Long Term Disability Law Blog
This case centers on a claimant who worked as a bank branch manager and became seriously ill with cirrhosis of the liver, forcing him to stop working. Although Sun Life initially approved and paid his disability benefits, they later imposed a 24-month limitation, claiming his condition was caused by alcohol abuse. This classification significantly reduced the duration of his benefits and threatened to cut them off entirely, despite the claimant disputing any connection between his illness and alcohol use.
To challenge this, the attorney worked closely with the claimant’s doctors to gather strong medical evidence showing that his cirrhosis was actually non-alcoholic (NASH) and unrelated to prior alcohol consumption. The doctors provided detailed explanations, testing results, and formal statements clarifying the diagnosis. Additional support came from a Social Security disability determination, where both medical reviewers and a judge agreed that the condition was not alcohol-related. This comprehensive evidence directly countered Sun Life’s reasoning for applying the policy limitation.
As a result, the appeal was successful, and Sun Life removed the 24-month restriction, allowing the claimant to continue receiving benefits long-term as long as he remains disabled. The case highlights how insurers may attempt to apply policy limitations to reduce payouts, even when not medically justified, and underscores the importance of detailed medical documentation and persistence in appeals—especially in complex or initially rejected cases.