For a plan member whose disability claim has been declined, the new process can help them decide next steps. If they choose to appeal, we’ve made the process easier and more efficient.
What’s changing
We’re introducing two key areas of change within the disability appeal process.
1. Improved plan member communications
Our Disability Case Managers (DCMs) play a central role when a plan member’s disability claim is declined. They communicate the decision and serve as a support for the plan member, in taking next steps.
We’ve enhanced DCM training to ensure our verbal and written communications are clear, concise and transparent. We’ve also redesigned some letters to plan members. These letters clearly communicate decisions and offer concrete next steps in the appeal process.
In addition, we’ve created a new, easy-to-use appeal form. The form lets plan members communicate their intent to appeal with ease. Plan members will continue to have 30 days to inform us that they intend to appeal any decline decision.
With improved communications, our goal is to help plan members better understand the decision and where they are in the process. This can also help them determine if they wish to appeal or not.
2. New streamlined process
Plan members who appeal their disability claims decision will no longer follow three levels of appeal. Instead, the plan member only needs to appeal once. The Disability Appeal team will ensure all required internal levels of review are completed before a decision is final. They’ll then communicate the final decision to the plan member and plan sponsor. These changes allow for a more streamlined and efficient approach to decision-making.
We’ve also formed a new appeal committee and created quality control programs to support our new process.
Plan members who make a disability claim are experiencing a difficult time in their life. Our goal is to make the process easier – and enhance the plan member experience during this trying time.
There is no need to communicate these changes to plan members. Those plan members who receive a decline letter will simply benefit from a better plan member experience.
Disability management – a key area of focus
In 2021, disability management is a key area of focus for Sun Life. We’ve made significant investments to enhance our disability operations – and we continue to do so. This includes:
- Introducing new training and coaching techniques to build on our mental health knowledge and claims expertise.
- Moving to an enhanced case management platform. This will help us provide more proactive communications and problem-solving – and better insights into disability trends.
- Growing our team by hiring over 100 new disability case managers, nationally. This ensures a sustainable caseload for Disability Case Managers, and the time needed to proactively manage plan member recovery.
The enhanced disability appeal process is just one of many enhancements to come.
Questions? We’re here to help.
For Clients with fewer than 50 employees, please contact your Client Service Administrator at 1-877-786-7227.
For Clients with more than 50 employees, talk to your Sun Life Group Benefits Representative for more information on how we are shaping the future of disability.
