What changes occur in Sun Life’s long-term disability benefits after 2 years?
After two years on Sun Life’s long-term disability (LTD) benefits, a significant change typically occurs in the definition of disability. Initially, to qualify for benefits, you must be unable to perform the duties of your own occupation. However, after the two-year mark, the criteria often shift to whether you can perform any occupation for which you are reasonably suited by education, training, or experience.
This change in definition can impact eligibility for continued benefits. The transition from ‘own occupation’ to ‘any occupation’ is a common feature in many LTD policies, including those offered by Sun Life. This shift requires a reassessment of your condition and capabilities to determine if you still qualify under the new criteria.
During this reassessment period, Sun Life may request updated medical documentation or conduct additional evaluations to ascertain your current health status and ability to work. This process may involve consultations with healthcare providers, vocational experts, or even independent medical examinations.
If you are deemed capable of performing another occupation, your benefits may be terminated. However, if you continue to meet the revised definition of disability, your benefits should continue, potentially until the policy’s maximum benefit period, which could extend until retirement age.
It’s important to stay proactive during this transition by maintaining thorough medical records and staying in communication with your healthcare providers. This documentation can be crucial in demonstrating your ongoing disability and inability to work in any capacity.
Additionally, understanding the specifics of your policy is crucial, as there may be variations in terms and conditions. Reviewing your policy documents or consulting with a legal or insurance professional can provide clarity and help you navigate this critical juncture in your disability benefits journey.
Why Sunlife denies long-term disability claims after 2 years
Sun Life, like many insurance providers, often reassesses long-term disability claims after two years to determine if the claimant still meets the policy’s definition of disability. Initially, the definition may be based on the inability to perform one’s own occupation, but after two years, it often shifts to the inability to perform any occupation for which the claimant is reasonably suited by education, training, or experience.
The transition from ‘own occupation’ to ‘any occupation’ is a common reason for claim denial after two years. This change in criteria means that even if a claimant cannot return to their previous job, Sun Life may determine that they can perform other types of work, thus no longer qualifying for benefits.
Sun Life may also deny claims if there is insufficient medical evidence to support continued disability. Over time, they expect ongoing documentation from healthcare providers to substantiate the claim. If the evidence does not convincingly demonstrate that the claimant is still unable to work, the claim may be denied.
Another reason for denial could be related to improvements in the claimant’s condition. If medical evaluations suggest that the claimant’s health has improved to the point where they can return to work, Sun Life might conclude that the individual no longer qualifies for long-term disability benefits.
Sun Life may also conduct independent medical examinations or vocational assessments to reassess a claimant’s ability to work. If these assessments indicate that the claimant can engage in gainful employment, it could lead to a denial of the claim.
In some cases, non-compliance with policy requirements, such as failing to attend medical appointments or not participating in recommended rehabilitation programs, can result in a denial. Sun Life expects claimants to actively participate in their recovery and adhere to treatment plans.
Finally, administrative or procedural issues, such as missing deadlines for submitting required documentation or failing to provide requested information, can also lead to a denial of benefits. It is crucial for claimants to stay informed about their responsibilities and maintain open communication with Sun Life to avoid such pitfalls.
How can Kotak Law help if Sunlife stops long-term disability benefits after 2 years?
Kotak Law can provide valuable legal assistance if Sun Life stops your long-term disability benefits after two years. They specialize in disability law and have experience dealing with insurance companies, which can be crucial in navigating the complexities of your case.
One of the key ways Kotak Law can help is by reviewing your claim and the reasons provided by Sun Life for terminating your benefits. They can assess whether the termination was justified or if there are grounds to challenge the decision.
If there is a basis to dispute the termination, Kotak Law can represent you in negotiations with Sun Life and their lawyer. Kotak Law’s expertise can be instrumental in advocating for your rights and potentially reinstating your benefits or obtaining a lump sum settlement without the need for prolonged litigation.
Kotak Law can also provide guidance on gathering additional medical evidence or expert opinions that may strengthen your case. This can be particularly important if Sun Life’s decision was based on a lack of sufficient medical documentation.
Throughout the process, Kotak Law can offer support and advice, ensuring you understand your rights and options. Their goal is to alleviate the stress of dealing with a benefits termination and to work towards a favourable outcome for you.
Kotak Law is a law firm that specializes in disability claims, including long-term disability cases. One of the notable aspects of their service is that they often work on a contingency fee basis.
When a law firm operates on a contingency basis, it means that the client does not have to pay any upfront fees or hourly rates. Instead, the lawyer’s fee is contingent upon winning the case or securing a settlement for the client.
In the context of Kotak Law, this arrangement can be particularly beneficial for clients who may be experiencing financial difficulties due to their disability and inability to work. It allows clients to pursue their legal claims without the added stress of immediate legal expenses.
If Kotak Law successfully helps a client obtain benefits or a settlement, they will take a pre-agreed percentage of the awarded amount as their fee. This percentage is agreed upon before the firm takes on the case, ensuring transparency and mutual understanding.
It’s important for clients to thoroughly understand the terms of the contingency agreement, including the percentage fee and any other potential costs that might be deducted from their settlement. This ensures that there are no surprises once the case is resolved.
If Sunlife has denied your claim after 2 years or at anytime call the lawyers at Kotak Law today for a free consultation.
