In Vicki Young v. Sun Life and Health Insurance Company, plaintiff Young, a mortgage broker, was initially granted disability benefits in September 2010 based on her diagnosis of fibromyalgia. The initial two years of her disability were based on her inability to perform the essentially duties of her own occupation.

After two years, Sun Life continued her long term disability (LTD) benefits on the grounds that she did not have the ability to perform the job duties of any occupation for which she was qualified. Suddenly, in 2015, Sun Life terminated her benefits, stating she was no longer disabled under the “any occupation” standard. Young’s administrative appeal was denied and she filed this ERISA lawsuit in the U.S. District Court for the Eastern District of California.
Continue Reading Court Reinstates Disability Benefits Erroneously Terminated by Sun Life

In Micha v. Sun Life Assurance Company of Canada and Group Disability Benefits Plan (Sun Life v. Group Disability), plaintiff John Paul Micha, M.D., was covered by a disability benefit policy through Sun Life which had been purchased by Group Disability, an employee welfare plan maintained to provide disability benefits to the employees of the medical group of which Micha was a part.
Continue Reading Court Orders Sun Life Assurance Company to Pay Appellate Attorney’s Fees

In Schmitz v. Sun Life Assurance Company of Canada (Sun Life), the claimant, Jeff Schmitz, was fired by Banner Engineering in July 2008 on the grounds his work performance was poor. In October 2011, Schmitz was diagnosed with multiple sclerosis. He then filed for disability benefits under the policy which covered him during his employment with Banner. He claimed symptoms caused by his multiple sclerosis were what caused his poor performance resulting in him being terminated. Therefore, he argued, he was disabled at the time he was fired.
Continue Reading Court Affirms Sun Life’s Disability Benefit Denial

In an unpublished opinion issued on July 7, 2014 from the United States Court of Appeals for the Tenth Circuit, a Federal Court ruled somewhat surprisingly and approved Sun Life’s decision to “offset” VA Benefits from a disabled Veteran’s monthly disability benefits. While this case is not “binding precedent,” it can serve as a warning for those that are receiving VA Benefits, or any other income benefits, that are not listed in their Long Term Disability (LTD) ERISA Policy.
Continue Reading Federal Appeals Court Rules that Sun Life Can Offset VA Benefits Even Though Such Benefits Are Not Listed in the Policy

Mr. R had worked as a shop floor supervisor before his chronic back pain, which resulted from a slip and fall that herniated several disks in his back, and resulted in three failed back surgeries, caused him to file for long-term disability under his Sun Life Assurance Company of Canada group long-term disability insurance policy. Like most group long-term disability policies, Mr. R’s Sun Life policy paid disability benefits for the first 24 months if he was disabled from his own occupation as a shop floor supervisor.

Continue Reading Federal Court Finds Sun Life Assurance Company of Canada’s $8000 Worth of Surveillance on Disabled Shop Floor Supervisor Unreasonable

Disability Blog & Cases:
California Federal Court Finds That MetLife Abused Its Discretion And Awards Financial Analyst Long-Term Disability Benefits

Shelia W. and her California disability lawyer prevailed in a lawsuit against MetLife when the United States District Court of the Southern District of California found the insurer to have abused its discretion when it terminated Shelia’ disability benefits under the “own occupation” standard.

Disability Blog & Cases:
Sun Life Pays Disability Benefits For Three Years To A Claimant Who Wasn’t Actually Covered Under A Sun Life Policy

In the case of Pamela P. v. Sun Life and Health Insurance Company, the court record shows that Pamela P. applied for long-term disability benefits under an employee benefits plan that was maintained by Los Padres Bank for its employees and was awarded disability benefits for over three years. Said plan was underwritten by Sun Life with its Group Certificate governed by ERISA (the Employee Retirement Income Security Act)…

Disability Blog & Cases:
Another Cigna Hired Gun Doctor To Be Exposed!

Utah Court Wants To Know Relationship Between Dr. Carol Flippen and Cigna Life Insurance

In Mary A. Vs Sun Life Assurance Company of Canada, the Plaintiff, with the help of her Alabama Disability Attorney, files this lawsuit against Sun Life seeking reinstatement of long term disability benefits as promised under the terms of the Plan.

History of Case

Plaintiff is a disabled individual who was employed by Liberty National as a Sales Agent. This occupation required her to consistently spend an average of nine hours "in the field" traveling to and from job sites. It further required 10-11 hour work days during the course of a week. The Plaintiff was required to perform and fulfill numerous essential job functions, requirements, and qualifications associated with her occupation. Some of these functions included compiling lists of prospective clients, contacting those prospective clients, calling on policyholders to deliver and explain the policy, and servicing the business of existing and new customers.

On or about January 28, 2007, Plaintiff became unable to work due to a culmination of disabling physical health issues. These issues related to seizure auras, physical pain, fatigue, sleepiness, dizziness, and problems with memory. These issues primarily relate to seizure auras, physical pain, fatigue, sleepiness, dizziness, and problems with memory. As a result of her health problems and inability to continue working, the Plaintiff filed an application for long term disability benefits with Sun Life on or around July 12, 2007.

Sun Life approved the claim and began paying out monthly disability benefits effective July 27, 2007. The Social Security Administration determined that the Plaintiff was unable to perform any gainful occupation based on her physical health problems, thereby approving her for Social Security Disability benefits upon her initial application. These benefits began to be paid out in July 2007.

Sun Life Abruptly Terminates Long Term Disability Benefit Payments

On or about July 31, 2008, Sun Life informed Plaintiff that she no longer qualified for disability payments based on a review of her records. Plaintiff filed an appeal of this decision via letter dated August 4, 2008. Plaintiff also supplied additional medical documentation that she was still disabled and unable to work. She included notes from two different physicians she had been seeing, both of whom stated that Plaintiff was not able to work.

Despite this mounting evidence, on August 17, 2009, Sun Life terminated Plaintiff’s long term disability benefits retroactive to July 27, 2009. Plaintiff filed an appeal letter on or about October 21, 2009. Once again, she submitted multiple pieces of medical evidence, including statements from both treating physicians, to back her claim. Sun Life failed to respond to this latest appeal until it finally sent a letter to the Plaintiff on March 26, 2010.

Due to its failure to follow ERISA regulations, Plaintiff’s administrative remedies have been exhausted, leading to the filing of this lawsuit against Sun Life.

Premise of Argument Against Sun Life

Sun Life wrongfully denied Plaintiff’s claim and subsequent appeals. It relied upon several biased and erroneous physician consultant reports generated by physicians who are regularly utilized by insurance companies to deny claims.

Furthermore, these physicians were employed by third-party vendor companies Network Medical Review and Professional Disability Associates, companies which receive a substantial portion of income from providing physician consultant reviews to insurance companies and employers. These physicians ignored most of the medical evidence in the claim, cherry-picked evidence favorable to justify a termination of benefits, and misconstrued evidence and statements contained in the claim record.

Relief Sought By Plaintiff Against Sun Life

Plaintiff wants the following relief due to the wrongful termination of long term disability benefits:

  • An award of penalties of $110.00 per day, per violation for each day that the Defendants fail to provide the long term disability benefits that are promised under the Plan
  • An award of all associated attorney’s fees and court costs
  • All other relief that the Court decides to be proper and fair 

About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. To request a free legal consultation call 800-411-9085.

Disability Blog & Cases:
Court Takes Sun Life To Task For Denial Of Disability And Life Insurance Benefits Of Man With Brain Tumor

The widow of a claimant, who died from a malignant brain tumor, brought this lawsuit with the help of her Colorado Disability Lawyer after Sun Life refused to award cancer disability benefits.

Disability Blog & Cases:
CIGNA Disability Claim Denial: A Claimant’s View

Every day disability claimants around the country contact our disability attorneys about a CIGNA disability claim. Many individuals tell us similar stories about the manner in which their CIGNA disability claim has been handled. We wanted to share with you a recent comment that was posted on our website about a CIGNA denial.

Disability Blog & Cases:
Sedgwick Terminates PNC Compliance Specialist’s Long Term Disability Benefits

Recently, a former Compliance Specialist for PNC Financial Services Group was unsuccessful in her lawsuit again her former employer and Sedgwick. This case is a strong reminder that even though a claimant has been awarded disability benefits from the Social Security Administration, it does not mean that the Long Term Disability Insurance Provider must also award disability benefits.

Disability Blog & Cases:
Medical Doctor suffering from disabling chronic conditions sues AXA Equitable for wrongful denial of disability benefits

A Montana disability lawyer recently filed a federal lawsuit against the AXA Equitable Life Insurance Company (AXA). The Plaintiff, Marise J., M.D., was employed as a licensed medical doctor and was board certified in internal medicine. She had been practicing medicine for over 30 years.

Disability Blog & Cases:
Aetna Disability Denial of Marriott Employee Upheld by Louisiana Federal Judge

A former Marriott Employee was unsuccessful in his lawsuit seeking a reversal of Aetna Life Insurance Company’s disability insurance denial. As a former director of engineering, earning more than $200,000 a year, this former Marriott employee stopped working due to disabling lumbar herniations and back pain…

Disability Blog & Cases:
Who is Making the Decisions on a Sun Life Disability Benefits Claim?

Disability insurance claimants are routinely telling our disability insurance attorneys about their dissatisfaction with the manner in which a disability insurance company has handled their claim for disability benefits. Let’s take a look at why this disappointment is taking place.

FAQ: Tax Issues
How can a claimant exclude their disability insurance benefit payments from Federal Income Tax?

What actions can a claimant take in order to exclude Disability Insurance Benefits from personal income tax?

After receiving disability benefits for 5 years from Sun Life insurance Company, Connie never expected her disability insurance benefits would be denied. Connie Hepburn was a "participant" in a Sun Life Disability benefit plan ("the Plan,") due to her employment with Toyoda-Koki Automotive North America, Inc. ("Toyoda") as a Shipping Supervisor in the Production Control Department. Sun Life acted as the plaintiff’s group disability insurer during the period for which her claim for benefits accrued, in addition to being the claims administrator for these benefits. The abovementioned plan was initially underwritten and administered by Genworth Financial prior to its employee benefits business being sold to Sun Life in 2007.

Sun Life Disability Application History

In April 2004, the plaintiff had developed a pituitary tumor known as a "pituitary adenoma." As a result of a decline in her health, the plaintiff stopped working on May 26th 2004. The plaintiff also stated that she underwent surgery to remove the tumor on the following day, May 27th 2004.

Claim For Sun Life Disability Benefits

On August 3rd 2004, the plaintiff filed a claim for long-term disability benefits with Genworth Financial on the ground that the surgical treatments the plaintiff underwent to remove the tumor had left her impaired both cognitively and functionally. The plaintiff’s claim was approved by Genworth Financial and her disability benefits was continuously recertified for a period of five (5) years based on her substantial medical proof of disability.

The plaintiff stated in the lawsuit that her condition had progressively worsened, and her memory problems have correspondingly worsened as well. She also developed a series of immunodeficiency ailments, including Gullian-Barre disease, a rare and very serious disorder which leads to paralysis of the limbs and restricts gait and movement. In addition, she has also been diagnosed with a number of intestinal and bladder infections which cause her great personal discomfort throughout the day and have permanently altered her ability to lead a normal life.

Termination of Long Term Disability Benefits After Receiving Payments for 5 Years

On October 20th 2009, Sun Life terminated Plaintiff’s long term disability benefits. Sun Life’s purported "reason" for terminating the plaintiff’s benefits was that "the medical on record does not support an inability to perform any gainful occupation at a sedentary level of activity."

The plaintiff submitted an ERISA appeal to the decision to terminate her disability benefits by Sun Life. Sun Life, however, upheld its denial on March 4th 2010. Subsequently, the plaintiff made another appeal to Sun Life’s denial and was again denied on November 2nd 2010 on the ground that the plaintiff did not provide "satisfactory proof’ that she remained disabled under the contract. This was despite the fact that in all of her appeals, the plaintiff provided substantial, credible, and overwhelming medical evidence of her continuing disability.

On November 2, 2010, Sun Life, again, upheld the termination of the claim stating, that, in its discretionary review of her claim, Plaintiff had not provided "satisfactory proof’ that she remained disabled under the contract. The plaintiff claimed that her medical condition has been in a period of steady deterioration of both her mental and physical abilities. Specifically, the Plaintiff stated that she suffered a loss of:

  • Her cognitive abilities to think and process information correctly.
  • Her ability to react and respond appropriately to stimuli.
  • Her gait and ability to move, stand, and sit properly.
  • Her ability to speak, concentrate and communicate effectively.

The plaintiff also stated that she suffered a series of debilitating physical ailments which have permanently altered her mobility and she had been rendered totally and permanently disabled within the definition of the Plan. The plaintiff also informed Sun Life that the Social Security Administration had determined the plaintiff to be totally and permanently disabled.

In the lawsuit filed by her Tennessee disability lawyer, the plaintiff alleged that after losing the above mentioned argument, Sun Life purported to review Plaintiff’s medical evidence and concluded that she suffers from "no disability" in the face of multiple different medical experts and the Social Security Disability Administration, all of whom found her to be totally disabled.

Legal Grounds For Lawsuit Filed by Tennessee Disability Insurance Attorney

Accordingly, under ERISA, the Plaintiff’s claim has been improperly denied as:

  • Sun Life has failed to properly interpret its own group disability insurance contract such that Plaintiff’s long-term disability benefits were terminated, despite her meeting the policy’s basic eligibility requirements.
  • The plaintiff and her employer fully paid all premiums and was entitled to coverage under the subject disability insurance policy.
  • She has been adjudicated totally and permanently disabled by the Social Security Administration.
  • The Plaintiff provided evidence of total and permanent medical disability to Sun Life from multiple physicians.
  • Sun Life’s selective evaluation of the plaintiff’s medical evidence precludes Sun Life from claiming that Plaintiff is not totally disabled.

Relief Requested by the Plaintiff

The plaintiff seeks the following relief from the Court:

  • An order compelling Sun Life to pay the plaintiff forthwith the full amount of benefits due to her and to continue such payments for the period set forth in the Plan, including interest on all unpaid benefits.
  • Disgorgement of any profits or gain Sun Life has obtained as a result of the wrongful action alleged in her Complaint and distribution of any profits or gain to the plaintiff.
  • Any and all such other relief as may be just and appropriate.
  • Reasonable attorneys fees and costs pursuant to ERISA

About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. To request a free legal consultation call 800-411-9085.