We do not handle social security disability claims
Recent Post

Court Finds Sun Life Unreasonable in Evaluating Pre-Existing Treatment

WRITTEN BY:
Justin Frankel
June 11, 2013 | Disability Insurance Claims
Over $250 Million Recovered for Our Clients

A Federal judge in Missouri has determined that Sun Life acted unreasonably, where it sought to apply a pre-existing limitation clause in its long term disability insurance policy to deny coverage to a claimant. Often, ERISA group LTD policies have provisions which will serve to bar coverage for long term disability insurance, even where a claimant receives the full amount of short term disability coverage.

Here, the Sun Life policy had a pre-existing limitation clause, which permitted Sun Life to evaluate whether the claimant had received medical treatment, care or services, including diagnostic measures, or took prescribed drugs for the disabling condition during the three month “look back” period prior to the insured’s effective date of coverage, as the claimant became disabled within the first twelve months of coverage.

The claimant had suffered from a progressive eye condition, retinitis pigmentosa, for nearly twenty years prior to filing the disability claim. He had taken significant amounts of a non-prescribed over the counter supplement at his doctor’s recommendation, but had not visited any doctor or medical facility during the look back period.

Sun Life first determined that the claimant was not disabled, but then, after agreeing he was totally disabled, took the position that coverage was limited by the pre-existing limitation in the policy. Sun Life sought to rely upon the use of the supplement as evidence that the pre-existing limitation applied and benefits were limited.

The Court determined that Sun Life’s interpretation of the policy language to limit coverage was improper, and inconsistent with the language of the provision. The Court thus ordered Sun Life to pay benefits to the claimant, but kept open issues relating to pre-judgement interest and other relief.

If you are unable to continue working and have not completed twelve months of active employment with an employer, it is possible that your insurer will seek to apply a pre-existing limitation provision to bar or limit coverage. Careful consideration to these issues is of paramount significance.

Kutten v. Sun Life

Justin C Frankel

Written By Justin Frankel

Attorney

Justin C. Frankel is committed to fighting for the rights of clients when their long term disability insurance claims have been denied, delayed or terminated.


Client Testimonials

Rating stars 5.0 Average on Martindale & AVVO
  • We know how important our work is to the people we represent, and we’re pleased to share this recent note from a client. Dear Justin and Christina, I wanted to take a moment to express my sincere g…
  • Our 60-year-old client worked for the world’s largest out-of-home advertising company as a Senior Buyer and outdoor furniture supplier, doing everything necessary to manage a contract for twenty ye…
  • Successful ERISA Appeal of Cigna Denial for High-Ranking Aviation Executive from Florida A 61-year old woman with a prestigious role at a leading aviation company never imagined she would stop work…
  • ERISA Case Headed to Trial in Federal Court – Barber v. Sun Life & Health A Federal Judge in Connecticut has scheduled a trial with live witnesses in an ERISA case, to be decided under the arbi…
  • F&N Resolves a Four Year Delay in UNUM Lump Sum Settlement Matter We were contacted by a 56 year-old man from Maryland who had been trying to negotiate a lump sum settlement of his private disa…
  • Our client, a successful New York dentist, was on claim for a number of years with Trustmark Insurance, due to severe orthopedic issues, which did not permit him to safely and effectively practice …
  • “OK, now that I have had a chance to calmly review the documents, I just wanted to thank you for all of your help. I am certain that if I would have tried to do this myself, I would not have had th…
  • The Law Office of Justin Frankel Navigates Complex Issues, From Claim Preparation to Lifetime Management, for Chiropractor A New York chiropractor in his mid-50s was concerned about complex issues …