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. You need to let Sun Life know within 30 days if you want to appeal it. Sun Life has an appeal team, specifically for reviewing disability appeals; consisting of disability claims consultants (DCCs) and an appeal committee. 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
You complete and send Sun Life the appeal form, which would be included in their decision letter.
- Sun Life will let you know when they receive your appeal.
- A DCC will review your appeal and any other information you provide.
- Sun Life will call you to review your claim with you.
The appeal process may not change their decision. If the DCC does not change the decision on your claim, their appeal committee, which includes senior members of their disability team, will do one final review. When this is complete, Sun Life will let you know the final decision.
Appeal with the Disability Insurance (DI) Plan Board of Management (National Joint Council)
Once the appeal process within Sun Life has 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 can be sent to email.courrier@njc-cnm.gc.ca or if you prefer you can send your request by mail to the following address:
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
Do not send any personal or medical information. This type of information should be shared directly with the provider – Sun Life.
Sun Life’s Client Advocacy team
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’s Client Advocacy team.
Please note that they cannot evaluate medical evidence or make decisions. It is to thoroughly and objectively investigate complaints and act as a mediator, by exploring different possibilities that may lead to a resolution.
Client Advocacy - Contact Information
Use their digital form available at www.sunlife.ca/en/support/how-to-make-a-complaint/contact-us/
Client Advocacy, Sun Life
1155 Metcalfe Street
Montreal QC H2B 2V6
Delivery code: 602E15
To contact Sun Life
Call 1-800-361-5875