess your claim and formulate a personalized strategy to get you approved for benefits.
Riemer Hess knows what tactics SunLife is likely to utilize depending on the unique facts of your claim. We can then pre-empt any red flags that SunLife may question and make sure your claim is submitted with the strongest evidence possible.
For example, our client Kelly was in a car accident where she suffered multiple injuries, including a broken shinbone, herniated discs in her back, and recurring migraines due to a neck injury. Even though Kelly worked in a mostly sedentary role as a marketing manager, the pain from her injuries proved too much to sit at a desk for extended periods. Kelly immediately filed for long term disability benefits through her employer-sponsored plan with SunLife.
After paying out benefits for almost a year, SunLife suddenly terminated Kelly’s benefits, claiming that she should have recovered and there was no supportive evidence of her ongoing disability. Kelly retained Riemer Hess to handle her appeal with SunLife.
Riemer Hess immediately: (1) contacted SunLife to notify them of their representation; (2) requested SunLife’s claim file containing the documents reviewed by them when deciding Kelly’s claim; (3) referred Kelly out to undergo a Functional Capacity Evaluation with a quialified medical professional, and (4) began obtaining Kelly's medical records on her behalf. The claim file showed a report from SunLife’s medical consultant assessing Kelly as able to work. The consultants had merely reviewed an incomplete file of Kelly’s medical records. Accordingly, Riemer Hess coordinated with Kelly’s treating physician to obtain a letter rebutting SunLife’s consultant’s baseless and incomplete opinion.
All new evidence was submitted to SunLife along with a comprehensive appeal letter refuting all of SunLife’s unjustified reasons for terminating Kelly’s long term disability claim. SunLife reversed their decision and continued to pay Kelly her long term disability benefits.
What should I do if SunLife denies my disability claim?
If SunLife denies your long term disability claim or terminates your benefits are an initial approval, the good news is that you do have options. If your SunLife long term disability policies grant you the right to an administrative appeal. If your claim is governed by ERISA, you will be guaranteed the right to at least one appeal. This appeal is conducted as an internal process with SunLife, where a different representative will review your claim and any new evidence to make a second decision.
Your denial letter from SunLife should explain your appeal rights in detail. It may be tempting to appeal immediately, but keep in mind that if you do not submit new evidence of your disabling condition, SunLife is likely to deny your claim again. It’s important to take the time to make sure all supporting evidence of your restrictions and limitations are submitted to SunLife with your appeal.
The administrative appeal is most likely your one opportunity to avoid drawn-out and expensive litigation proceedings. If your claim is denied or terminated, we recommend consulting with an experienced ERISA attorney who can review your denial letter, policy, submitted claim, and assist you with your appeal.
Have courts criticized SunLife's disability claims handling practices?
Courts have condemned SunLife for its handling of long term disability claims. Here are a few examples of the court criticizing SunLife for its practices:
- Roehr v. Sun Life Assurance Co. of Canada, 21 F.4th 519 (8th Cir. 2021): The Court criticized Sun Life for terminating previously approved benefits in the absence of any medical change; for selectively relying on a single notation in the treating physician’s exam notes; and for failing to obtain an in-person examination, despite one of Sun Life’s own reviewers recommending one.
- Gross v. Sun Life Assurance Co. of Canada, 880 F.3d 1, 6 (1st Cir. 2018): The Court criticized Sun Life for relying on brief and non-probative surveillance footage; for cherry-picking from the evidence; for making speculative conclusions about malingering, symptom exaggeration, and symptom fabrication; for failing to consider the impact of medications; and for failing to consider other contributory factors relevant to the plaintiff’s disability).
- Wilkinson v. Sun Life & Health Ins. Co., 674 F. App'x 294, 297 (4th Cir. 2017): The Court found that “Sun Life shut its eyes to evidence in plain sight.”
- Solnin v. Sun Life & Health Ins. Co., 2015 WL 6550549, at *3 (E.D.N.Y. Oct. 28, 2015), aff'd sub nom., Solnin v. Sun Life, 672 F. App'x 121 (2d Cir. 2017): The Court rejected the non-probative surveillance footage that Sun Life had relied on, as well as the flawed and unreliable opinions of Sun Life’s medical paper reviewers.
How can an attorney help me win long term disability benefits from SunLife?
The experienced ERISA attorneys at Riemer Hess are highly familiar with SunLife and its practices. We can help you gather and submit the strongest claim, proactively develop your file, and review your evidence for any red flags to get ahead of SunLife’s tactics.
If you are filing a long term disability claim with SunLife, appealing a wrongful denial or termination of benefits with SunLife, or facing litigation with SunLife, the New York disability attorneys at Riemer Hess can help. Call Riemer Hess LLC at (212) 297-0700 or click the button below to schedule a consultation on your disability case.