An Alabama business owner is appealing an Unum long term disability denial after he was diagnosed with a rare, fast growing brain tumor.

Plaintiff Raymond L. was diagnosed with grade IV glioblastoma. Glioblastoma is a rare, quickly growing brain tumor that can only be treated by radiation, chemotherapy and surgery.

Raymond began experiencing seizures, which prompted him to seek medical help. It was at this point he was diagnosed with gliblastoma. Initially, his seizures kept him from working.

Because he is the owner and operator of his company, Advanced Manufacturing Systems, or AMS, he was the “primary person responsible for bringing in, and seeing to completion, all business and projects for the company,” according to this Unum long term disability denial lawsuit.

He claims that since his departure from his workplace, the gross revenues for Advanced Manufacturing Systems have “plummeted.”

Raymond says he went through the proper channels to file a claim under his group disability benefit under the group policy issued by Unum Life Insurance Company of America. This claim was approved on Dec. 29, 2015.

Additionally, at the same time, Raymond was approved for a separate disability benefit under an individual policy that he had through Provident Life and Accident Insurance Company.

This claim, interestingly, was processed and administered by the same claims personnel and the approvals were announced in the same decision letter.

During this time the comptroller for AMS inquired with the claims personnel about the amount of Raymond’s benefit. The claims handler responded with information that his benefit was based on salary, not on business earnings. If Raymond could provide some tax documents regarding the business, perhaps his benefit could be expanded.

However, when Raymond provided these documents, according to this Unum long term disability denial lawsuit, it set into motion a new review of the situation by Unum.

Unum concluded, according to Ramond’s Unum long term disability denial lawsuit, that not only were they paying him too much, but now Raymond owed them money. The lawsuit explains that Unum’s “position was based on what it contended was an expanded definition in the changed-out policy of what earnings were included not just for the policy’s earnings baseline, but also its provisions relating to income earned while the claimant is disabled.”

Another letter, this one dated January 3, 2017, stated that his benefit was being terminated because it had been found that his “disability earnings” exceeded the amount permissible for him to remain eligible for that benefit. The letter stated that his claim was closed retroactively six months prior.

This Unum long term disability denial lawsuit claims that Unum now expects Raymond to repay them nearly $21,000 in “overpayment” of disability benefits.

The main contention between Raymond and the insurance provider is what is passive income versus what is active income. Raymond believes that the language of the plan does not include passive income he may have made while being disabled. Unum believes otherwise and has therefore ended his benefits.

This Unum Long Term Disability Denial Lawsuit is Case No. 7:17-cv-01690-LSC in the United States District Court for the Northern District of Alabama, Western Division.