While attentions have been turned to Unum’s unfair claims practices, a new “bad boy” of claims has taken center front. Some have reported disgruntled attorneys from Unum found refuge at Sun Life and account for the last 18 months of egregious claim terminations. However, there is evidence Sun Life engages in claims practices which are unique and do NOT come from Unum’s direction or example.
Sun Life appears to have hired very limited internal resources preferring instead to rely on cheap outsourcing of peer reviewers for the purpose of writing what appears to be on first inspection credible reports. A closer look at the reports though indicates sources of small insurance-paid facilities are available and are rendering shoddy graphs, time lines and narrative reports to support Sun Life’s point of view. Files reviewed by DCS also show voluminous collections of miscellaneous paperwork obviously added to the file with the thought “the more paper….the more credible.” If you actually look at, and read the documents, it quickly becomes clear the information is cheaply obtained and produced. Clearly, Sun Life is chasing paperwork in an effort to produce the semblance of credibility, and it’s working.
Voluminous paperwork is also applied to denial letters which are frequently more than 20 pages long. The tactic being used is to intimidate the insured, judge or reviewer into thinking that the backup evidence is so overwhelming the decision must be the right one. Think of the claimant’s reaction receiving a 20-page denial letter. This insured may also be intimidated into thinking an appeal or challenge to the denial is fruitless and Sun Life might be right after all.
In addition, Sun Life Financial’s mode of claim investigation makes the CIA look like amateurs and crosses the line of “investigating the unique circumstances of a disability claim”. The claimant AND his family members are investigated as well as anyone remotely connected with the claimant in any capacity. One claimant found considerable paperwork in his file investigating Linda Nee – imagine that! Private investigation and direct, deliberate challenges to a claimant’s reputation and credibility are relied upon as proof of claim termination.
Instead of adjudicating the policy in accordance with contract provisions, Sun life seems to operate under the presumption the claimant is “suspect” and engages in personal and private investigation to discredit the individual not the claim. I call this the “dirty laundry” claims process which can also be described as the “smearing of the claimant’s reputation” in order to not pay claims. While Unum targets its victims to gain the “biggest bang for the buck”, Sun Life Financial just goes for the jugular.
Sun Life’s medical peer reviews often border on the ridiculous and are not medically sound. The most current to my knowledge is Sun Life’s insistence that stress has no bearing on Coronary Artery Disease (CAD). There are sufficient medical journal writings documenting the adverse effects of stress on potential catastrophic heart attacks in the future. The great extent of the medical evidence should make Sun Life look like criminals. Yet, the company persistently plays the numbers, remains firm in its decisions, and forces the majority of claimants to seek counsel and file lawsuits in order to receive payments they were already entitled to.
If Sun Life is your insurer then take note of the 11 pages of paperwork the company requires you to fill out for STD and another 11-12 pages for LTD. Applications are not disabled-person friendly. I’m beginning to think perhaps the length and scope of burdensome applications is deliberately designed to exhaust claimants quickly from the beginning of the application process.
Employers, be careful of wayward insurance agents. One sales agent I spoke to this year hailed Sun Life as the best group insurer out there and recommended Sun Life to a major hospital group. I’ve spoken to Canadians insured by Sun Life Financial of Canada who quickly become frustrated since Canada does not have ERISA laws and punitive damages are non-existent.
Bottom line, Sun Life doesn’t pay claims for any reason and claimants have a real fight collecting benefits under the policies. Its claims process is filled with cheap, over done outsourced resources often documenting medically unsound medical data which is relied upon to terminate claims. Adding an exhaustive private investigative effort to destroy the claimant’s credibility and reputation, Sun Life can now be easily called the “new insurance criminal on the block”.
Possible payback for Sun Life might be to encourage claimants to write to state insurance departments requesting immediate conduct market evaluations of the company and its claims practices. The DOIs may not immediately react but if enough people complain the states have to do something. The US Department of Labor should also be informed of Sun Life’s activities. Sun Life may vary well inherit the same fate of Unum and the Regulatory Settlement Agreement if it continues on the path of conducting its business in such an unconscionable manner.