Sun Life LTD Insurance Claim Denials

Having your long-term disability (LTD) benefits claim denied by Sun Life can make you feel angry and frustrated. After years of contributing to your policy, when you find yourself in a situation where you need the most protection, the insurance provider denies your claim.

At Kantor & Kantor, we understand the frustration and uncertainty accompanying such situations. Our experienced team of legal professionals focuses on assisting individuals who have encountered challenges with Sun Life LTD insurance claims.

If Sun Life Insurance denies your claim, you can challenge their decision and secure the benefits you are entitled to through an appeal. Our lawyers for Sun Life LTD insurance claim denials are adept in overturning insurance claim denials and are ready to assist you in this process. We are people helping people, and you can contact us at 818-886-2525 for a free consultation.

We offer a free case evaluation to discuss how our attorneys can assist you. Contact us now at 818-886-2525 for a free consultation.

What Is Sun Life Long-Term Disability Insurance?

Sun Life Insurance Company is a segment within Sun Life Financial, a Canadian-based financial services provider. Sun Life Financial boasts assets under administration exceeding $125 billion and a substantial international asset management portfolio exceeding $1.3 trillion. Sun Life Insurance stands out as a prominent global provider of life and disability insurance, extending its insurance and financial services offerings worldwide. In the United States, Sun Life secures its position as the sixth-largest provider of group insurance benefits.

Despite its significant standing, Sun Life has faced numerous allegations of wrongfully denying claims and engaging in insurance bad-faith practices. Accusations have surfaced regarding Sun Life’s disability insurance division, claiming a breach of fiduciary duties to customers. This stems from the division’s dual role of being responsible for disbursing disability benefits and determining the eligibility of individuals for such benefits. This dual role has raised concerns about conflicting interests and potential improprieties.

There is a tendency for the company to encourage insured individuals to settle for an amount below the specified benefits outlined in their plans. It is crucial not to accept any settlement offers from Sun Life hastily; instead, seek advice from our Sun Life LTD Insurance claim denials attorney, who can carefully assess the figures involved.

Understanding the Sun Life LTD Claims Process

Sun Life deliberately complicates the process of filing LTD claims for its policyholders. Upon receiving a claim, Sun Life may promptly seek any conceivable “legal” grounds to dismiss it. While instances of fraudulent claims occur, our experience indicates that such occurrences are infrequent compared to insurers perceived as adversarial figures within the system. The deliberate strategy of assertive claim denials can leave honest employees who are genuinely too unwell to work feeling victimized.

Throughout this process, you must provide Sun Life with substantial medical evidence. This evidence needs to establish the existence of your condition and demonstrate its debilitating impact on your ability to perform your current job.

Individuals attempting to pursue appeals independently often encounter an overwhelming and exasperating experience. Insurance companies, including Sun Life, frequently demand redundant information, assert non-receipt of documents you’ve undoubtedly sent, or reject claims based on inaccurate information.

Why Did Sun Life Deny Your LTD Insurance Claim?

The reasons for denial can vary, and a comprehensive evaluation of your case is essential to identify and address these factors. Here are some common grounds for denial:

1. Insufficient Medical Evidence

Sun Life may deny a claim if they perceive the medical evidence provided does not adequately support the disability claim. This can often be due to incomplete medical records, conflicting opinions among health care professionals, or an inadequate connection between the claimed disability and the evidence presented.

2. Policy Interpretation Discrepancies

Insurance policies can be complex, and discrepancies in interpreting policy terms and conditions can lead to denials. Sun Life may deny a claim based on a misinterpretation of policy provisions, exclusions, or limitations.

3. Administrative Errors

Denials may occur due to administrative errors, such as paperwork mishandling, processing mistakes, or miscommunications within Sun Life.

4. Failure to Meet Policy Requirements

Every insurance policy comes with specific requirements and conditions that must be met to qualify for benefits. If Sun Life determines that you have not met these requirements, they may deny your claim.

5. Independent Medical Examinations

Sun Life may request an Independent Medical Examination (IME) to evaluate the nature and extent of your disability. If the results of the IME are used to deny your claim, our legal team can scrutinize the examination process and findings to ensure fairness and accuracy.

6. Failure to Follow Proper Procedures

Non-compliance with the procedures outlined in your policy, such as deadlines for filing or appealing a claim, may result in denial.

Tactics Used By Sun Life to Deny Insurance Claims

Insurance companies may resort to various strategies that, while legal, can be perceived as unfair or manipulative. Here are some common tactics used by Sun Life:

1. Lack of Transparency in Policy Terms: One of the common complaints against Sun Life is the alleged lack of transparency in policy wording. Policyholders often claim that the language used in insurance policies is complex and ambiguous, leading to confusion about coverage details. This lack of clarity may enable Sun Life to deny claims based on interpretations that favor the company, leaving policyholders unaware of potential coverage gaps.
2. Delayed Claims Processing: Policyholders have reported instances where Sun Life allegedly engages in deliberate delays when processing claims. Prolonged investigations and paperwork requirements may frustrate claimants, potentially discouraging them from pursuing their claims.
3. Selective Use of Medical Evidence: Policyholders may assert that Sun Life engages in the selective use of medical evidence to support claim denials. This may involve relying on the opinion of a single medical professional, disregarding contrary medical opinions, or interpreting medical records in a manner that favors the insurer’s position. Such practices may be perceived as an attempt to manipulate the claims assessment process.
4. Inadequate Investigation: Policyholders often claim that Sun Life conducts inadequate investigations before denying claims. An insurer has to thoroughly and impartially investigate claims to ensure fair and accurate assessments. Allegations of incomplete or biased investigations may be raised if claim denials appear to be based on insufficient information or a lack of due diligence.
5. Unreasonable Demand for Documentation: Policyholders often face the challenge of providing extensive documentation to support their claims. However, some claimants accuse Sun Life of unreasonably demanding excessive documentation, creating additional hurdles for policyholders to overcome. This tactic may be perceived as a deliberate effort to complicate the claims process and increase the likelihood of denial.

If Sun Life has denied your LTD insurance claim, contact Kantor & Kantor Insurance claim denials attorney today for assistance.

What Do I Need to Appeal a Denied Sun Life Long-Term Disability Claim?

Once you thoroughly examine the denial letter, the next step involves identifying the most effective evidence to strengthen your appeal. This is a critical opportunity to address any weaknesses in your claim, making it essential to present compelling evidence during the appeal stage.

To obtain the strongest evidence for your appeal, consider taking the following steps:

1. Obtain Additional Medical Evidence: Medical records alone may not be sufficient. Seek opinions from external experts who can conduct functional capacity and neurophysiological evaluations, providing additional support for your case.
2. Consult a Vocational Expert: A vocational expert can assess your ability to perform specific job duties, highlighting the limitations imposed by your condition. This expert evaluation can substantiate how your condition hinders your capacity to work.
3. Request a Specialized Report From Your Doctor: Obtain a detailed report from your treating physician, emphasizing aspects of your condition that a standard medical report might overlook. Maintain open communication with your doctor to ensure a thorough explanation of how your condition impacts your daily life.
4. Secure Witness Statements: Gather statements from family, friends, and coworkers who witness the daily impact of your condition. These statements can provide insight into how your condition affects your personal life and your performance in the workplace.
5. Adhere to Appeal Deadlines: Missing deadlines can lead to appeal denials. Given the strict deadlines under ERISA, meticulously track and meet all associated timelines to avoid any setbacks.

Additionally, updating any evidence submitted with your initial claim is crucial. If you underwent an evaluation for your initial claim, consider repeating the evaluation to demonstrate to Sun Life that your condition continues to have a significant impact on your life. Regularly updating your evidence reinforces the ongoing nature of your condition.

Why Choose Kantor & Kantor?

Choosing the right legal representation is pivotal when confronted with the distressing situation of a Sun Life LTD insurance claim denial. At Kantor & Kantor, we recognize the significance of this choice and offer compelling reasons why we are your ideal advocates in navigating the complexities of insurance disputes:

1. Seasoned Expertise: Our legal team handles insurance denials, particularly on LTD claims. We have an in-depth understanding of the intricacies of insurance policies, industry practices, and the nuances of legal arguments necessary to challenge claim denials successfully.
2. Documented Results: We have a track record of success in securing benefits for clients facing insurance claim denials. Our attorneys have successfully litigated against major insurance providers, including Sun Life, and have a history of obtaining favorable outcomes for our clients.
3. Compassionate Advocacy: We understand the emotional toll an insurance claim denial can take on individuals and their families. We approach each case with compassion, recognizing our clients’ personal challenges. Our attorneys take the time to listen to your story, understand your unique circumstances, and tailor our legal strategy to meet your specific needs. We are not just legal advocates; we are people helping people and are here to help you secure the benefits you deserve.
4. Comprehensive Approach: Challenging an insurance claim denial requires a comprehensive approach that involves legal expertise, thorough analysis, and strategic advocacy. Our legal team collaborates closely, combining diverse skills and perspectives to develop a robust and customized strategy for each case. We leave no stone unturned in our pursuit of justice, employing a meticulous and thorough approach to build the strongest possible case on your behalf.
5. Client-Centered Focus: Our clients are at the center of everything we do. We prioritize clear communication, transparency, and accessibility throughout the legal process. Our attorneys take the time to educate clients about their rights, explain legal procedures, and provide realistic expectations.
6. Skilled Negotiators and Litigators: Our legal team consists of skilled negotiators and litigators who are prepared to pursue every avenue to resolve your case. Whether through negotiation with Sun Life or litigation in court, we can strategically advocate for your rights. We aim to achieve your best possible outcome through a settlement or court judgment.

A History of Winning Cases Against Sun Life

We have a history of success against Sun Life in various legal settings. Our legal victories include cases where Sun Life’s denial tactics were rigorously contested and we emerged triumphant. These successes illustrate our prowess in dismantling Sun Life’s defense strategies and advocating effectively for our clients. Here are some cases we have won against Sun Life:

• Holmgren v. Sun Life and Health Insurance, 354 F.Supp.3d 1018 (USDC N.D. CA 2018)
• Young v. Sun Life and Health Insurance Company, 285 F.Supp.3d 1109 (USDC E.D. CA 2018)
• Green v. Sun Life Assur. Co. of Canada 259 Fed.Appx. 42 (9th Cir. 2007).

Our Sun Life LTD insurance denial attorneys at Kantor & Kantor will help you gather all medical records and other documentation to help you fight your Sun Life Insurance claim denial.

How We Can Help With Your Case

Facing a Sun Life LTD insurance claim denial can be an overwhelming and stressful experience. Our team of seasoned attorneys is dedicated to providing comprehensive support tailored to the unique circumstances of your case. Here’s how we can assist you in challenging and overturning the denial:

1. Thorough Case Evaluation: Our first step is to meticulously review your insurance policy, medical records, and the reasons for the denial. This comprehensive evaluation helps us identify discrepancies, policy misinterpretations, or overlooked evidence that may strengthen your case.
2. Gathering Additional Evidence: In many instances, claim denials stem from insufficient or misinterpreted medical evidence. Our team collaborates with medical experts to gather additional documentation, opinions, and testimonials that bolster your claim. We ensure that all relevant medical information is presented to Sun Life, supporting the legitimacy of your disability and the need for benefits.
3. Legal Analysis and Strategy Development: Our attorneys delve into the legal aspects of your case, analyzing policy language, relevant statutes, and case law. This meticulous legal analysis enables us to develop a strategic plan tailored to the specific nuances of your situation. We leverage our expertise to craft compelling arguments that challenge the denial and highlight your entitlement to LTD benefits.
4. Negotiation With Sun Life: Direct negotiations with Sun Life are often critical to the claims process. Our experienced negotiators work tirelessly to communicate with Sun Life on your behalf, presenting the strengthened case and advocating for a fair resolution. We aim to reach a favorable outcome without requiring protracted litigation, saving you time and reducing unnecessary stress.
5. Litigation: Our team is prepared to pursue litigation if negotiations do not yield a satisfactory result. Whether through appeals or court proceedings, we tenaciously advocate for your rights, presenting a compelling case to challenge the denial and secure the benefits you deserve.

Contact Kantor & Kantor to Help With a Sun Life LTD Insurance Claim Denial

Don’t face the challenges of a Sunlife LTD insurance claim denial alone. Kantor & Kantor is here to provide the legal support you need. Contact us at 818-886-2525 for a free consultation and let our Sun Life LTD insurance denial attorneys fight for the benefits you deserve. We are people helping people and are dedicated to helping you navigate the complexities of insurance claims and secure a favorable outcome for your case.

Attorney Glenn R. Kantor

Glenn Kantor is a founding partner of Kantor & Kantor LLP. As a young attorney, Glenn saw the injustice of wrongful insurance denials and created a law firm to represent individuals seeking to obtain their rightful benefits. Glenn is committed to ensure that clients receive the benefits they are entitled to under their insurance policies or group health plans. [Attorney Bio]