Long Term Disability Law Blog
For someone seeking long term disability benefits from Canadian-based disability insurance carrier Sun Life, trying to tackle this process on your own can be a major challenge. Insurance companies like Sun Life often seem to speak their own unique language and have a vested interest in denying a claimant’s request for benefits. At Dell & Schaefer, our nationwide team of long term disability insurance attorneys has helped thousands of claimants recover disability benefits from insurance carriers like Sun Life, and we can help you too. Read on for some tips and tricks we’ve learned along the way.
GREG DELL: Hi, I’m Greg Dell with attorneys Dell and Schaefer. And today I’m here with attorney Alex Palamara. And we’re going to discuss applying for disability benefits with the Sun Life Disability Insurance Company. Alex, you’ve handled hundreds of claims against Sun Life. Lots of appeals, many lawsuits. Right off the bat, what’s your take on Sun Life in terms of it being one of the top 10 largest disability carriers, but what do you think about them when someone calls you about Sun Life?
ALEX PALAMARA: I mean, there’s nothing really special about Sun Life. They’re kind of one of the run-of-the-mill insurance companies. We deal with them a lot, because unfortunately, they do deny a lot of claims. They do the typical review of an application, review the appeals, and they deny a lot of claims. We see them left and right. So I don’t think there are any more special or better company than let’s say a Cigna or MetLife, because to me, they’re all kind of one in the same sometimes.
GREG DELL: So Sun Life being a Canadian-based company who in the last couple of years, tried to make a big push into the United States. They took over the Miami Dolphins stadium and sponsored that. So they’re really trying to go more mainstream in the US. And primarily what we see for them is a group disability policy. So can you get into, I mean, most of the people watching this video have a Sun Life policy from their employer. What does it mean that it’s a group disability policy?
ALEX PALAMARA: So when it’s a group policy, more often than not, the policy’s going to be governed by the ERISA laws, the Employee Retirement Income Security Act. The ERISA laws are not the most favorable laws to people in your shoes, to the claimants. I mean, they really do favor the insurance company.
If the insurance company were to deny your claim, for instance, not only do you have to prove, you have to go through the appeal process, but let’s say you file a lawsuit. Not only do you have to prove that you are disabled, you also have to prove the decision to deny the claim was arbitrary and capricious. And the ERISA laws also take away certain rights, like the right to a jury trial.
When you’re a plaintiff, you want to have a jury, a jury of your peers judging whether the decision to deny the claim was right or wrong, rather than a federal judge appointed for life. Typically they’re conservative people. You want more, you definitely want a jury trial in this scenario. So the ERISA laws are not favorable for those two big reasons.
GREG DELL: OK. So the fact that the that this claim is maybe governed by ERISA for 99% of the policies sold by Sun Life, to me, that makes the application process that much more important. And here in this video, we’re going to discuss some tips for applying. And the idea is, is that a person does something, does the application process the right way.
And you know we offer a service, obviously, where we help people to apply. But let’s go through four or five of our probably the best tips that someone could take away to give themselves the best chance of getting approved. So where would you start in terms of, you’re considering filing a claim. What’s the single most important thing?
Helpful Tips to Get Your Sun Life Disability Claim Approved
ALEX PALAMARA: Well, the first thing is, when I help a client apply for benefits, I put it on a silver platter. I don’t just reach out to the insurance company, get the application documents, willy nilly fill them out and send it back. Because I know the insurance company’s going to do their own investigation of the claim. And they might do a not so good job of requesting the medical records or proving it to themselves that you’re disabled. I mean, to be honest with you, the proof is in the pudding. And you have to prove it to them that you are disabled. And proof is in the form of medical records and support from the treating providers.
So the first thing you actually need to do, is talk to your treating providers. You got to go off start making probably more doctor’s appointments or your upcoming doctor’s appointments, go speak to your providers and say, hey, listen, this is what I’m dealing with, this is what I feel every single day. I’m working full-time. I don’t think I can do it anymore. For these reasons, what are your thoughts? Get your doctor thoughts. Explain to your doctor what you do for a living as well. And so first and foremost, we need support from your treating providers. Without it, it’s going to be very hard to get a claim approved.
GREG DELL: OK, from your experience, are most of these doctors receptive to that? Do they say, sure, just give me the form? What is the usual response that your clients get from their treating doctors?
ALEX PALAMARA: You know, it could be 50-50. Some doctors are.
GREG DELL: Really? That low, 50-50.
ALEX PALAMARA: Yeah. Some doctors are more than helpful. Some doctors just have a busy practice and they don’t have the time, they don’t think they have the time to help you fill out some forms, even though the forms are typically maybe two or three pages at most. Takes them, I don’t know, a minute, two minutes to fill out. I guess they have to do some research into your claim. Maybe look at some medical records to give an honest opinion. But I can’t see them spending more than five to 10 minutes to fill out attending physician statement, I mean, on a typical case.
What Do You Do if Your Treating Doctor Will Not Support Your Disability Insurance Claim?
GREG DELL: So what does a claimant do if their treating doctor says, no, I’m not going to support your disability claim? What can they do at that point in time?
ALEX PALAMARA: I mean, you have to talk to your doctor, explain to them more what your goals are, and what you’re feeling, what your restriction and limitations are, and explain to the doctor, listen, I can’t see you anymore, because my income is about to be cut off. And my income and my insurance allow me to see you.
And if you’re unable to be supportive of my claim or assist me with this claim, then I have to go find another doctor or I have to get a second opinion, someone who might be more than helpful or more capable of supporting my claim or filling out these forms for me. Because I mean, sometimes when people tell me that the doctors are not willing to give them the five minutes it takes to fill the forms, I just get, I kind of get angry at it. Because it literally is, takes the doctors little to no effort.
And you can also tell your doctor, they’re never going to be called to a deposition. They’re never going to called to trial. That’s another thing about ERISA. There’s no witnesses in any trial. And the insurance company cannot take any depositions of these doctors. So once they write their opinion down and send in their medical records, the doctor, it’s really out of their hands. They have no more obligation on this case.
Sun Life Will Most Likely Contact Your Doctor(s) at Some Point During Your Claim
GREG DELL: Right. But Sun Life is a company that will call the doctor.
ALEX PALAMARA: Sometimes.
GREG DELL: More, I find that happens a lot. That they have their own in-house team of nurses and doctors, and then they’ll reach out to the doctor. So a claimant may be watching this video and thinking, well, my doctor is somewhat supportive, but not really. And my advice on that is, you got to get yourself to a doctor that is very supportive. Because Sun Life’s going to pick up the phone and call your doctor. And if your doctor is wishy-washy, your claim is not going to get approved.
ALEX PALAMARA: Right.
GREG DELL: Because you know any excuse that Sun Life has to deny a claim, they’re going to go ahead and take that and run with it and deny the claim. Because not only they may not call the doctor, I know why you said sometimes they’re going to call. They will almost definitely send a secondary letter.
ALEX PALAMARA: That’s true.
GREG DELL: And what’s the danger with those letters that you usually see?
ALEX PALAMARA: Well, in the denial letters, they often say, we reached out to your doctor and we gave him 10 days or 20 days to respond and we never, we never received a response. So we’re going to go with our doctor’s opinions, as no one else is disagreeing with our doctor’s opinion. So they kind of use it against you if your doctor doesn’t respond. So that’s a very good point.
The other thing they’re doing nowadays is, after you file an appeal, the insurance company is sending you a letter with a copy of the review that they recently had conducted during the appeal process. And they give you another 10 days or 15 days or 20 days to have your doctors, the treating providers, review it and respond to it.
So you actually, you do definitely need doctors who can be supportive of your claim and willing to take out the five, 10 minutes to fill the attending physician statement, and maybe the 10 minutes or 15 minutes to perform a review of the insurance company’s consultant’s opinion to maybe review it and find holes in it and disagree with it.
GREG DELL: Right. Now when we’re on the claim, we work with the claimant to complete the attending physician statement, where basically they can walk into the doctor with almost a quasi draft of attending physician statement to say, look, we’ve reviewed your medical records and everything else, and these are my symptoms and my complaints and what I can or can’t do.
Is this form consistent with your findings? And if it is, great, please use this as a guide. If it’s not, please write what you feel is appropriate. But I want you, doctor, to understand, that this is what my definition of disability is. And so let’s segue into that second aspect, which is for someone applying, how important is it to understand the definition of disability in your policy?
ALEX PALAMARA: So important. I mean, most disability insurance policies have a change in definition of disability, that for the first 18, 24, 36 months, you have to prove that you’re unable to perform the duties of your own occupation. So it’s an own occupation policy the great majority the time for the first part of the claim. Then it becomes any occupation. But when you’re applying, it’s always own occupation for the great majority of claimants. Every now and then it’s an any occupation policy, but I see that one in 100 maybe.
GREG DELL: Right.
ALEX PALAMARA: So typically you have to prove that you can’t do your own occupation. So when you speak to your doctor, you got to say, doctor, this is what I do for a living, and be as specific as possible what your, what those duties are.
GREG DELL: Right.
ALEX PALAMARA: Whether it’s lifting, whether it’s sitting all day, whether it’s, driving a truck, whether it’s using your brain. Who knows? So you have to talk to your doctor and explain what the material duties of your occupations, so they know what it is when they’re filling out the form. So they can apply your symptoms and your restrictions and limitations to those duties that you have to perform at your own occupation.
GREG DELL: Now many of our clients have two or three, sometimes four doctors. Does every doctor need to complete this attending physician statement or is one going to be sufficient?
Does Every Treating Doctor Need to Complete an Attending Physician Statement for Sun Life?
ALEX PALAMARA: One can be sufficient, especially if it’s a specialist. I often think, the more the merrier.
GREG DELL: Right.
ALEX PALAMARA: If they’re going to be supportive, get them to fill out a form and send it in with your application for sure. If it’s someone who’s going to be wishy-washy, then maybe just go with the specialist or go with the people that are going to be more supportive of your claim, because you don’t want any doubt in there.
Sun Life loves to find out, they love to poke holes in your claims by just finding certain sentences in your medical documentation when it says, which says patient doesn’t complain of this, or says no this, no that. So if a doctor is wishy-washy or not that supportive, they find that doubt and they run with it.
GREG DELL: So another tip and another challenge that claimants face, is many of our clients have been working for months, maybe years with their disabling condition. And I call it a disabling condition, because eventually reaches a point where they can’t continue to manage the symptoms and work. When should the claimants start to have a conversation with their doctor about support for a disability claim?
ALEX PALAMARA: It’s a good question. I get, every single case is a little bit different, but when that thought it in your head, that there’s no way, I can’t see myself working that much longer, you can start talking to your doctor a year before, a couple months before or the day of. Because all that matters, that you have the ability to prove they you’re unable to perform your own occupation. And I see it sometimes in denial letters. Where they’ll deny claims, saying your client has had this condition for two years, what’s changed? Now he’s claiming or she’s claiming disability.
GREG DELL: Not sometimes. You see that.
ALEX PALAMARA: Right. All the time.
GREG DELL: More often than not.
ALEX PALAMARA: They say, what’s changed? It’s like, nothing’s changed. Just because my client was being a hero, I mean, you should actually reward them. They should have made this claim two years ago. It kind of offends me sometimes when they deny it for that reason. Because for the most part, my clients don’t want to make disability insurance claims. If they make a disability insurance claim, they’re already losing typically 40% of their income.
So if they’re making $100 grand a year, it’s going down to $60 grand a year. So you have to be a crazy person to give up 40% of your income for a claim that’s questionable going to be approved or not. Even if you have the best claim ever, you could still have an insurance company or somebody that can still deny your claim. So it’s so important to have support from your treating providers and have it on a silver platter when you file that application for benefits.
GREG DELL: Right. And when you mean the silver platter, you mean being prepared.
ALEX PALAMARA: Having everything prepared. All the I’s dotted, T’s crossed, everything.
GREG DELL: Right. And I just don’t want people to get into a false sense of security to think that when you, even from the moment you call Sun Life, they’re starting to immediately evaluate the claim. They’re going to have someone, if not when you call them, within a day or so, someone’s going to call you on a recorded line and start asking you questions that could immediately. It’s almost like anything you say can and will be used against you, same exact thing with Sun Life once you call them.
So you don’t have to call them right away. And often, when we’re handling the claim, we might wait 30, 60, or 90 days, and the first time we notify them is when we submit the claim. This way, you don’t have Sun Life on your back the entire time, calling your doctors, doing everything. You get everything in line, prepare that silver platter, like you’re saying, the way you want, and then submit the claim.
So I do like you brought up that every claim has its own nuances and every medical condition and the number of doctors and the language in the policy. There’s so many factors, which is why one of the best things we always do is, we encourage people to get a copy of their short-term or their long-term disability policy, contact us, whether email or phone, let us review the policy for you. It’s always a complementary review.
And then we’ll discuss the options, whether we think you have a good claim, a bad claim, here’s what you need or don’t need. We’ll let you know how we charge for these types of things. Alex, you represent clients in just about every state. So our clients are all over the country. Sun Life is national and international. So really, the presence of where your lawyer is is not important. It’s important that you have your treating doctors close to you.
And the last thing I would say is, we have a lot of videos. Some about Sun Life, a lot about medical conditions, a lot about this process. And we hope that you find that helpful. You can subscribe to our YouTube channel, where we regularly bring up more videos. And really, this is just scratching the surface on the application process, because there’s a lot more that’s involved with something that they try to make a simple process, which it’s not.
ALEX PALAMARA: It’s always a free consultation. You will literally talk to an attorney. Whenever you call our firm, you’ll always speak to an attorney. Always a free consultation. We’ll give you not just a few minutes, many minutes of our time, and go through everything with you.
GREG DELL: That’s great. Thank you for considering us, and we look forward to discussing your claim with you.
We hope this has helped you see what may be around the bend. If you’d like to get started on an appeal of Sun Life’s denial of your request for disability benefits (or want some help filing your initial claim), look no further than Dell & Schaefer. All we need to start fighting for your right to receive disability benefits is a copy of your long term disability insurance policy and, if your request was denied, a copy of your denial letter. Visit our website today to schedule your FREE consultation with an experienced member of our legal team.