How to submit a long-term care insurance claim
- For long-term care claims, it's a good idea to wait until your policy’s waiting period is over before starting your claim. This is in case you recover before the waiting period ends.
- For Retirement Health Assist (RHA) policies, it’s best to wait until your policy’s coverage effective date to start your claim.
- To be eligible for long-term care, you need to:
- always need substantial physical or stand-by assistance from another person to perform two or more of the activities of daily living.
- need continual supervision by another person for protection from harm to your physical health and safety as the result of mental deterioration due to an organic brain disorder such as Alzheimer’s disease, irreversible dementia or brain injury.
- Activities of daily living:
- Bathing (washing oneself)
- Dressing (to put on, take off, fasten and unfasten)
- Feeding (feeding oneself by getting food into the body, NOT including cooking or preparing a meal)
- Toileting
- Transferring (moving to or from a bed or chair)
- Continence
The above definitions are general information only. Your policy will include the specific definitions that apply to your coverage, which may be different. Please speak with your advisor if you have questions about your policy’s definition of long-term care eligibility.
3 helpful tips
- Be timely. Contact us as soon as you’re aware that you need to file a long-term care claim.
- Be thorough. Give us as much information as you can when you send us your claim.
- Be complete. Please fill out all of the information on the claim form. Remember to sign and date the forms you send us.
The most common missing information is:
- Physician contact information: the full address, including postal code and phone number of all of the doctors you consulted. This includes regular attending physicians and specialists.
- Signatures: If you’re unable to sign the Long Term Care insurance – Claimant’s statement form due to your illness, make sure it’s signed by your power of attorney for property. Submit the form appointing the power of attorney along with the signed Long Term Care insurance – Claimant’s statement form.
1. Contact us
Please call us at 1-877-786-5433, Monday to Friday from 8 a.m. to 8 p.m. ET to let us know you’re planning to file a claim for long-term care insurance.
We’ll start by asking you for basic information:
- Your name
- Policy number
- Date of birth
- Telephone number
- Address
- The type of illness or condition
2. Send us additional information
Once we’ve confirmed the basic information for your claim, we’ll ask you to complete one or more forms depending on your illness or condition.
An advisor will connect with you to confirm what we need. They’re also happy to answer questions about your claim.
If you have questions, you can also call us at 1-877-786-5433, Monday to Friday from 8 a.m. to 8 p.m. ET. We’re here to help.
3. Send us your claim information
You can send forms and any other details to us using one of the options below. Please keep a copy of the documents you send us for your records.
If you need to send medical information for your claim, your doctor can send us medical information directly.
Fax:
1-866-487-4745
Mail:
Sun Life
227 King St S
PO Box 1601 Station
Waterloo, ON N2J 4C5
Sun Code: 300A50
Courier:
Sun Life
227 King St S
Waterloo, ON N2J 4C5
Sun Code: 300A50
Email:
ltcclaims@sunlife.com
If you choose to send your information by email, we can’t guarantee the privacy or security of email communications while they’re on their way to us.
4. Our review
After we receive the information we need, we’ll start our review of your claim. We may also reach out for further information if we need it.
You can ask your advisor for an update on your claim or send them more information any time during our review.
You can call us at 1-877-786-5433, Monday to Friday from 8 a.m. to 8 p.m. ET. We’re here to help.
5. The claim decision
Once we’ve finished our review, we’ll send you a letter to let you know if your claim is approved.
- If we approve the claim, we’ll make the payment by cheque.
- If you’d prefer your payment by electronic funds transfer (EFT), be sure to give your advisor a copy of a void cheque when you start your claim.
- Depending on your policy, there may be a specific period of time before we can make the payment. This is what your policy calls a waiting period.
If we don’t approve the claim:
- We’ll send you a letter with a detailed explanation about our decision, including any relevant medical information.
- If you choose to appeal our decision, we’ll give you next steps.
- You’ll have 90 days to send us new information. If your doctor charges a fee to send us new medical information, you’ll have to pay the cost.
Need to talk to someone?
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