Sun Life Reverses Denial

Saturday, December 19th, 2015

A 56 year old former account executive with hypertrophic cardiomyopathy asked me to represent her after Sun Life denied her application for long term disability (“LTD”) benefits, even though Sun Life had approved her application for short term disability (“STD”) benefits. The only thing that had changed was that a Sun Life nurse said the claimant could work because she had 5 METS on a stress test.

I argued that Sun Life made diametrically opposed decisions without being able to identify any difference in the requirements for evaluating disability under the STD and LTD claims. Similarly, I pointed out that Sun Life made diametrically opposed decisions without being able to identify a single piece of medical evidence that showed the claimant’s medical condition had changed, let alone improved. To make sure there was no misinterpretation of the medical evidence, I obtained a report from the claimant’s cardiologist explaining how the objective medical evidence had not changed, and that there was no basis for equating 5 METS with the ability to work.

Unlike Reliance, CIGNA and Unum regularly do, particularly at this time of the year, Sun Life made the decision to overturn its denial without insisting on extensions. Claims handlers frequently delay approvals as a means of manipulating reserves to meet financial goals. Last month, when Sun Life wrote that it had the right to “toll” the time to render a decision, I responded by sending a letter that quoted the ERISA regulatory deadlines. Sun Life verbally approved the LTD claim before the deadline expired.

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