If you are receiving disability benefits from Sunlife, it is possible those benefits will disappear after two years of receiving them. This may be shocking news to those who rely on their disability benefits, but it is not uncommon. This happens to many employees, and with the help of experienced disability lawyers, it is something you can fight.
Why Were My Sunlife Long Term Disability Benefits Denied After Two Years
If your Sunlife long term disability benefits have been denied after two years, it could be because the meaning of “totally disabled” as required by the insurance policy has changed. For the first two years of receiving LTD benefits, disability benefits only require a worker to be unable to perform the essential tasks of their pre-disability employment. This means a disabled employee must be unable to perform the essential duties of their current position. If, for example, you are a driver who is now unable to drive because of their disability, you would be unable to perform the essential duties of your own occupation and could qualify for long term disability benefits.
After two years, however, this definition changes. It is not enough to be unable to perform the essential duties of your own occupation. After two years of receiving long term disability benefits, an employee must be “totally disabled” such that they cannot perform any occupation to which they are reasonably qualified, based on their training, education, or experience. For example, if you are a driver who is now unable to drive because of your disability, there is a possibility you would still be able to perform in some other job even if you can no longer be a driver. In this case, you may be denied long term disability benefits after two years.
This is a much more difficult test for an employee to meet. Sunlife will be more critical of your claim, and much more likely to deny you your benefits. This should not be surprising. Sunlife wants workers to return to work so that they no longer have to pay for the benefits you are entitled to.
“Totally Disabled” Does Not Mean you Cannot Work
Sunlife might apply a very strict definition of “totally disabled”, but this might not be the definition that our courts adopt. “Totally disabled” does not mean the employee must be completely incapacitated and unable to care for themselves.
According to one Ontario court, the total disability must be based on the worker’s “education or lack thereof, age, work experience, and medical condition”, along with the worker’s continued inability to perform substantially all of the duties in any occupation for which they are qualified. It is not about whether a job exists that the worker is capable of performing, but whether there is a job for which the worker is reasonably fit based on what the worker has done before.
In Paul Revere Life Insurance Co. v. Sucharov, the Supreme Court of Canada expressly agreed that “the test of total disability is satisfied when the circumstances are such that a reasonable man would recognize that he should not engage in certain activity even though he literally is not physically unable to do so.”
It should not be impossible to be “totally disabled”, even though Sunulife and other insurance companies may wish that were the case.
I Have Been Denied My LTD, What Can I Do?
If Sunlife has denied your long term disability benefits, you might be able to fight this. Rather than appealing the decision internally, you should speak with a legal expert. At Monkhouse Law, we specialize in helping employees who have been wrongfully denied LTD claims. We have helped many employees successfully challenge insurers’ denials of their LTD claims. If you have a question regarding your eligibility for LTD benefits, you should contact a Long Term Disability Lawyer at Monkhouse Law for guidance.
This was written by Shane Burton-Stoner. Shane is licensed by the Law Society of Ontario and is an Employment Lawyer at Monkhouse Law.
Monkhouse Law is an employment law firm located in Toronto focusing on employees’ issues. We offer a free 30-minute phone consultation. Please call us at 416-907-9249 or fill out this quick form.