For Canadians on long-term disability (LTD), a reassessment often occurs at the two-year mark. Insurance companies, including Sun Life, use this opportunity to determine if an individual is still “totally disabled” under their policy.
This is known as the “change of definition” date. Sadly, it’s not uncommon for claimants to be suddenly cut off LTD benefits at this point—even when nothing about their health has improved.
I’ve seen this happen to countless clients struggling with chronic pain, depression, post-concussion syndrome, autoimmune disorders, and other debilitating conditions.
If you’re approaching your change of definition date with Sun Life, or you’ve already been cut off LTD benefits, here’s what you need to know.
1. The ‘change of definition’ gives Sun Life a new test—not a reason to assume you’ve recovered
For the first 24 months, LTD coverage focuses on whether you can do the duties of your own occupation. After two years, Sun Life’s criteria shifts to any job that fits your background, training and experience.
In LTD cases that my firm has handled, including one involving Sandra Bullock’s $5.3-million claim in Georgetown, this transition led to a denial that was ultimately overturned with proper medical documentation.
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The key point: the legal test changes, but your rights don’t. If your condition still prevents you from working in any reasonable capacity, you may still qualify for LTD.
2. A cut-off isn’t final—get Sun Life’s rationale in writing
Some insurance companies deliver the “bad news” to claimants over the phone. If this happened to you, contact Sun Life immediately and request a denial letter.
This document will force the insurer to clearly outline in writing why you were cut off LTD—making it extremely difficult for them to pivot to a different explanation at a later date.
READ MORE: 3 signs your long-term disability claim may be denied
Once you have the denial letter in your possession, connect with a disability lawyer. My firm can review your situation and advise you of potential next steps.
Even if you don’t have this document, it’s still in your best interest to get legal advice. We provide LTD consultations at no cost to you.
3. The opinion of your doctors carries more weight than Sun Life’s internal answers
Sun Life, like other insurance companies, often rely on short assessments or paper-based file reviews conducted by consultants who’ve never treated you.
Meanwhile, the medical professionals involved in your care understand your condition, your limitations and your prognosis.
READ MORE: 3 things you need to do if the insurer’s medical consultant doesn’t think you’re disabled
In the event that you receive a cut-off or warning letter:
- Book an appointment with your treating doctors.
- Get your treatment team to review the insurer’s rationale.
- Have them explain in writing why you can’t perform any job, not just your previous role.
4. Avoid Sun Life’s internal appeals—they rarely work and can cost you months of income
Internal appeals are handled by the same insurance company that denied you. They’re not independent, and in most cases, they simply confirm the original decision.
Many people reach out to my firm after attempting multiple appeals—losing precious time that could’ve been used to obtain a real resolution.
READ MORE: 3 key things to know about the appeals process and LTD
If Sun Life cut off your access to LTD benefits, we can move your file out of the internal appeal loop and into a formal legal process. In most cases, we’re able to reach a settlement without getting the courts involved.
The bottom line
When Sun Life and other insurance companies begin to request new medical assessments, ask about return-to-work options or suggest that you may no longer qualify for LTD, your best course of action is to contact a disability lawyer.
Don’t wait for your insurer to cut off your access to LTD benefits—disrupting your financial stability and potentially worsening your condition.
With strong medical support and proper legal guidance, you can successfully challenge the decision and secure the compensation you’re owed.
READ MORE: Insurer being difficult? 3 reasons to hire a long-term disability lawyer
Denied or cut off LTD by Sun Life? Asked if you want to appeal the decision?
Contact Samfiru Tumarkin LLP or call 1-855-821-5900 for a FREE disability consultation. We help Canadians in all provinces (excluding Quebec) challenge unfair long-term disability decisions and get the compensation they deserve.
Sivan Tumarkin is a disability lawyer and co-founding partner at Samfiru Tumarkin LLP, Canada’s most positively reviewed law firm specializing in long-term disability claims and employment law. The firm provides legal insight on Canada’s only Disability Law Show on TV and radio.