Hello again, I am so grateful to have found this forum and the responses from people so far 
I made a previous post before the current news, and I’m left looking for more advice.
My LTD with Sunlife is approved until the 2 year mark in November. I was forced to do a physical OT Assessment even though I am on a mental health claim. It went poorly from my perspective. It was then set up for me to do an interview with a Sunlife rehab consultant who deemed it not appropriate for me to be rehabbed back to work at this point. The kicker is, the day before this assessment even happened I received a denial for a Change of Definition after November. There are quite a few things I’m confused about including how I’m not fit for rehab but also fit to do another job. How can they pre disapprove that far in advance when conditions can get better or worsen? In the denial letter it referenced that my doctors has said it was recommended I return to work (from home only), however these notes are 3+ years old and from when I was seeking accommodations before ever applying for LTD. I confirmed with my psychiatrist that ongoing and updated notes were sent to Sunlife stating I could not work at any occupation and it would be a year to a year and a half before it could even be considered. I know insurance like to find loopholes but this seems like pure negligence on their part? Like so many here dealing with the same situation I am angry and upset and my symptoms have again worsened.
My question for anyone have been through this is advice on next steps. So far I have:
- Requested a copy of my complete file from Sunlife, this will take about a month to receive they said.
- Have appointments made with every practitioner I see (it’s a lot) who will all provide updated and supportive notes. It will take a few weeks to gather all of these.
- Preparing an application for CPP. I was approved for DTC last year and didn’t realize I could have applied for CPP before my 2 years on LTD. I realize this could help my LTD appeal but it will be months I assume before I would ever heard back if I’m approved.
- I have not filed an appeal with Sunlife yet. Should I be doing this yet where I am waiting on my complete file and all of my updated medical notes?
- Contacted my union, waiting to hear back.
- I have not yet talked to a lawyer and I’m unsure if I can or if this has to go through my union?
I simultaneously feel like I need to take immediate action on everything, but know I cannot as I have to wait for files and appointments. I also have less mental capacity and energy to do any of it. Any kind or wise words of advice would be appreciated.
Thanks again
I’m sorry to hear this and for everything you’re going through. I would highly suggest at this point going straight to a lawyer. Insurance companies deny purely for financial reasons because what they’re betting on is people just go back to work or if people litigate that they just settle. The sort of behavior that you are referencing would be considered bad faith and after the Baker precedent, I would have expected insurance companies to behave but they’re not.
Sadly at this point your best option is to litigate. Your insurance company knows exactly what they did would not be viewed favorably by a judge but they also know that they’re more than likely going to get away with it.
My insurance company is doing the same thing but fortunately my financial position means that even if I have to litigate I will have my day at trial. I’m so tired of companies behaving like this and if my insurance wants to be an asshat then I will be one too. It’s mostly out of principle at this point because I’m so tired of reading stories like yours and so many others. We all deserve better.
Focus on retaining a lawyer and on CPP. Nothing else matters right now. From a settlement or litigation perspective it really comes down to credibility. Whose story will be more credible? Yours or your insurer? The settlement discount number will be based on that which will be in large part down to your medical file and your situation.
I know nothing about unions but I do know that there are disability lawyers for unionized employees.
Thank you for your reply. Can I ask what a settlement discount number is?
I agree with you wholeheartedly. If money was no object I would sue not just for appeal/continuing payments but for emotional distress and so forth. My workplace did the same to me, denying accommodations that were backed and requested by countless medical practitioners who said that if I were forced out of a longstanding work from home situation my condition would worsen, and it did, to the point of total disability. My union said I had such a strong case they wanted me to go to court for human rights violations but the appeal process for everything sent me from struggling but functional to complete burnout. I feel the same now, every bit of progress I’ve been making has been taken away because the insurance company has put me into complete panic and despair for the future. I truly cannot believe how brazen they are being, and when it comes to mental health they are playing with people’s lives. Not to be dark but my therapist has expressed to them updates regarding fears of psychosis, suicide risk, hospitalizaton etc from any extreme stress/anxiety. They just don’t care and it’s heartbreaking to think of everyone who might be going through this or worse.
I have no concept of what legal council/litigation would cost in disability cases so I can’t even begin to know if I’m able to manage that, or if my union has lawyers. I will for sure explore talking to someone in the coming weeks though.
Given the acuteness of the LTD denial, I am more worried about giving you information that would be of no value at this point. Settlement discount number is simply a % discount of the sum of the future payments of LTD. For example, if you had 10 years of payments left at $1000/month, the total $ amount if $120K. However, the settlement discount percentage looks into a number of things such as the strength of the case, discounting future value of money for today, etc. It can range but this is way ahead of anything I think you should be focusing on now.
A thing that helped me with the whole case is that ultimately it is just business and LTD is just a contract. It’d be a lawsuit for breach of contract, nothing more and nothing less. The courts, through a judge and/or jury may care about our individual situations but ultimately the rest is just contract law and that underpins LTD.
The vast majority of disability lawyers simply take a % of the win. They have no upfront costs and it’s usually about 30% of the win. It can be steep. The other option is to fund hourly but that is out of pocket