We appealed the denial of our client’s disability insurance claim with Sun Life insurance company based on the insurance company’s inaccurate assessment of the medical records.
Our client suffers from chronic cysts all over the body, which results in unbearable pain and a breakdown of his cognitive functions. He has undergone surgeries to correct the issue, but it has not relieved the pain he lives with each day. He also suffers from sleep apnea which does not allow him to sleep for more than 4 hours at a time. Additionally, his doctors reported that he suffers from anxiety, depression, paranoia, and impaired concentration. As a result of the pain from the cysts, the sleep apnea, and his mental state, his doctors concluded that he could not work reliably in his occupation or any other occupation.
He was a general manager for a medium sized company, which Sun Life stated was performed at a light physical exertion level. His job required frequent talking, occasional standing/walking, and ability to pull or carry up to 20 pounds. However, his doctors’ reports clearly indicate he suffers from extreme physical impairments and mental impairments that prohibit him from being a reliable employee. Specifically, they state that he cannot carry or pull more than 5 pounds and cannot lift anything that requires his abdominal muscles. Additionally, he stutters when he speaks and his sentences do not make sense.
Sun Life Insurance’s denial letter indicates that the main reason for the denial was our client’s mental incapacity, which they did not find to be enough to be totally disabling. However, their analysis failed to consider the physical impairments from which he suffers. They based their denial on a small piece of the medical evidence provided.
After submitting our appeal letter and all the relevant medical documentation establishing our client ongoing disabling conditions, Sun Life reversed their denial and awarded long term disability benefits.
Because each client’s case is unique and has different facts, results similar to those in other clients’ cases are not guaranteed.
