We recognize the importance in this time of uncertainty that Sun Life be the kind of partner that you have come to trust for communication, information, and compassionate, professional claims handling. To that end, Sun Life’s Disability Claims Department has taken several proactive steps to help ensure the appropriate handling of COVID-19 claims. In evaluating disability claims, we are taking a forward-facing approach to gathering all the necessary information important in the claims process. This may include contacting the member’s physician(s) directly to gathering information which is critical to making a disability decision. We will always ensure clear lines of communication to address any questions that members or employers may have.
We have provided specialized COVID-19 training to our Short-Term Disability Case Managers. Additionally, we have created a small team consisting of our top technical experts to review any related claims, help to answer questions and ensure benefit decisions are made timely. Our Short-Term Disability team works closely with Sun Life’s Medical Director as well as trained clinicians to deliver the highest quality of service and claim handling.
We have also developed claim guidelines to assist in addressing the COVID-19 virus disability claim evaluation process:
Positive COVID-19 Test
If a plan member has tested positive for COVID-19 and cannot perform the duties of their job, we will consider the member Totally Disabled for at least 14 days from when the member was first unable to perform his or her duties. Benefits will start after the member meets the applicable elimination period. Benefits may be offset by other sources of income. If the employee remains disabled after that time, we will work them to obtain required medical documentation.
Plan members and plan sponsors still need to complete a Short-Term Disability claim statement as part of the application process. This allows us to validate important information such as health status, last day worked, salary information, and also confirm coverage.
Our Claims and Medical Teams will assist in gathering the information needed. We realize that, given current conditions, employers and healthcare providers are operating and communicating in non-traditional ways.
No Positive COVID-19 Test Result and Displays Symptoms
If a plan member has a flu-like illness but has not been tested or does not have a positive test result for COVID-19:
- We will continue to adjudicate each claim based on the definition of total disability and,
- We will apply the elimination period
We will not pay Short-Term Disability benefits to a plan member who does not have a positive COVID-19 test, is not ill, and otherwise does not meet the applicable policy’s definition of disability. This applies whether they self-isolate:
- At the direction of their employer, or
- Following any government or public health directive that recommends employees stay home as a precaution to prevent the spread of COVID-19.
For clarity, if plan members do not have signs of an illness, or have not tested positive for COVID-19 but are placed under quarantine by a doctor or public health official, they will not be eligible for Short-Term Disability benefits.
Employees may qualify for other benefits including, but not limited to, unemployment compensation, and other federal, state, or local statutory benefits or other absence-related benefits.
Please note that the information above is intended to be a summary, and all claims decisions are subject to the terms of your group’s specific insurance policy.
Sun Life wishes that all of its valued Clients stay safe and healthy and offers the following website with recommendations by the CDC.