Hello everyone, I’ve posted in the past and sad to say the stress of dealing with LTD has gotten worse and not better. I am at the end of my rope and finally considering taking legal action.
I have received my internal file from Sunlife and it is more apparent than ever that my case is being grossly mishandled.
- I had an early COD denial 7 months in advance of the 2 year mark, followed by an interview where my insurers own rehab assessor said I wasn’t able to rehab back to work at this point.
- I’m on a mental health claim and despite my file including an assessment of my documents by their own Psychiatrist who recommended I be sent for a third party Psychiatric assessment before the COD, my case worker sent me to an OT. Despite in their own report stating my issues were outside their scope, my case worker used their results of their assessment to immediately send me a denial of COD.
- My denial also included a completely false statement that my doctor stated I could return to work, it absolutely does not and they have never said this.
- During the appeals process my appeals case worker keeps moving the goal post. I was send an email stating the items they needed to process the appeal and I gave it to them and more. This includes documents from 9 separate doctors and specialists all stating I cannot work at any occupation.
- After a month of radio silence I check in and am told 5-10 business days and I would have a decision. My therapist then attempted to contact the case worker, which they wouldn’t answer and the next day I’m sent another email requesting that they now want me to see a third party Psychiatrist. This was never once communicated to me as a requirement of the appeals process and has already gone over the 10 business days without any contact to even set this up.
- Both case workers have evaded contact my my therapist, both telling me I don’t have the correct form filled out for them to speak to her. After pressing the issue the appeals worker then tells me there is no form. Even though I’ve sent in various forms trying to get them to accept one, they said to write something on a piece of paper. I oblige, and they are still not taking her calls.
At this point I may need to hire a lawyer. Both to deal with my change of definition denial but also their actions and negligence have worsened my condition considerably. This has been well documented and sent to them by multiple specialists. Does anyone have experience going legal in this particular situation, such as seeking damages / emotional distress etc? Most information I’ve read about is simply suing the insurer to win your appeal. Thank you for any information 