What Types of Disability Policies Are Offered By Sun Life?
Each policy offers different rights and determines whether or not you are on a level playing field.
ERISA Disability Insurance for Groups
Through employers that are governed by ERISA, Sun Life offers disability policies. Sun Life ERISA policies generally have the following:
- strict definitions of disability and occupation,
- limitations on how long payment will be made for mental conditions or subjective conditions like headaches, pain, fibromyalgia or chronic fatigue,
- “other income” provisions that allow for a dollar for dollar reduction for the receipt of Social Security disability benefits, workers’ compensation benefits, and personal injury settlements, and
- A “golden handcuff” on a judge that only allows for a claims denial or termination reversal if Sun Life’s decision is “arbitrary and capricious.”
Non-ERISA Disability Insurance for Groups
Group plans offered by a church or by a municipal employer are NOT generally covered by ERISA. The policy terms are much like those of an ERISA plan but there is one CRUCIAL difference: A claim’s denial or termination can be challenged in state court and new evidence can be submitted at trial.
State law courts are a much friendlier place for the policyholder than Federal court. You are entitled to a jury trial in a state law claim and not some Federal judge just making a decision based on Sun Life’s file stuffed full of things that are unfavorable for you!
Disability Insurance for Individuals (ID)
Private individual disability policies known as ID policies are without a doubt, the best, yet most expensive policy. The policy terms and coverage are broader and more generous. However, that means a high monthly premium and a lot of financial exposure that Sun Life has if you become disabled.
It isn’t uncommon for Sun Life to invoke a pre-existing exclusion or a medical condition policy rider right out of the box as a way to justify a denial of the claim from the beginning of the claim. That is just one reason why it is so important for a policyholder to contact me BEFORE they stop working and apply for benefits.
The Eighth Circuit takes an overly broad view of treatment. In Kutten v. Sun Life Assur. Co. of Canada, 759 F.3d 942 (8th Cir. July 21, 2014) the court ruled that taking non-prescription Vitamin A was enough to trigger the pre-existing condition exclusion and it qualified as “medical treatment.” Really? Would a doctor’s advice to take an over the counter supplement to avoid joint pain enough to apply the pre-existing condition clause if the policyholder developed arthritis and claimed an inability to perform their own occupation? Apparently in the Eight Circuit.
Sun Life fights an individual disability claim as hard, if not harder than an ERISA claim and if you are not careful, costly mistakes can be made during the initial application and appeal stages of a case.