u/Asleep-Frame-6292

Hi everyone,
I am looking for some opinions from people who may have experience with Sun Life group benefits/ claim reviews.
I have health benefits through my employer in Canada. Recently Sun Life selected some of my claims for review and askd me to provide invoices.
The situation is basically this:-
I had submitted some counselling claims for service received in Canada and some for services recd outside Canada.
For the Canadian providers, I normally submitted the claims through the Sun Life app.
For the services outside Canada, I later learned that they were supposed to be submitted through a different process.
I mistakenly submitted some of the out of country claims through the regular app and selected a provider from the list because the actual provider was not showing there.
Sun Life contacted one of the providers listed on the claims, and the provider confirmed that they did not provide those particular services.
Sun Life then asked me for the supporting invoices, which I provided.
I also explained to Sun Life that the claims were submitted incorrectly and that the services were actually received from the out of country providers.
Some of these claims had already been paid, and Sun Life is now reviewing them further.
Sun Life has now told me that they will be doing a further review of claims under my plan and that it could take some time.
I am obviously concerned because I do not want this to be treated as something intentional. It was a submission mistake and I have been cooperating with them and providing the invoices or information they requested.
My main questions are:
What normally happens in a situation like this?
Could Sun Life simply reverse or recover the payments and close the matter?
How serious can it become if they believe the claims were submitted incorrectly?
Can Sun Life terminat or restrict someone access to their group benefits?
Would Sun Life normally involve the employer in a situation like this?
just trying to understand what people have seen happen in real-life situations.

I’m looking for advice from anyone who has dealt with a Sun Life group benefits claim investigation.
Sun Life selected approximately $850 of my mental-health claims for review. Around $400 were submitted correctly for Canadian providers, while about $450 were for counselling services I actually received and paid for from an out-of-Canada provider.
The issue is that I mistakenly submitted the out-of-Canada claims through the Sun Life mobile app, selecting a Canadian provider from the provider list. At the time, I didn’t know that out-of-Canada services had to be submitted through the separate Client Care Request process on Sun Life’s website. Since the out-of-Canada provider wasn’t available in the app, I selected a provider from the available list.
Sun Life contacted the Canadian provider shown on the claims, and that provider confirmed they did not provide those services.
Sun Life then asked me for supporting documents. I submitted invoices for both the Canadian claims and the out-of-Canada claims, showing the services and payments. At the same time, I proactively explained to Sun Life that the out-of-Canada claims had been submitted under the wrong provider because I misunderstood the submission process. I also explained that I have since been using the correct Client Care Request process for out-of-Canada claims.
After receiving my explanation and invoices, Sun Life replied that “further review of claims under your plan will occur” and that it could take several weeks before I hear from the investigator.
I’m now quite anxious about what this means.
What is the realistic outcome in a situation like this?
Could Sun Life simply reverse/deny the incorrectly submitted claims and ask for repayment? Does providing genuine invoices showing that the services were actually received and paid for make a difference? Could this potentially affect my entire group benefits coverage?
Has anyone experienced a similar Sun Life investigation where the services were actually received but the wrong provider/process was used?
I’m not looking for legal advice — just trying to understand what typically happens in real-life situations.