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Sun Life Appeal Won For NY State Employee with Migraines & Eye Disorder

The case involves a 56-year-old New York State employee who had worked for the state for approximately 25 years. She began experiencing debilitating migraines and eventually developed vision loss in her left eye. Doctors discovered that she had a meningioma growing on her left optic nerve. The tumor required surgery, but by the time it was removed, it had severely damaged the optic nerve and left her with approximately 50% vision loss in her left eye.

Although the tumor was successfully removed, the client continued experiencing significant medical problems. Her vision remained impaired, and she continued suffering from severe migraines. Sun Life initially approved her long-term disability claim and paid benefits for almost a year. The insurer then terminated her benefits, reasoning that because the tumor had been removed and she had completed the expected recovery period, she should be capable of returning to work.

Sun Life acknowledged the client’s remaining vision loss but did not consider it sufficiently disabling. The insurer also discounted the severity of her migraines, despite the fact that they continued to interfere significantly with her daily functioning. The denial focused heavily on the fact that the tumor itself was no longer growing rather than on the lasting effects of the tumor, damage to her optic nerve, and continuing migraines.

Attorney Jason Mackrie developed an appeal designed to document the full impact of these conditions rather than evaluating each diagnosis in isolation. Key components included:

• Working with the client’s treating physician to complete an Attending Physician Statement detailing the severity of her migraines and resulting restrictions and limitations.
• Documenting that her migraines were severe enough to require Botox treatment and remained debilitating despite that treatment.
• Obtaining a neuropsychological evaluation to assess the cognitive effects of her vision impairment and migraines.
• Documenting memory difficulties and problems processing information caused by the combination of her conditions.
• Demonstrating how her symptoms affected her ability to perform the cognitive requirements of her occupation.
• Rebutting the conclusions reached by Sun Life’s reviewing physicians with evidence from her treating providers and the neuropsychological evaluation.

The neuropsychological evaluation was particularly important because the client’s occupation was a sedentary desk job requiring significant cognitive ability. She needed to analyze substantial amounts of information and perform in a relatively fast-paced environment. The evaluation helped demonstrate that her disability was not limited to vision loss or episodes of head pain. Her migraines and visual impairment were also affecting her memory, information processing, and ability to consistently perform cognitively demanding work.

The appeal brought together the client’s diagnoses, ongoing symptoms, physician support, treatment history, and neuropsychological findings to demonstrate why she could not perform the duties of her occupation. Sun Life ultimately reversed its denial and reinstated her long-term disability benefits.

The claim will continue to require careful management because the policy eventually changes from an own-occupation definition of disability to an any-occupation standard. To prepare for future reviews, the client must continue documenting her treatment, migraines, visual limitations, cognitive difficulties, and any new findings from her physicians. Her medical records will remain important in demonstrating that these conditions continue to prevent her from working.

The case also illustrates why migraine disability claims can be particularly challenging. Symptoms can fluctuate significantly, with a person sometimes experiencing several relatively manageable days followed by multiple days of debilitating migraines. That unpredictability can itself interfere with the ability to maintain reliable full-time employment. For this client, documenting the combined effects of her permanent vision loss, persistent migraines, and resulting cognitive difficulties was critical to overcoming Sun Life’s denial.