Blogs

When you become unable to work because of illness or injury, your long-term disability (LTD) benefits are supposed to protect you. You pay premiums with the expectation that Sun Life will support you during a time of real vulnerability. But for many policyholders, the opposite happens: Sun Life delays, reduces, or denies the LTD benefits they need to survive.

A Sun Life denial can trigger fear, anger, and financial uncertainty. It may feel personal, but it isn’t—Sun Life’s denial process is systematic, predictable, and often based on technicalities. The good news is that a denial is far from final. Many can be overturned with strong evidence and the right legal strategy.

At Kotak Law, we represent clients across Canada whose Sun Life LTD benefits have been denied or terminated. After years of navigating Sun Life disputes, we’ve identified consistent patterns—patterns you can leverage to strengthen your case.

This comprehensive guide explains why Sun Life denies LTD claims, the most common tactics they use, and how to fight back to secure the financial support you deserve.

Why Sun Life Denies Valid LTD Claims

Sun Life is one of Canada’s largest insurers. Like all insurance companies, they are motivated to minimize payouts and protect profits. While they have a legal obligation to assess claims fairly, their systems are designed to question, scrutinize, and often reject claims whenever possible.

A denial does not mean you are not disabled. It usually means:

• Your evidence was not specific enough
• Sun Life relied on internal medical consultants
• They interpreted your policy narrowly
• They used surveillance or social media out of context
• They applied the two-year “any occupation” changeover aggressively

Understanding these tactics gives you a strategic advantage in challenging your denial.

Common Patterns in Sun Life LTD Denials

Over the years, we have seen specific, recurring themes in Sun Life denial letters. Being aware of these patterns can help you identify flaws in their reasoning and strengthen your response.

1. “Insufficient Objective Medical Evidence”

This is the most common reason Sun Life denies LTD claims.

Even if you’ve submitted:

• Specialist reports
• Diagnostic imaging
• Therapy notes
• Medication history

Sun Life may still say, “There is not enough evidence to support functional impairment.”

Here’s why:
Sun Life often focuses on your ability to function, not your diagnosis.

For example:

• Diagnosis: “Chronic fatigue syndrome.”
• Functional evidence: “Patient cannot sustain attention for more than 15 minutes and has profound post-exertional fatigue that prevents consistent attendance at work.”

Sun Life wants detailed medical descriptions of how your condition limits your work capacity. Without this, they default to denial.

This is especially common for:

• Chronic pain
• Fibromyalgia
• PTSD
• Depression or anxiety
• Long COVID
• Migraines
• Autoimmune disorders

Conditions with fluctuating symptoms or invisible impairments are often targeted.

2. Misapplication of the “Pre-Existing Condition” Clause

Sun Life often denies claims on the basis that your disability is related to a “pre-existing condition” if:

• You were treated,
• Had symptoms, or
• Took medication

during the look-back period before your LTD coverage began.

The problem:
Sun Life frequently stretches the definition of “related condition.”

Example:
You are disabled today due to severe lumbar disc herniation. Sun Life may deny your claim citing a minor chiropractic visit years ago for neck stiffness.

These decisions are often unreasonable and can be overturned with clear medical timelines.

3. Termination at the Two-Year Mark (“Any Occupation” Test)

Most LTD policies contain two definitions of disability:

Own Occupation (first 24 months)

You are disabled if you cannot perform the essential duties of your own job.

Any Occupation (after 24 months)

You must be unable to perform any job for which you are reasonably suited by education, training, or experience.

Sun Life frequently cuts off benefits after two years—even when:

• Your condition has not improved
• Your symptoms have worsened
• The suggested “alternative jobs” are unrealistic
• Their assessment is based solely on paperwork, not in-person evaluation

They often rely on:

• Transferable Skills Analyses
• Internal medical consultants
• Generic job market assumptions
• Outdated occupational data

These terminations can absolutely be challenged.

4. Reliance on Internal Medical Consultants

Sun Life heavily relies on:

• In-house doctors
• Occupational therapists
• Nurse case managers

These individuals often never meet you. Instead, they conduct paper-only reviews and override the findings of your treating physicians.

Internal reviewers frequently conclude:

• You can perform sedentary work
• Your symptoms are “subjective”
• There is “insufficient objective evidence”
• Your disability is “not supported by medical findings”

Courts often view these reviews skeptically—especially when your treating specialists offer more credible, detailed assessments.

5. Surveillance and Social Media Monitoring

Sun Life routinely uses surveillance methods such as:

• Private investigators
• Parking lot observations
• Zoom lens photography
• Social media analysis

A short clip of you carrying groceries or a cheerful Facebook photo can be used to argue:

• Your symptoms are exaggerated
• You are more active than reported
• You are not credible

But these snapshots rarely reflect the full reality of chronic illness—especially conditions that fluctuate or cause delayed pain.

Surveillance is challengeable and often misinterprets context.

How to Fight Back Against a Sun Life LTD Denial

A denial or termination of benefits is not final. Here is the strategic approach that gives claimants the greatest chance of success.

Step 1: Carefully Review Sun Life’s Denial Letter

The denial letter outlines Sun Life’s rationale. Common reasons include:

• Lack of objective evidence
• Failure to meet “any occupation” definition
• Discrepancies in medical records
• Conflicting opinions from Sun Life’s internal doctors
• Alleged non-compliance with treatment
• Pre-existing condition exclusion

Understanding the insurer’s reasoning helps you target the exact weaknesses in their analysis.

Step 2: Strengthen Your Medical Documentation

The strongest claims include detailed, consistent, medically supported evidence of functional limitation.

Ask your doctors for:

• Narrative medical reports

These should focus on what you cannot do, not just your condition.

• Objective testing (if applicable)

This may include:

• MRIs or CT scans
• EMG studies
• Psychological testing
• Pulmonary or cardiac tests
• Cognitive assessments
• Functional capacity evaluations (FCEs)
• Clear descriptions of functional limits

Examples:

• Cannot sit longer than 30 minutes
• Cannot sustain concentration
• Difficulty interacting with others
• Unable to perform repetitive movements
• Cannot handle workplace stress

This is what Sun Life pays the most attention to.

Step 3: Track All Deadlines

Sun Life LTD policies have strict time limits:)

• Legal limitation periods (typically two years from the date of denial in Ontario and Alberta)

Missing a limitation period can permanently prevent you from recovering benefits.

Step 4: Obtain Support from Your Treating Physicians

Sun Life gives the most weight to:

• Consistent medical follow-up
• Supportive physician opinions
• Clear functional restrictions

If you are not regularly seeing your treating providers, Sun Life may claim:

• You are “non-compliant”
• You are not following treatment
• There is “insufficient ongoing evidence”

Regular medical updates strengthen your case significantly.

Step 5: Speak With a Disability Lawyer

Most claimants feel overwhelmed dealing with Sun Life. A disability lawyer can:

• Take over all communication
• Request and analyze your policy
• Identify weaknesses in Sun Life’s reasoning
• Gather persuasive medical evidence
• Challenge internal medical reviews
• Obtain expert opinions
• File a lawsuit if necessary
• Negotiate a strong settlement

At Kotak Law, we only represent you—not the insurance company.

Do Not Fight Sun Life Alone

Sun Life denies many legitimate disability claims—not because you aren’t disabled, but because the insurer’s process defaults to minimizing payouts.

You paid for this protection. You deserve the benefits your policy promises.

At Kotak Law, we specialize in disability law. We understand how Sun Life assesses, denies, and terminates claims, and we know how to dismantle their arguments. We fight for your rights so you can focus on your recovery.

If Sun Life has denied or cut off your LTD benefits, contact us today. We will review your denial, explain your options, and fight to secure the compensation you’re entitled to.

Frequently Asked Questions About Sun Life LTD Denials

1. Why did Sun Life deny my long-term disability claim?

Sun Life commonly denies LTD claims based on insufficient “objective” medical evidence, inconsistent documentation, pre-existing condition exclusions, opinions from their internal medical consultants, or their assessment that you can perform alternative work. Many denials rely on technicalities rather than the true severity of your disability.

2. Is it common for Sun Life to deny LTD claims?

Yes. Sun Life is one of the largest disability insurers in Canada, and denials—especially for mental health, chronic pain, and fluctuating conditions—are very common. We regularly assist clients whose valid LTD claims were denied or terminated without proper justification.

3. Can I appeal a Sun Life LTD denial?

Yes, but internal appeals often rely on the same Sun Life medical reviewers who issued the denial. Many claimants choose to consult a disability lawyer first to determine whether an appeal or a lawsuit is the strongest path forward.

4. What evidence does Sun Life look for in LTD claims?

Sun Life places heavy weight on:

• Detailed medical reports describing functional limitations
• Objective testing (MRI, CT, EMG, cognitive assessments)
• Consistent specialist follow-up
• Compliance with treatment recommendations

They are less concerned with your diagnosis and far more concerned with what you can and cannot do in a work setting.

5. Why did Sun Life stop my LTD benefits after two years?

Sun Life often terminates benefits at the two-year mark due to the shift from the “own occupation” test to the stricter “any occupation” test. They may claim you can perform sedentary, entry-level, or alternative work—even if those jobs are unrealistic given your restrictions, education, or real-world labour market.

6. Does Sun Life conduct surveillance on claimants?

Yes. Sun Life frequently uses:

• Private investigators
• Video surveillance
• Workplace visits
• Social media review

A small snapshot of activity—such as lifting groceries or attending a family event—may be used out of context to question your credibility. Surveillance is challengeable and often misinterprets reality.

7. What is a Sun Life “independent medical examination” (IME)?

An IME is a medical assessment ordered and paid for by Sun Life. Although called “independent,” these physicians are retained by the insurer and may provide opinions that differ from your own doctors. You usually must attend an IME, but inaccurate reports can be challenged.

8. Can Sun Life deny my claim for a pre-existing condition?

Yes, but they often apply the pre-existing clause too broadly. Sun Life may point to minor or unrelated medical visits in the look-back period to deny your claim, even when your current disability is clearly different. These denials can often be overturned with proper medical timelines and expert opinions.

9. How long do I have to challenge a Sun Life LTD denial?

In Ontario and Alberta, you typically have two years from the date of the denial to start a lawsuit.

10. Should I use Sun Life’s internal appeal process?

Internal appeals rarely succeed because the same internal medical reviewers simply re-assess the file. For many claimants, a lawsuit is more effective and creates meaningful pressure for Sun Life to negotiate a fair settlement.

11. What should I do immediately after receiving a Sun Life denial letter?

You should:

1. Carefully read the denial letter to identify Sun Life’s reasoning.
2. Request updated medical reports focusing on your functional impairments.
3. Avoid posting on social media.
4. Speak with a disability lawyer as soon as possible.
5. What disabilities does Sun Life commonly deny?

We frequently see denials for:

• Depression, anxiety, PTSD
• Chronic pain and fibromyalgia
• Migraines
• Long COVID
• Autoimmune disorders
• Chronic fatigue syndrome
• Cognitive impairments
• Back, neck, and spinal injuries

Sun Life often challenges conditions without clear “objective” markers.

13. Do I have to follow every treatment Sun Life suggests?

Sun Life may argue you are “non-compliant” if you refuse or delay treatments. However, you are not required to undergo unreasonable, invasive, or inappropriate treatment. Your doctor’s recommendations take priority. If Sun Life claims non-compliance, a lawyer can challenge this.

14. How much does it cost to hire Kotak Law for a Sun Life LTD denial?

Kotak Law works on a contingency fee basis, meaning no win, no fee. Our maximum contingency fee for LTD and STD cases is 33% plus applicable HST or GST. You pay nothing upfront.

15. Will I have to go to court if I sue Sun Life?

Most cases settle without a trial. Filing a lawsuit simply gives you legal leverage and compels Sun Life to negotiate seriously. Kotak Law handles all communications and litigation steps on your behalf.