You will be advised in writing by Sun Life that your claim has been denied and will be provided with details of what information is needed to appeal the decision. There are two (2) opportunities within Sun Life to appeal the decision on your claim before requesting an independent review from the Disability Insurance Plan Board of Management.
Appeal within Sun Life
1st Appeal – The Abilities Case Manager (ACM) will review the new information that you provide. If it is not sufficient to change the decision, your claim will be forwarded in its entirety to the next level of management. They will review the ACM's findings, and if they agree with the assessment, will issue a letter that will explain the decision and indicate the information needed to appeal to the 2nd level.
2nd Appeal – The Sun Life Management Unit will review the new information that you provide. If it is not sufficient to change the decision, your claim will be forwarded in its entirety to the next level of management. They will review the Sun Life Management Unit's findings, and if they are in agreement with the assessment, will issue a letter that will explain the final decision. If your claim remains closed, this completes Sun Life's internal appeal process.
Appeal with the Disability Insurance (DI) Plan Board of Management (National Joint Council)
Once the two levels of appeal within Sun Life have been exhausted, you may request an independent review by the DI Plan Board of Management. The Board will only consider a review once all levels of appeal within Sun Life have been exhausted. The Board, which is comprised of both management and federal public service union representatives, reports to the National Joint Council. The Board reviews each case and endeavours to recommend a course of action to the insurer or the employee which may facilitate a resolution to the case. Such recommendations are not binding, but the Board has been able to bring many cases to a satisfactory resolution.
Requests for independent review should be sent to:
The Secretary DI Plan Board of Management
National Joint Council
C.D. Howe Building, West Tower
7th Floor, 240 Sparks Street
P.O. Box 1525, Station B
Ottawa, ON K1P 5V2
Other recourse – Sun Life Ombudsman's Office
If at any time during the claim management process you feel you have been dealt with unfairly or you have a complaint about a service provided by Sun Life, you should contact the Sun Life Ombudsman's Office.
They cannot evaluate medical evidence or make decisions. The Ombudsman's role is to thoroughly and objectively investigate complaints and act as a mediator to explore possibilities that may lead to a resolution.
Ombudsman's Office, Sun Life
225 King Street W., 7th Floor
Toronto, ON M5V 3C5