Dr. Katherine L. Alley has filed an Unum lawsuit alleging the insurance giant wrongfully denied her long-term disability benefits.

Before she became completely disabled, Alley reportedly served as a breast surgeon to women who needed various conditions treated. With her disability, she was allegedly no longer able to perform the necessary job functions of her occupation, and was unable to earn any wages.

Alley obtained her license to practice medicine in 1978 and became well-respected in her field, but she suffered spinal nerve damage injury in 2011, which ended her career, according to the Unum lawsuit.

Alley reportedly received surgical treatment for her condition in May 2010 and had filed for disability benefits soon after. Alley had been insured under two Unum Life Insurance Company disability insurance policies to ensure maximum long-term disability benefits, with the first policy agreed to on Feb. 15, 1985 with monthly payments of $4,769.

The second policy that was solidified on Dec. 15, 1986 with the promise of $9,836 per month. Allegedly, there had been no problems with either of these policies until Alley filed benefit claims for them when she became disabled, she claims in her Unum lawsuit.

Overview of the Unum Claim Denial Lawsuit

Under the conditions of the disability insurance policies, for Alley to be considered “Totally Disabled” she would have to lose over half of her net earnings and be unable to function adequately in her occupation due to an injury caused by an accident.

After Alley started experiencing painful symptoms in her neck in November 2009 that steadily worsened, she found that she would need the benefits after she developed a foot drop and with an MRI examination, found out that she had developed a spinal meningioma, a benign tumor arising from the spinal cord to the brain, she explains in her Unum lawsuit.

As mentioned earlier, Alley had undergone surgery to remove the tumor in May 2010 but reportedly developed another shoulder drop on her right side, and experienced a significant amount of pain. By late April or May 2011, it had become clear that physical therapy would not solve her shoulder condition, and it was concluded that the surgery had caused a loss of function. Prior to the meningioma removal surgery, Alley reportedly had experienced significant pain in her shoulder but had no signs of muscle weakness or pain in her shoulders.

According to Alley’s disability insurance lawsuit, on June 28, 2011, an additional surgery was performed to correct the shoulder injury, but had not be successful. Due to the injury, Alley was allegedly forced to work in a reduced capacity from May 7, 2010 to June 28, 2011, and she was no longer to carry out her duties as a breast surgeon. Due to the unexpectedness of the spinal meningioma injury, Alley’s condition met the disability insurance policy’s definition of “Totally Disabled.”

On Aug. 17, 2011, Alley reportedly filed for disability benefits citing her spinal injury and the disability she incurred after the surgery. Several months later, Alley received an insurance claim denial from Unum on the grounds that Alley’s spinal injury was “a risk of surgery and [was] not considered an accident.”

Unum considered Alley’s spinal injury a medical condition and not an accident, and the insurance giant reportedly denied the claim based on the fact that she filed for her disability insurance benefits under the injury provision, rather than the policy’s sickness provision.

Due to the fact that Unum had evaluated Alley’s claims under the injury provision of her policies, the company had stopped making disability payments on the plaintiff’s 65th birthday. Alley appealed this decision, requesting Unum reconsider this decision to deny her benefits. On Jan. 6, Unum granted Alley’s request for benefits until March 7, stating that her condition was not caused by an accident.

Alley submitted additional materials that supported her claim that her condition was caused by an injury on March 5, 2014. Unum still denied the request, and has yet to pay any additional benefits to Alley despite medical testimony proving that she meets the policy’s conditions.

The Unum Lawsuit is Katherine L. Alley v. Unum Life Insurance Company, Case No. 1:14-cv-00849-RBW, in the U.S. District Court for the District of Columbia.