Sun Life Disability Claim - Sun Life Ignores Medical Information
An Indiana Federal Judge recently ruled partially in favor of a claimant who was denied Long Term Disability (LTD) benefits by Sun Life. In the December 2012 ruling in the ERISA Disability Lawsuit, the Court found that Sun Life needed to review and properly address the medical opinion of one of the claimant’s treating physicians. This physician’s review and opinion were in stark contrast to the final opinion and decision of Sun Life. As such, the Court’s decision still leaves hope that the claimant will be able to receive long term disability benefits.
Medical History and the LTD Claim
The claimant previously worked as a Sales Specialist at Teachers Credit Union. As an employee of Teachers Credit Union, the claimant was provided coverage under both a short term and a long term disability plan. After a long history of epilepsy, the claimant began experiencing an increased frequency of seizures in May 2009. A few months later in July 2009, the claimant suffered a seizure while driving which resulted in a car accident. After this incident, the claimant did not return to work.
The claimant applied for and received short-term disability benefits from her employer. However, when she applied for long-term disability benefits with Sun Life, she was denied. In its first decision to deny benefits, Sun Life reviewed the medical records and opinions of the claimant’s treating physicians. To justify its position to deny benefits, Sun Life noted that an Attending Physician’s Statement completed by one of her physicians did not restrict the claimant from walking, standing, bending, sitting, etc. Using this lack of restrictions, Sun Life concluded that the claimant could perform the duties of her occupation. The Claimant Appealed.
In the Claimant’s appeal of Sun Life’s initial decision to deny benefits, the claimant submitted additional evidence which included a vocational report by another treating physician, Dr. Blankenship. In his report, Dr. Blankenship noted that walking, sitting, standing, bending, etc., were not the issues. The issue was the inability to predict seizures and the issues related to having a seizure. Dr. Blankenship concluded that the claimant would not be a reliable worker. Furthermore, Dr. Blankenship noted that the claimant experienced difficulty with memory and word finding. Dr. Blankenship concluded that this would prevent the claimant from performing her prior occupation.
Sun Life was unmoved. In a letter dated November 16, 2010, Sun Life again denied the claim for long term disability benefits. In this letter, Sun Life stated that it had reviewed and considered the newly submitted evidence. Furthermore, Sun Life stated that it had an independent records review conducted by an additional physician. This physician concluded that the claimant was capable of full-time work. This report was then submitted to a vocational consultant who determined that the claimant could perform the material duties of her prior occupation. With this information, Sun Life again denied her claim.
ERISA Lawsuit Filed
With her administrative remedies exhausted, the claimant’s only avenue for benefits was an ERISA disability lawsuit. In her complaint, the claimant contended that Sun Life’s decision was arbitrary and capricious because Sun Life failed to consider and discuss the report of her vocational expert, Dr. Blankenship.
The Court agreed. While the Court noted that Sun Life did not need to address every piece of evidence that was contained in the claimant’s medical records, it should have, however, addressed Dr. Blankenship’s relevant and contrary report. Sun Life had failed to mention the report in its denial letter. Furthermore, Sun Life’s independent medical reviewer and vocational expert each failed to even mention Dr. Blankenship’s contrary opinion.
The Court noted that the “focus of the arbitrary and capricious standard is to ensure that the plan administrator’s reasons for denial ‘meet ERISA’s requirement that specific and understandable reasons for a denial be communicated to the claimant.'” The Court continued that “(e)ven when records are based on subjective complaints, Defendant must still explain the reasons for dismissing those complaints.” The Court concluded that because Sun Life “failed to address Dr. Blankenship’s relevant and contrary report, Defendant’s decision is arbitrary and capricious.”
Unfortunately for the claimant, the Court did not conclude that Dr. Blankenship’s report required that Sun Life find her to be disabled. The Court merely ruled that Sun Life must “address and explain why it accepts or rejects the report in light of the evidence in this case.” So while the claimant might have won a battle, she still might ultimately lose the war.
Although our firm did not handle this case, we handle many like it throughout the country. Please contact us, the disability attorneys at Attorneys Dell & Schaefer , Chartered, for a free consultation and to discuss your disability claim.
For Sun Life Disability Insurance Reviews, Complaints, Denied Claims & Attorney Help click here.
Resources to Help You Win Disability Benefits
Submit a Strong Sun Life Appeal Package
We work with you, your doctors, and other experts to submit a very strong Sun Life appeal.
Sue Sun Life
We have filed thousands of disability denial lawsuits in federal Courts nationwide against Sun Life.
Get Your Sun Life Disability Application Approved
Prevent a Sun Life Disability Benefit Denial
Negotiate a Sun Life Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Policy Holder Rating
Unscrupulous Tactics
What a mess
Reply
They leave you unable to fight
Reply
Sun Life is a real pain
Reply
Everytime SunLife receives my information they ask for another 7 to 10 business days
Reply
I have lost everything due to non payment of my claim.
SunLife said if I don't apply for SSI they will lower my payments
Reply
I don't understand SunLife's overpayment letter
Reply
Q: Can SunLife offset dependent social security benefits received on account of my wife's disability?
Q: Does SunLife have a required time to make a decision? Can they request medical records that have nothing to do with my illness?
Q: What happens if a policy doesn't mention something I believe I had and paid for (COLA)?
Q: Can SunLife deny me on the basis on a preexisting condition?
Q: Can I sue SunLife if I signed a Settlement & Release Agreement?
Q: Can I still get my short term disability benefits if I'm terminated?
Q: Can I sue SunLife for pain and suffering?
Q: Should I be worried that SunLife is trying to deny my claim by making it seem like I have a mental disorder? Can they deny my claim if I refuse to undergo this needless psychiatric assessment?
Tips for Applying for Sun Life Disability Insurance Benefits
Can a Disability Claimant Refuse to Attend an IME During an Appeal?
Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?
Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak
Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company
Disability Benefit Denial Reason #3 - Video & Social Media Surveillance
How Do You Fight a Long-Term Disability Denial?
Disability Denial Reason #2 - Change of Disability Definition & Vocational Review
Sun Life Wrongfully Denies Disability After Paying For 23 Months
Sun Life Overturns Its Previous Denial of LTD Benefits for Massachusetts Teacher
After Appeal Sun Life Finally Approves Disability Benefits for Data Engineer
Sun Life overturned previous denial of LTD for California Diagnostics Manager
Unum and Sun Life approve disability benefits to OB/GYN
After appeal filed by Attorney Jay Symonds, Sun Life overturned its previous denial of long term disability benefits for Florida ICU Nurse
Sun Life Approves Disability Benefits to Surgical Services Director
Sun Life ignored its own medical expert's opinions supporting registered nurse's inability to work in a sedentary occupation due to severe rheumatoid arthritis
Reviews from Our Clients






