Sun Life Long-Term Disability in Canada: 2026 Guide to Benefits, Denials and Legal Help

Sun Life Long-Term Disability Coverage

Sun Life is among Canada’s leading providers of long-term disability insurance, offering coverage through employer group benefit plans and individual policies. This monthly benefit aims to maintain financial stability when illness or injury prevents you from working. Coverage typically begins after a waiting period (commonly 3-6 months) during which Sun Life Short-Term Disability or employment insurance may provide income support.

To qualify for Sun Life long-term disability benefits, you must satisfy the definition of disability outlined in your specific policy. Most policies define disability in two distinct phases:

• Own Occupation Period: During the initial two years of LTD benefits, you generally must be unable to perform the duties of your own occupation. This means that if you cannot perform your specific job, you may qualify for benefits even if you could potentially work in a different capacity.
• Any Occupation Period: After two years, the definition typically changes to require that you be unable to perform any occupation for which you are reasonably suited by education, training, or experience.

Some policies impose maximum benefit periods for specific diagnoses, while others provide coverage until age 65 if you continue to meet the established disability definition.

Application Process for Sun Life Disability Insurance

Applying for Sun Life disability insurance begins with notification to your employer’s HR department or directly to Sun Life if you have an individual policy. You’ll need to complete several forms:

• Plan Member’s Statement: Sun Life’s detailed claimant form requiring personal, medical, and occupational information. This form is significantly more extensive than those of many other insurers.
• Attending Physician’s Statement: These forms must be completed by your doctor, documenting your diagnosis, treatment plan, functional limitations, and prognosis.
• Plan Sponsor’s Statement: Your employer provides information about your job duties and workplace accommodations attempted before your disability leave.

Once submitted, a Sun Life case manager will review your file, possibly request additional information, and may contact your healthcare providers directly. They may also arrange an independent medical examination (IME). Be prepared for this process to take several weeks to months, depending on the complexity of your case.

Sun Life Long-Term Disability Payment Schedule

If approved, your Sun Life long-term disability payments will be issued monthly directly to your bank account. The amount you receive is calculated based on your pre-disability earnings and the benefit percentage specified in your policy.

LTD benefits are typically taxable if your employer paid the premiums, while benefits from personally paid policies are generally tax-free. Sun Life will issue appropriate tax forms annually if your benefits are taxable.

Sun Life Long-Term Disability Benefits: What Happens After 2 Years?

Approximately 3-4 months before the two-year mark, Sun Life typically initiates a comprehensive review of your claim. This review process includes:

• Requests for updated medical information from all treating practitioners
• Possible referral for an independent medical examination
• Functional capacity evaluations to measure your physical abilities
• Transferable skills analysis to identify potential occupations you might be able to perform
• Surveillance to observe your activities outside medical appointments

During this assessment period, your case manager will compare your documented limitations against the requirements of various occupations. They’re looking for evidence that you could perform some type of work, even if it’s part-time, lower-paying, or completely unrelated to your previous career.

If Sun Life approves your claim beyond the two-year mark, you’ll continue receiving benefits as long as you meet the “any occupation” definition. But if Sun Life determines you could earn 60-70% of your pre-disability income (the exact threshold varies by policy), they may terminate your benefits even if such jobs aren’t available in your geographic area or you haven’t worked in that field before.

Common Reasons for Sun Life Financial Disability Claims Denials

Sun Life financial disability claims are denied with disturbing frequency, even when claimants are legitimately unable to work. The underlying reality is that, as an insurance company, Sun Life has a financial incentive to deny claims. While they are obligated to assess claims fairly under their contract and Canadian insurance law, the grey areas in disability assessment leave considerable room for interpretation, often to the detriment of legitimate claimants. These are the primary reasons Sun Life denies long-term disability claims:

Insufficient Medical Evidence

The most frequent basis for denial is Sun Life’s assertion that there is inadequate medical documentation to support your disability. This may occur when:

• Your medical records lack specific functional limitations
• There are gaps in your treatment history
• Specialists’ reports are missing or outdated
• Objective test results (like MRIs or bloodwork) don’t align with subjective complaints
• Your doctor’s chart notes don’t consistently document your symptoms

Definition of Disability Not Met

Sun Life often claims that, while your condition is present, it doesn’t prevent you from working. They may argue that your limitations are not severe enough to satisfy the policy definition, particularly for conditions with symptoms that fluctuate or aren’t easily measurable through diagnostic testing.

Pre-Existing Condition Exclusions

Many Sun Life policies contain exclusions for conditions that existed before your coverage began. If you sought treatment for similar symptoms during the look-back period (typically 3-12 months before coverage), Sun Life may deny your claim even if your condition worsened after coverage began.

Policy Exclusions and Limitations

Some conditions have specific benefit limitations built into the policy. For example, many Sun Life policies limit benefits for mental health conditions, substance abuse disorders, or self-reported symptoms (like pain or fatigue) to 12-24 months, even if these conditions prevent work indefinitely.

Surveillance Evidence

Sun Life regularly employs surveillance to observe claimants engaged in activities that appear inconsistent with their reported limitations. A few hours of video showing you shopping, driving, or performing household tasks can be used to deny or terminate your claim, even if these activities cause you pain or require days of recovery afterward.

Social Media Investigations

Your public social media posts may be scrutinized for evidence contradicting your disability claims. Photos of social events, travel, or physical activities can be used against you, even if they are rare exceptions to your normal limitations.

Missed Deadlines or Procedural Errors

Technical issues, such as submitting forms after deadlines, failing to attend scheduled medical examinations, or not providing requested information promptly, can result in denial regardless of your medical condition’s severity.

Non-Compliance with Treatment

Sun Life expects you to follow recommended treatments. If you decline certain medications due to side effects, miss appointments, or choose alternative therapies over conventional treatment, they may deny benefits, citing failure to mitigate your disability.

Contradictory Medical Opinions

If Sun Life’s medical consultants or independent examiners provide opinions that contradict your treating physicians, they often give these opinions greater weight than those of doctors who have treated you for years.

Self-Reported Conditions

Conditions without clear objective findings, like fibromyalgia, chronic fatigue syndrome, chronic pain, or certain mental health disorders, face heightened scrutiny. Sun Life may dismiss these claims as merely subjective or lacking medical foundation, despite their genuine impact.

Return to Work Attempts

Unsuccessful attempts to return to work may be used against you. Sun Life might argue that your ability to try working, even briefly, demonstrates capacity for some form of employment, ignoring that the attempt proved your inability to sustain work.

Appealing Denied Sun Life Disability Insurance Claims

Receiving a denial letter for your Sun Life disability insurance claim can be devastating, particularly when you’re genuinely unable to work. However, a denial is not the final word. You have options to challenge this decision. The appeal process for Sun Life long-term disability generally follows these stages:

Internal Appeal

Sun Life maintains a structured two-level internal appeal process that differs from many other Canadian insurers:

• Level 1 – Claims Specialist Review: Your initial appeal is evaluated by a claims specialist not previously involved in your file. This review focuses on whether policy terms were correctly applied and if all relevant medical evidence was considered.
• Level 2 – Group Claims Review Committee: If your first appeal is denied, you can request escalation to Sun Life’s Group Claims Review Committee, a panel of senior claims personnel who conduct a final administrative review.

The internal appeal is your opportunity to correct misunderstandings or provide missing information. However, success rates for internal appeals are relatively low, as Sun Life is essentially reviewing its own decision. While you should pursue this option, prepare for the possibility that you’ll need to take further action.

Legal Action

For many denied claimants, litigation becomes necessary. In Canada, you can sue your insurer for:

• Breach of contract (failing to provide benefits as promised in the policy)
• Bad faith (if the insurer handled your claim unfairly or unreasonably)
• Punitive damages (in cases of particularly egregious conduct)

It’s important to note that most disability insurance Sun Life policies are governed by provincial limitation periods—typically two years from the date of denial. Failing to commence legal action within this timeframe may permanently bar your claim, regardless of its merit.

Get Help from an Experienced Long-Term Disability Lawyer

Sun Life long-term disability claims are deliberately complex; the policies are filled with exceptions and limitations, and the insurer has teams of adjusters, medical consultants, and lawyers working to minimize payouts. This imbalance of power and expertise puts individual claimants at a disadvantage.

An experienced disability lawyer can:

• Frame your claim in legally advantageous terms
• Work with your healthcare providers to ensure reports address all elements
• Ensure all time-sensitive requirements are met promptly
• Contest mischaracterizations in surveillance and social media, and provide proper context for any observed activities

The sooner you involve legal counsel, the stronger your position becomes. Many claimants contact a lawyer only after multiple appeals have failed, having unknowingly made statements or omissions that weaken their case. A lawyer involved from the application stage or immediately after an initial denial can help you avoid these pitfalls. Contact Matthews Abogado Long-Term Disability Lawyers to discuss your situation and learn how we can help protect your rights and get the disability benefits you need.

FAQ

What Medical Conditions Qualify for Sun Life Long-Term Disability Insurance?

Sun Life long-term disability insurance covers a wide range of medical conditions that prevent you from working, including:

• physical disabilities (cancer, heart disease, multiple sclerosis, severe injuries)
• mental health disorders (depression, anxiety, PTSD)
• chronic pain conditions (fibromyalgia, arthritis)
• neurological disorders

The key factor isn’t the specific diagnosis but rather how your condition impacts your ability to perform your job duties.

How Much Does Sun Life Pay for Long-Term Disability?

Long-term disability Sun Life benefits typically pay between 60 and 70% of your pre-disability gross income, up to the maximum monthly benefit specified in your policy. The exact percentage and maximum amount depend on the terms of your LTD Sun Life policy. This monthly payment may be reduced by other income sources, including CPP disability benefits, Workers’ Compensation benefits, automobile insurance benefits, and earnings from part-time work.

Can Sun Life Terminate My LTD Benefits If I Work Part-Time?

Most disability insurance Sun Life policies include provisions for partial disability that allow you to work part-time while still receiving adjusted benefits. However, if your part-time earnings exceed the threshold specified in your policy, Sun Life may reduce or terminate your benefits.

How Should I Handle Sun Life’s Request for a Medical Examination?

When Sun Life requests an independent medical examination (IME), you should:

1. Ask for details about the examiner’s specialization and the purpose of the assessment.
2. Request that the examination be audio-recorded (a right supported by the Canadian courts).
3. Bring a friend or family member as a witness.
4. Request a copy of the examiner’s report.
5. Consult with your treating physician before and after the examination.

While policy terms require you to attend these evaluations, understanding your rights helps ensure the process remains fair.

When Should I Hire a Lawyer for My Sun Life Disability Claim?

You should consider hiring a long-term disability lawyer for your Sun Life claim in several situations:

• Immediately after receiving a denial letter
• When approaching the two-year mark, when Sun Life transitions from “own occupation” to “any occupation”
• If Sun Life requests an independent medical examination
• When they conduct surveillance
• If they’ve reduced your benefits due to other income sources
• When they’ve imposed limitations based on mental health or self-reported conditions

Early legal representation often results in better outcomes for Sun Life financial disability claims, as lawyers can help structure your application, gather appropriate medical evidence, and ensure deadlines are met.

How Does Sun Life’s Wellness Assessment Impact My Disability Claim?

Sun Life’s Wellness Assessment program, which includes health questionnaires and sometimes biometric screening, is marketed as a wellness initiative but may impact disability claims. Information collected through these programs could potentially be accessed during claim investigations. While Sun Life states this information is confidential, be aware that participation in these programs might generate health data that could be referenced if you later file a disability claim.

What Happens If I Return to Work and Then Become Disabled Again?

If you return to work after receiving long-term disability from Sun Life and then become disabled again, the policy’s recurrent disability provision determines what happens next. For disabilities related to the same or connected conditions that occur within 6 months (timeframe varies by policy) of returning to work, Sun Life typically restarts your benefits without a new elimination period, and you continue under the same claim. However, if you’ve been back at work beyond the recurrent disability timeframe (usually 6 months), Sun Life will treat this as a new claim requiring a new elimination period and updated medical documentation.