In this article, we discuss everything you need to know about Sun Life long-term disability benefits. That includes a discussion of rules, as well as information about applying for benefits and appealing a denial. We also discuss Sunlife long-term disability complaints, important court cases, and more.
Let’s get started!
- About Sun Life
- Sun Life Long-Term Disability Rules
- Short-Term Disability Benefits
- How to Apply for Sunlife Long-Term Disability
- Appealing a Denial
- Buyouts and settlements with Sun Life Long term Disability
- Sun Life Long-Term Disability Complaints
- Important court cases involving Sun Life long-term disability
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About Sun Life
Sun Life, Sunlife, and Sun Life Financial are all shortened names for the Sun Life Assurance Company of Canada. It is one of the big three life insurance companies in Canada — the other two being Manulife Financial and Canada Life (formerly Great-West Life).
Sun Life sells and administers a range of insurance and financial products, including short- and long-term disability benefits plans. Sun Life sells individual and group disability insurance policies to consumers and employers. It also acts as a third-party administrator for disability plans set up and funded by large employers or non-profit groups.
If you have a disability claim involving Sun Life, it is important to learn as much about them as possible. I wrote this guide to give you an overview of Sun Life long-term disability. I include links to articles that provide more information about Sun Life disability applications, appeals and lump-sum settlements.
Sun Life Long-Term Disability Rules
There are no general rules applicable to all Sun Life long-term disability claims.
If you need to file a long-term disability claim with Sun Life, you should get a hold of the particular group policy or plan document that applies to you. The rules for eligibility, payment amounts, and claim procedures will all be there. These group policies and plan documents are unique, so the only way to know the rules for your situation is to get the document that applies to you.
You can find a summary of your benefits in the group benefits booklet or certificate of insurance. You can request a copy of this booklet or certificate from your employer, union, or association. This booklet includes all the information relevant to your claim. So, you don’t need a copy of the original group insurance policy issued to your employer or association.
Sun Life also issues individual insurance policies, usually to self-employed professionals, executives or small-business owners. You would have to buy this type of policy from Sun Life — usually using an independent insurance broker. If you have an individual insurance policy from Sun Life, then you can find the rules for your benefits in the insurance policy and any amendments or riders attached to it.
Looking for a more in-depth explanation on how long-term disability works? Check out our article on long-term disability in Canada.
Short-Term Disability Benefits
If you need to file a short-term disability claim with Sun Life, you need to get a copy of the benefits booklet that applies to you. There are no general rules for Sun Life’s short-term disability claims. Therefore, the benefits and claims process is unique based on your particular group insurance or income continuation plan.
When dealing with Sun Life for a short-term disability claim, it is important to know the role Sun Life plays in paying and administrating benefits.
There are two scenarios for how Sun Life will administer and pay short-term disability benefits. First, Sun Life can be the insurer, administrator, and payor of benefits under a group insurance policy. Second, Sun Life can act only as the third-party administrator of benefits paid by your employer or association.
In most situations, the claims process will not change regardless if Sun Life acts as the insurer or third-party administrator. But, Sun Life’s role as a third-party administrator does become relevant if you need to file a legal appeal or lawsuit for payment of benefits. If Sun Life is a third-party administrator, you would need to take legal action against the actual payer of benefits. This is usually your employer or association.
Third party administrator
There are situations where Sun Life will act as the third-party administrator of a disability plan. In other words, the plan is set up and funded by a government, large employer, or other association. We refer to these types of plans as non-profit disability plans. In these situations, Sun Life acts only as the administrator of the plan. In other words, they exercise authority delegated to it by the organization that funding the plan. There is no insurance policy, per see. But, you can find the rules for benefits in a document called the “Plan Text” or something similar.
With non-profit disability plans, you may have restricted rights on appeal. These plans may have strict procedures and deadlines that don’t follow the same rules as regular long-term disability policies. For example, you may be unable to pursue your appeal using the lawsuit process. You might be limited to using the grievance and arbitration process set out in a collective agreement.
Some examples of large group policies managed by Sun Life include:
- Federal Public Service Long-Term Disability Plan
- Newfoundland and Labrador Public Service Long-Term Disability Plan
How to Apply for Sunlife Long-Term Disability
The steps you will need to take to apply for short- or long-term disability benefits with Sun Life will depend on your specific disability policy or plan. While the application forms are usually very similar from plan to plan, you must use the specific forms designated for your plan or policy. There are no “general application forms” you can find and use online.
You usually get the application forms from your employer. You can also find them in the secure online portal for your specific group insurance plan.
Once you get the forms, the process to apply for disability benefits is very similar in all cases. You will need to submit three forms: a claim form that you fill out, a medical form your doctor fills out, and a form your employer fills out.
For more information, check out our article on how to apply for long-term disability.
How to check your disability claim status
The best way to determine the status of your Sun Life disability claim is to contact the representative assigned to your case. If your claims representative does not respond to your inquiries, you can follow Sun Life’s complaint process. Try to work with the claims representative and use the complaint process as a last resort.
Appealing a Denial
There is no one-size-fits-all approach to appealing a disability claim denial from Sun Life. You must follow the appeal rules that apply to your disability plan. Start by getting a copy of the booklet that describes your specific disability benefits. You can get this from your employer, association, or insurance broker.
Internal Appeal
Generally, your short or long-term disability appeal will involve two or more opportunities to appeal to a Sun Life claim representative. These are called internal appeals. You will have a deadline for each round of appeal. These deadlines vary, but can be anywhere from 30 to 90 days.
You must notify Sun Life in writing about your intention to appeal before the end of the appeal deadline. Ideally, you should also get any new medical information to the claim representative before the deadline. However, if you are experiencing delays in getting the information, they will usually extend the deadline — as long as you notify them in advance.
Legal Appeal
If your attempts at an internal appeal through Sun Life get denied, your next step is to pursue a legal appeal. This means that you’re taking your case before a judge who will make the final decision on whether your disability benefits get approved.
When you move to this external appeal, Sun Life will typically assign a new claims representative as well as a lawyer. In addition to the judge. This means you’re getting a whole new set of fresh eyes on your claim. In many cases, just having this new team of people look at the evidence is enough to get your claim approved.
If not, the process for the legal appeal basically goes like this: You’ll usually get interviewed by Sun Life’s lawyer and representative so they can get a better understanding of you and your situation. After that, you and your lawyer work together to get any new information or medical record. And then, each side presents their case to the judge for a final decision.
If you are appealing a long-term disability claim under a group insurance policy, we recommend you follow our 7 steps to appeal a long-term disability denial.
If you are appealing a long-term disability claim in a situation where Sun Life is acting as a third-party administrator, then you need to first determine if any unique appeal rules will apply to you.
Buyouts and settlements with Sun Life Long term Disability
Most life insurance companies, including Sun Life, will agree to lump-sum buyouts or settlements in certain situations. There is no provision under the policy or plan for these settlements. So, both sides have to agree to them.
However, some disability plans prohibit buyouts — unless the claim is in litigation. It is important to understand the difference between a buyout and a settlement.
Lump sum buyouts
Buyouts refer to a situation where an insurance company will make a one-time payout of an approved long-term disability claim. So, instead of making monthly payments, the insurance company will agree to give you a one-time payment that represents a portion of the future benefits payable under the policy.
Sun Life will sometimes agree to lump-sum buyouts of approved long-term disability claims. In my experience, lump sum buyouts are best when they are initiated by Sun Life. This happens when Sun Life proactively identifies a group of individuals for whom they would consider buyouts, and then reaches out to those people.
People often ask me if they can initiate a buyout regarding their approved claim with Sun Life. In my experience, most people who want to initiate a buyout from Sun Life are not in a situation where Sun Life would agree to one. In my experience, Sun Life is not interested in buyouts of approved claims that are contested or contentious. Sun Life will only consider buyouts in stable situations where they believe it is a win-win for both you and them.
Lump sum settlements
Like most life insurance companies, Sun Life will consider lump sum settlements for denied disability claims that are in litigation. However, they do this on a case-by-case basis, and there is no right for any person to get a settlement.
These settlements are related to denied disability claims, opposed to approved disability claims. These settlements are negotiated by your lawyer and result in one-time settlements of all claims you have against Sun Life. The settlements usually include clauses for confidentiality, so people cannot speak about them.
Sun Life Long-Term Disability Complaints
Sun Life has an internal complaints process. These are for complaints related to the service you have received. The process is as follows:
You first raise your issue with your claims representative. If they do not resolve the issue, you ask them to escalate your concern to their supervisor or team leader. This will result in the team leader reviewing your complaint.
If the team leader or supervisor does not resolve your complaint, you can then contact the Sun Life Ombudsman Office.
Email: [email protected]
Fax: 416-595-1431
Mailing address: Ombudsman’s Office, Sun Life Financial, 227 King Street St Waterloo, ON N2J 1R2
Important court cases involving Sun Life long-term disability
Sun Life has been involved in several notable court cases involving long-term disability benefits. Here is a partial list of some of the important cases:
Fidler v. Sun Life Assurance Company of Canada
This is a decision of the Supreme Court of Canada. It is the leading case on when courts can order an insurance company to pay mental distress damages after wrongfully denied a person’s long-term disability benefits.
Clarke v. Sun Life Assurance Company of Canada
This is a recent case about the deadline to file legal appeals in Ontario. It gives guidance on when the limitation clock starts to run.
Stene v. Sun Life Assurance Company of Canada
The court ruled that Sun Life’s group disability policy, issued to Telus in British Columbia, was under the exclusive jurisdiction of the Labour Relations Act. In other words, the disability claimant was barred from suing Sun Life in the courts and had to resolve all disputes via the union grievance process.
Lipovetsky v. Sun Life Assurance Company of Canada
In this case, the claimant refused to attend an Independent Medical Examination unless she was allowed to bring a friend with her and could record the examination. Sun Life objected to both requests. The judge allowed her to bring a friend, but rejected the request to record the examination.
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