Top managers of President Obama's administration have done nothing after seeing quotes from numerous U.S. Judges' that prove Metlife and doctors' paid by Metlife are endangering the lives of many patients.
The Judges quotes you’ll see later in this blog include :
(1) In the case of Brenda Zanny, U.S. District Judge Richard Enslen wrote :
“MetLife and its henchmen should appreciate that such conduct may itself precipitate the suicide death of a person who has placed implicit trust in their organization. This record is an open indictment of MetLife’s practices and treatment of the mentally-ill and long-term disability benefits."
(2) In the case of Jacquelyn Addis, U.S. District Judge Timothy J. Savage wrote that Metlife and their consultant Dr. Greenhood ignored MRI reports that evidenced Multiple Sclerosis and brain lesions. They also ignored sphincter incontinence, pain, nerve damage, trembling, stumbles and falls, and shaking in the upper and lower extremities.
(3) In the case of Joanne Vick, U.S. District Judge Robert Cleland wrote that Metlife (and their Dr. Greenhood mentioned above) said Ms. Vick had never fallen.
Judge Cleland then wrote that Metlife and Dr. Greenhood were ignoring the medical records that prove Ms. Vick actually fell and broke her foot in 5 places when she developed diabetic kytoacedosis following childbirth.
Judge Cleland then wrote that Metlife and Dr. Greenhood were ignoring the medical records that prove Ms. Vick actually fell and broke her foot in 5 places when she developed diabetic kytoacedosis following childbirth.
* As you look at more Judges' quotes please remember it takes years to get these cases to trial and very sick patients may die because they have no money for surgery and medical treatment, food, or housing.
The only reason the insurance companies are allowed to sell these insurance policies to 150 million Americans is because they have agreed to be regulated by U.S. Title 29 which mandates :
“ a fiduciary shall discharge his duties with respect to a plan solely in the interest of the participants and beneficiaries”
“with care, skill, prudence, and diligence”
(4) Here are quotes from U.S. District Judge Nancy Gertner who won the Thurgood Marshall Award of the American Bar Association in 2008.
Judge Gertner wrote these quotes in the case of Whitehouse verses Metlife :
“It misquoted Whitehouse’s doctors and cherry-picked or took out of context statements made. The denials continued to press factual inaccuracies even after being informed of the errors.”
“Perhaps most egregious of all, it misquotes Dr. Bhan as stating that Whitehouse “[was] able to function” AR 116 when, in fact, he said “she was not able to function.” AR 121 (emphasis added).
“Anderson stated that he was “surprised” that his and Dr. Bhan’s reports were not taken to support Whitehouse’s “serious functional limitations . . . . Mrs. Whitehouse was NOT able to function professionally (or personally), with such a major formal thought disorder as major depression with psychosis.”
(end of quotes)
(The Anderson mentioned above is a psychological counselor. This case provides evidence that Metlife has recklessly endangered a second patient with very serious Psychological problems)
(5) Here are quotes from the Report and Recommendation written by U.S. Magistrate Judge Jennifer Guerm in the case of Wright verses Metlife :
(5) Here are quotes from the Report and Recommendation written by U.S. Magistrate Judge Jennifer Guerm in the case of Wright verses Metlife :
"On October 18, 2004, Dr. Barnett wrote a letter to MetLife stating:
"I am gravely disturbed by your misrepresentation of the facts with regard to my discussion with your independent physician consultant and your lack of due diligence in collecting further medical information regarding Mr. Wright’s health condition."
"You indicate in your letter that “it was concluded that you are out of work primarily due to work related stress.” I spent over 30 minutes on the phone with your independent physician consultant explaining that this was definitely not the case. Indeed, this consultant seemed to have had a preconceived notion that stress was why the patient was out of work and that there was no cardiovascular disease contributing. I very clearly explained that this was not the case. Indeed, Mr. Wright has ongoing cardiac disease including ischemia and loss of function due to previous myocardial infarctions."
"Each time I expressed the belief to your consultant, she would return to the fact that she felt that stress must be the major issue that was keeping him out of work.... Furthermore, I carefully explained to your physician that Mr. Wright has nonunion of the sternum resulting in severe pain and contributing to his disability, and yet you fail to mention that at all in your note."
(End of Dr. Barnett’s quotes that Judge Guerm included in her report)
Judge Guerm personally wrote :
"MetLife relied on clearly erroneous findings of fact in making its benefit determination. MetLife’s review of Plaintiff’s appeal consistently omitted or misrepresented relevant information in several ways."
Please remember this is only the introduction to many more quotes seen on this website. I found all of these case quotes searching google, and less than one percent of cases are even posted on the internet !!!!
(6) In my personal case MetLife completely ignored my long term claim for eye cancer for five years. MetLife did this while reading my desperate requests for help including the following that was filed in U.S. District Court in Nashville :
"the Plaintiff who has had cancer removed from his eye and leg and over 200 biopsies plus stitches in 100 places has no money for follow up treatment."
MetLife and my employer ignoring my eye cancer caused me to go into major depression and extreme stress and one of my doctor's requested that I see a Psychologist.
You’re about to see quotes from a four page report written by my Psychologist. In addition to all the patients who have medical conditions ignored, I am the third psychological claimant that was and is being endangered by Metlife, and the Obama administration has taken no noticeable action :
"It is my impression that three medical doctors paid by Metlife appeared to have ignored medical evidence. For example, Metlife’s paid consultant, Dr. Yanik, "evaluated" Mr. Schmittou without ever having seen him or his medical record from 2004 through 2008.
In fact, from the time he filed the claims in 2002 until the Court ordered a review in 2008, Metlife ignored both his claims for long-term disability based on vision impairments and on psychological impairments. In treatment, I have observed that the impact of such actions by Metlife has resulted in exacerbation of Mr. Schmititou’s psychological symptoms and periods of significant destabilization."
"While being diagnosed with cancer was itself traumatizing, the subsequent nine-year struggle with Metlife has proved even more devastating to Mr. Schmittou. His COBRA insurance expired. He had no money for food, housing, insurance, medical treatment, or medication for four years until he received Social Security Disability benefits.
His credit has been ruined. He has had to move in with his parents. He has developed desperate fears about homelessness. Understandably, his mental health deteriorated, traumatized by this threat to his life, his well-being, his sense of wholeness.
Now, in addition to his impaired vision, he has intense psychological distress, impaired concentration, impaired frustration tolerance, fitful sleep, irritability, and hypervigilance, all hallmarks of Post-traumatic Stress Disorder (PTSD). As a result, he is at greater risk for impulsive acts against himself or others."
"At various times, Mr. Schmittou has informed Metlife how desperate he has become. He has begged Metlife to stop the delays and obfuscations, because they added to his stress and depression, even to the point he often wished he were dead. Currently, he is so demoralized he is not seeking treatment for suspicious skin lesions or disturbing GI symptoms."
"In light of the violations Metlife has committed against Mr. Schmittou and Metlife's awareness of the additional harm caused him, Metlife's actions seem irresponsible, inhumane, dangerous, and reckless."
(end of quotes)
This is just an introduction to the Judges' quotes seen below.
There is so much overwhelming evidence of organized crime !!
The following quote indicates there are multiple insurance companies that are systematically violating the laws.
John Marshall Law School Adjunct Professor Mark Debofsky wrote the following about the insurance companies who sell these policies :
“empirical evidence is now available that shows insurers operating under ERISA have systematically engaged in the wrongful denial of claims.”
(ERISA is the U.S. Title 29 Employee Retirement Income Security Act)
If you are one of the 150 million Americans who have health insurance benefits through your job with a privately owned businesses or corporation your policy is governed by the ERISA laws.
The insurance companies are very aware they can violate the laws and endanger lives with little or no consequences!!
Please remember the only reason Metlife and the other insurance companies are even allowed to sell these insurance policies is because they have agreed to be fiduciaries who are regulated by U.S. Title 29 section 1104 which mandates :
“ a fiduciary shall discharge his duties with respect to a plan solely in the interest of the participants and beneficiaries”,
“with the care, skill, prudence, and diligence under the circumstances then prevailing that a prudent man acting in a like capacity and familiar with such matters would use in the conduct of an enterprise of a like character and with like aims”
(7) In the case of Solomon v. Metlife, Judge Robert Sweet wrote that Metlife trained appeals specialists to ignore evidence from the Social Security Administration (SSA). Here’s one quote from Judge Sweet :
"In addition, as in Glenn, MetLife urged plaintiff to apply for government benefits, but then disregarded the SSA’s grant of benefits. Indeed the appeals specialist assigned to decide Solomon’s appeal stated that she had been trained by MetLife to disregard SSA decisions and that the decision was only relevant if MetLife was paying benefits and could use it for an offset.”
(Full Judges quotes are seen 15 paragraphs below)
(Full Judges quotes are seen 15 paragraphs below)
Metlife Admitted To Multiple Frauds In The Sales of These Policies, But Nothing Is Being Done To Stop Their Doctor’s From Ignoring Symptoms When A Claim Is Filed !!
According to the Non-Prosecution Agreement (Agreement) entered into by the company, MetLife knowingly implemented a program of undisclosed and unreported payments designed to induce the San Diego-based insurance brokerage firm and its CEO to recommend MetLife to the brokerage firm’s clients. MetLife’s sales force was also instructed to leverage the improper payments to promote MetLife products.”
(end of quote)
(end of quote)
In 2006 Metlife was investigated by the New York Attorney General and paid fines and payments to a restitution fund regarding the sale of group life and disability, group long-term carelong-term care (LTC) policies that are regulated under ERISA ! They did not admit guilt but cooperated and agreed to business reforms. No one was arrested.
On April 15, 2010 Metlife entered into a non prosecution agreement in California and admitted to concealing millions of dollars of payments to an insurance brokerage firm for promotion of the sales of the exact same type of policies just mentioned !!
Here is a quote from the Department of Justice Press Release :
SAN DIEGO—U.S. Attorney for the Southern District of California Karen P. Hewitt announced today that the Metropolitan Life Insurance Company (MetLife) would pay $13,500,000 to the federal government based upon its role in making improper payments to a San Diego-based insurance broker. Those payments were not disclosed to MetLife’s customers or reported by MetLife as required by the Employee Retirement Income Security Act of 1974, commonly known as “ERISA.”
According to the Non-Prosecution Agreement (Agreement) entered into by the company, MetLife knowingly implemented a program of undisclosed and unreported payments designed to induce the San Diego-based insurance brokerage firm and its CEO to recommend MetLife to the brokerage firm’s clients. MetLife’s sales force was also instructed to leverage the improper payments to promote MetLife products. The Agreement also calls for MetLife’s continuing cooperation on any investigations arising out of the conduct described in the Agreement.
(end of quotes)
The quotes from numerous U.S. Judges seen below prove that Metlife and doctor's paid by Metlife are still committing frauds and ignoring life threatening medical conditions. This is occurring when sick patients file a claim on the policies that Metlife committed multiple felonies to sell !!
The quotes from numerous U.S. Judges seen below prove that Metlife and doctor's paid by Metlife are still committing frauds and ignoring life threatening medical conditions. This is occurring when sick patients file a claim on the policies that Metlife committed multiple felonies to sell !!
Here’s another company doing the same crimes at the same time :
On November 18th 2004 Unum Provident Insurance Company was involved in a highly publicized settlement with 48 states regarding their inappropriate claims handling practices.
Here are excerpts from the website of the Attorney General of New York :
“The investigations focused on assertions that UnumProvident had inappropriately denied claims for benefits under individual and group long-term disability insurance policies.”
“The settlement announced today requires UnumProvident and its subsidiaries: (1) to reassess approximately 200,000 claims that previously had been denied; (2) to completely restructure their claim handling procedures to ensure objectivity and fairness; and (3) to pay a $15 million fine.”
“The investigations focused on assertions that UnumProvident had inappropriately denied claims for benefits under individual and group long-term disability insurance policies.”
“The settlement announced today requires UnumProvident and its subsidiaries: (1) to reassess approximately 200,000 claims that previously had been denied; (2) to completely restructure their claim handling procedures to ensure objectivity and fairness; and (3) to pay a $15 million fine.”
(end of quotes)
Just like Metlife, Unum is still violating the law even after receiving a non prosecution agreement. Here are quotes from U.S. District Judge Barbara Crabb who wrote the following in August 2009 about the defendant Unum Insurance :
“Defendant conducted an extensive review of plaintiff's claim and retained a functional capacity evaluator to undertake an evaluation of plaintiff, but it did not explain why it chose to give greater weight to the opinions of four of its consulting physicians over the results of the evaluation.
What is much less clear is why the reviewer chose to believe four doctors who had never seen plaintiff and disbelieve the independent functional capacity evaluator it had retained and who had observed plaintiff closely as she tested him. It is no more clear why Dr. Sternbergh would ask for a functional capacity evaluation and then conclude from it that plaintiff could tolerate standing all day, when the evaluator had reached a different opinion."
U.S. Magistrate Judge Bryant wrote the following in my case about the Defendant Metlife :
“In particular, plaintiff has already more than sufficiently alleged defendants’ “fraudulent” abuse of prescribed claims procedures, and his citation to criminal provisions of Title 29, United States Code are futile inasmuch as the enforcement of such provisions “is the exclusive prerogative of the Attorney General.” West v. Butler 621 F.2d, 244 ( 6th Cir. 1980)
After Judge Bryant wrote this I went to the F.B.I's office twice and contacted the Attorney General numerous times and they would not investigate.
I continued painfully researching and saw where the Department of Labor's website writes the Secretary "is responsible" for investigating these exact violations !
Here is a quote from the DOL website :
“the Secretary of Labor is responsible for protecting the rights and financial security of more that 150 million employee benefit plan participants and beneficiaries and for assuring the integrity and effective management of the private pension and welfare benefit system.
I began calling the Department of Labor (DOL) in 2007.
During the first call I told Ms. Gloria Polk about some of the specific Judges quotes mentioned on this website and she said they would have to learn about the evidence before they could take action.
I said I had just told her and Ms. Polk said that did not count !!
I said I had just told her and Ms. Polk said that did not count !!
During the next four years I had more surgeries and continued contacting the DOL and Department of Justice.
The DOL finally acknowledged my evidence on October 29th, 2010 after I posted a video on YouTube and sent the link to Asst. Secretary of Labor Ms. Borzi and called her office and told her assistant about the link.
On December 27th, DOL Director of Participant Assistance Sharon Watson in Washington wrote a letter to me saying :
"We take the allegations you have made that Metlife has engaged in a pattern of fraudulent activities in your claim and other participants' claims very seriously and have taken the information under advisement"
I am very concerned that after four years of ignoring the evidence the DOL is now placing the evidence "under advisement".
I am very concerned that after four years of ignoring the evidence the DOL is now placing the evidence "under advisement".
(end of quote)
I am sure that every day that nothing is done about doctor’s intentionally ignoring medical conditions can cause the deaths or destruction of many claimants. There are many who will have no money for medical treatment while fighting the insurance company through years of complex violations and delays !!
President Obama, I have heard you make many profound statements about your faith and what it takes to be a Christian.
I am a struggling Christian and I’m not comfortable making profound statements like you do but I am certain that your allowing numerous medical doctors to ignore life threatening medical conditions works against the love that God has for all living beings.
I respectfully request that you stop delaying or ignoring the overwhelming evidence that proves numerous medical doctors are ignoring life threatening medical conditions.
I respectfully request that you stop delaying or ignoring the overwhelming evidence that proves numerous medical doctors are ignoring life threatening medical conditions.
Please read the following quotes from numerous Federal Court Judges, review the other evidence that has been submitted, and take immediate action to stop these crimes that are some of the most obvious and dangerous that have ever been committed in the history of the United States !!
Please also be very aware that multiple insurance companies are engaged in the exact same type of crimes that are destroying the lives of injured workers in America and war zone contractors who provide urgently needed support for our troops !!
Please also be very aware that multiple insurance companies are engaged in the exact same type of crimes that are destroying the lives of injured workers in America and war zone contractors who provide urgently needed support for our troops !!
Here is a small portion of the U.S. Judges quotes that prove Metlife endangers many lives :
The following quotes are from the Opinion written by Honorable U.S. District Judge Richard Alan Enslen in ZANNY v. KELLOGG COMPANY and METROPOLITAN LIFE INSURANCE CO.)
“Metropolitan Life Insurance Company has arrived at a formula for operating a profitable insurance business. It simply does not allow piddling things like facts to intrude upon its employee benefit claims decisions. Witness Zanny v. Kellogg Company and Metropolitan Life Insurance Co.”
“What is most shocking about the Report is the underlying context. In this instance, Mr. Kooi made the object of videotaped surveillance and spying at her home, on the road, and at her therapist’s offices a woman suffering extreme depression, paranoid symptoms, anxiety toward strangers and a history of repeated suicide attempts.”
“MetLife and its henchmen should appreciate that such conduct may itself precipitate the suicide death of a person who has placed implicit trust in their organization to foster mental health. MetLife should investigate the conduct of Mr. Kooi to insure that its agents are not either wittingly or unwittingly subjecting mentally-ill claimants to untoward risks of suicide death or other preventible injury.”
“This record is an open indictment of MetLife’s practices and treatment of the mentally-ill and long-term disability benefits. In this case, MetLife regularly reviewed the client’s file with an open intention to deny benefits despite the profound and compelling evidence of serious and prolonged mental illness.”
“On May1, 2002, MetLife requested Ann Tacl (a rehabilitation counselor) to provide a written report concerning Plaintiff’s employability. The Tacl report, for the most part, completely ignored medical information supporting disability, psychiatric hospitalization records, or the reports of examining psychologists and previous rehabilitation counselors who concluded that Plaintiff was not employable at any occupation nor able to operate a for-profit business. (Id.)”
“Tacl’s report is dated May 14, 2002. In it, she concludes that there is “no objective evidence that she [Plaintiff] has cognitive deficits . . . .” This conclusion is wildly inaccurate and wholly ignored the opinions of every psychiatrist or psychologist who has physically examined Plaintiff, including the most recent such examinations.”
“And What About those “Independent” Medical Exams and Reviews? Overall, the Tacl report is explainable only as the product of a professional who has been directed to reach a conclusion, has focused on data only in support of such conclusion, and who has scrupulously ignored all contrary data.”
(Quotes from Case 4:05-cv-00074-RAE Document 55 Filed 06/30/2006
UNITED STATES DISTRICT COURT WESTERN DISTRICT OF MICHIGAN SOUTHERN DIVISION, Case No. 4:05-CV-74 BRENDA ZANNY v. KELLOGG COMPANY and METROPOLITAN LIFE INSURANCE CO.)
The following quotes were written by Honorable U.S. District Judge Honorable Timothy J. Savage in the case of JACQUELINE ADDIS v. THE LIMITED LONG-TERM DISABILITY PROGRAM :
“MetLife relied almost exclusively upon the report of Dr. Gary Greenhood, an internist specializing in infectious diseases hired by MetLife, who did not examine Addis and did only a records review. Dr. Greenhood selectively viewed Addis’s medical records, and MetLife then selectively adopted parts of Dr. Greenhood’s report to support denial of the claim.”
“Although the denial letter listed reports of several physicians, it relied exclusively on Dr. Greenhood, the internist it had retained, and gave little consideration to Addis’s treating neurologist, Dr. Tatarian. There is no discussion of the reports or findings of any of the other physicians who are listed.”
“Dr. Greenhood selectively extracted portions of Dr. Tatarian’s treatment notes to support his conclusions, which are contrary to those of Dr. Tatarian. At the same time, he ignores parts that bolster Addis’s complaints and support her doctor’s diagnosis and prognosis.”
“In his report, Dr. Greenhood states that Addis’s physical examinations were “either unremarkable or demonstrated increased tone in the lower extremities.” Implying that these were normal findings, he ignored Dr. Tatarian’s observation that the increased tone in the lower extremities was a spinal cord abnormality.”
“Dr. Greenhood states that there were no objectively abnormal findings in the materials he reviewed, creating the impression that the absence of such findings rules out a disabling condition. He also ignores the MRI reports evidencing MS, November 2, 2000, and December 9, 2003. To the contrary, Dr. Tatarian documents a variety of spinal problems; and, MRIs consistently showed the presence of lesions and plaque on the brain. Dr. Greenhood ignores Dr. Tatarian’s report of a positive Babinski sign, which is indicative of nerve damage consistent with Addis’s complaints of stumbling and falling.”
“Both MetLife and Dr. Greenhood ignored the Multiple Sclerosis Medical Source Statement of Functional Abilities and Limitations completed by Dr. Ana Lavdas, one of Addis’s treating doctors. Dr. Lavdas reported that her patient’s prognosis was poor and she had significant functional limitations. Among the symptoms were pain in the lower extremities, fatigue, weakness and shaking in lower and upper extremities, poor coordination, bladder and bowel problems, blurred vision, and other physical problems. She noted that Addis had “significant and persistent disorganization of motor function in two extremities resulting in sustained disturbance of gross and dexterous movement or gait and station.” Dr. Lavdas concluded that her patient was “unable to work,” and could not sustain a job.”
“Significantly, there is no discussion of the records of Doctors Lavdas, McDonald, Gray, Files and McCarel, which he lists as having been submitted to him. Dr. Greenhood simply ignores them.”
“MetLife assigned reconsideration of Addis’s claim to Tammi Phillips, who was not a physician and whose qualifications are unknown.” “Her assessment ignores Dr. Tatarian’s unequivocal diagnosis that Addis was suffering from “relapsing, remitting MS with possible repeat exacerbation.”
“Disturbing, in light of the clear evidence to the contrary, is Phillips’s conclusion that Dr. Tatarian did not provide “any specific restrictions and limitations” that would prevent Addis from performing her own job. On the contrary, Dr. Tatarian specifically recommended that due to her unpredictable weakness, fatigue, sphincter incontinence, visual difficulties, and cognitive problems, Addis could no longer work.”
Civil Action No. 05-357 in The United States District Court For The Eastern District Of Pennsylvania on March 30, 2006
Here’s Dr. Greenhood again. In the case of Joanne Vick verses MetLife, Honorable U.S. District Judge Robert Cleland wrote that Ms. Vick developed diabetic kytoacedosis following childbirth.
Ms. Vick’s treating physician noted that she fell and broke her foot in 5 places. Metlife’s Dr. Greenhood never saw Ms. Vick, and he reviewed the medical evidence and wrote, "there is no indication of seizures or falls."
Here are two quotes Judge Cleland wrote in this case :
“Noticeably missing from Dr. Greenhood's report is any mention of Dr. Al-Kassab's November, 2001 office notes, Dr. Churchill's November 13, 2001 office notes, and Dr. Churchill's March 14, 2002 office notes. This is particularly significant in that Dr. Greenhood's August 2, 2004 report specifically noted that "[t]here is no indication of seizures or falls." Dr. Churchill's March 14, 2002 report, however, indicates that as a result of her right sided weakness, Plaintiff broke her left foot in January 2002--in five places, no less.”
“Moreover, both Dr. Greenhood’s and Dr. Gosline's reports contained numerous errors and inherent inconsistencies, which should have been noted by the plan administrator and resulted in less weight being given to them. (E.D. Michigan, Southern Division. No. 03-CV-73124-DT)
The next quotes concern Dr. Tracey Schmidt who is paid by Metlife. Dr. Schmidt is certified by the American Board of Internal Medicine that certified Dr. Greenhood who is mentioned in multiple cases in this Brief.
Here are quotes written by the Honorable Judges in the UNITED STATES COURT OF APPEALS FOR THE FIFTH CIRCUIT :
“Dr. Schmidt's analysis was unsatisfactory in other aspects as well. Contrary to her assertion that the file lacked mention of "any restricted ROM of joints other than the right foot abnormality," a February 2002 exam revealed that Audino's "wrists [were] swollen bilaterally with pain on range of motion of the left wrist" and her "left ankle was swollen with pain [on] range of motion." Although she noted in summarizing the evidence that Audino's physician had observed severe arthritis around the trapezius in August 2002, Dr. Schmidt failed to evaluate that finding in her analysis of whether Audino's impairments constituted disability under the plan.”
“Regarding Audino's rheumatoid arthritis and optic neuritis, Schmidt concluded that Audino's file lacked "objective evidence of a physical functional capacity impairment to a full time sedentary job."
GLORIA AUDINO versus RAYTHEON COMPANY SHORT TERM AND LONG TERM DISABILITY PLAN; METROPOLITAN LIFE INSURANCE COMPANY; No. 04-10729
You’re about to see quotes written by Honorable Judge Malachy Mannion in the case of JAMES KNOBLAUCH v. METROPOLITAN LIFE.
Judge Mannion wrote the first quotes regarding the questionable relationship Metlife has with the company Metlife pays to perform FCE’s that evaluate the claimant’s ability to work. Judge Mannion also details how there are far more limitations on the patients than Metlife is reporting :
“The court has noted, however, that there are several documents in the file which appear to contradict the defendants’ assertion that there was no questionable relationship between Isernhagen and Metlife or Synchrony. For example, there is a document titled “Isernhagen Work Systems Functional Capacity Report” which is on Metlife letterhead.”
“There is another document titled “Isernhagen Quality Providers/
MetDisAbility (sic) Referral Form” which gives specific directions to the FCE provider as to how Metlife FCEs are to be handled procedurally. This form requires the reviewer to“[C]ontact MetDisability with a verbal report 1 day after the FCE is completed.”
“There is a Metlife/Synchrony log entry dated April 5, 2002, which states:
...telephone call on voice mail from Cindy from Isernhagen
at 2:52 pm. FCE done 4/3 and 4/4...ee (sic) did pretty well. He
was compliant, cooperative, no self limiting. Unstable BP first
day, said she had to call MD his pressure was so high. On the
second day his heart rate was unstable and he was having
abdominal pain, so limitations were more medical [than] strength
factors...” (Doc. No. 20, p. 42)(emphasis added).”
“This more contemporaneous statement of the FCE results is telling in that it suggests far more limitations on the part of the plaintiff than later statements made by Metlife/Syncrony to the plaintiff in support of its decision to terminate benefits.”
“Also disturbing is the fact that Ms. Oxendine testified that she had not been provided with a copy of the plaintiff’s job description prior to performing the FCE. Ms. Oxendine stated, “...I did not have available to me at the time of his FCE a job description...[It] was not available at the time I performed the FCE.”
“Ms. Oxendine’s testimony also undermines the post-termination, post- appeal records review performed on July 9, 2002, by Joseph M. Nesta, M.D. For example, Dr. Nesta assumed that the plaintiff’s job description was before Ms. Oxendine at the time the FCE was performed.”
“After the plaintiff appealed the determination, the
defendants had a physician consultant, Joseph M. Nesta, M.D., review the
record. No independent medical examination was performed.”
“When Dr. Nesta did his records review, he stated, “...[B]y July 20, 2001
this individual was cleared by his surgeon to return to work.” He either did not know, or failed to include, the fact that the plaintiff’s surgeon, Dr. Scagliotti, released the patient “to return to light physical activity...as tolerated,” and that the plaintiff was “instructed to progress as tolerated.”. No interpretation of Dr. Scagliotti’s records could suggest that he was released to return to unrestricted full time work.”
“Dr. Nesta further stated in his report, “This individual also has had a
chronic pancreatic insufficiency. This is treated with pancreatic replacement
therapy.” As can be seen from Dr. Brislin’s above referenced report, the plaintiff’s ongoing pancreatic insufficiency was stated to be very difficult to control despite high doses of pancreatic supplements, and enzyme supplements.”
“There was never any discussion concerning the plaintiff’s other medical
complications including the inability to control the pancreatic insufficiency with medications, or fatigue. Fatigue is documented profusely in the FCE, but never mentioned by the defendants. There is no acknowledgment that
neither of the plaintiff’s treating physicians ever released him to full time work. In fact, the only treating, or examining physician who released him without restrictions was the orthopedic physician, whose actual name was never mentioned, and who clearly was referring only to the plaintiff’s shoulder capsulitis problem.”
MIDDLE DISTRICT OF PENNSYLVANIA CIVIL ACTION NO. 3:02-1801
The following quotes were written by the Honorable Judges from the 6th Circuit in the case of Wanda Glenn verses Metlife, (Case Number 05-3918)
“This inappropriately selective consideration of Glenn’s medical record was compounded by the fact that the occupational skills analyst and the independent medical consultant were apparently not provided with full information from Dr. Patel on which to base their conclusions.”
Here are quotes written by the Honorable Judges in the 6th Circuit in the case of Janice Spangler, v. Lockheed Martin Energy Systems, Inc.; Metropolitan Life Insurance Co., No. 01-5770, File Name: 02a0424p.06.
“Why Met Life did not also send Dr. Rice's report or the rest of Spangler's file to Crawford for review by the vocational consultant is inexplicable. Indeed, we can only conclude that Met Life, as Spangler contends, "cherry-picked" her file in hopes of obtaining a favorable report from the vocational consultant as to Spangler's ability to work.”
“Met Life's action in sending only Dr. MacKay's September 14, 1999, report to Crawford was arbitrary and capricious. Met Life should have provided Crawford with all of the medical records relevant to Spangler's capacity to work. As a result, the report by Crawford's vocational consultant was an incomplete and inaccurate representation of Spangler's ability to work.”
Reimer and Associates website shows the court wrote this quote in the case of Winkler v. MetLife, 2006 U.S. App. LEXIS 5447 (2d Cir. 2006).
“An administrator may, in exercising its discretion, weigh competing evidence, but it may not, as MetLife did here, cherry-pick the evidence it prefers while ignoring significant evidence to the contrary.”
In the separate case of Palmiotti V. Metlife, 2006 U.S. Dist. Lexis 13598 (S.D.N.Y. 2006) Reimer and Associates quoted the court as writing the following :
“MetLife's decision on Palmiotti's appeal was unsupported by substantial evidence because it was not based on a full and fair review of the initial decision and because material information was either ignored or was not solicited, and the information upon which MetLife did rely was fraught with errors.”
You are about to see quotes from my personal case, Barry Schmittou v. Metlife.
Even though I have had cancer removed from one eye and orbital surgery on the other eye I had to learn how to file a federal lawsuit for myself because of the following :
* * Metlife delayed the claim until the statute of limitations to file a lawsuit was within two months
* * They did not send a denial letter to my correct address
* * When I learned the claim had been denied all the attorney's I contacted said there was not enough time.
Filing the lawsuit was so difficult there were times I thought I might go completely blind and I had a return of the sharp pains in both eyes that felt like being jabbed in the eye with a needle.
As you will see I actually won the federal lawsuit, but I assert under oath with penalty of perjury my life has been destroyed in this process.
One of my biggest problems and concerns is seeing Metlife endanger so many very sick people, and the fact they are doing this to women including a woman who recently had a baby, one who has severe mental problems, one who has MS, and one who has actually died and been brought back to life, makes me so upset I am so obsessed in stopping them I am delaying treatment for what is probably a skin cancer that hurts and appears to be growing.
On January 25th 2007 U.S. Magistrate Judge Bryant wrote the following about fraud committed against me by the Defendant’s at Metlife disability :
“In particular, plaintiff has already more than sufficiently alleged defendants’ “fraudulent” abuse of prescribed claims procedures”
In 2008 U.S. Magistrate Judge Bryant wrote the following,
“Metlife’s administration of plaintiff’s claim and appeal is troubling, particularly when compared to the regulations which govern such administration.”
“the record is utterly devoid of any glimmer of recognition by Metlife of plaintiff’s attempt to assert an LTD claim, despite plaintiff’s repeated attempts to ascertain the status of the claim(e.g. AR 10, 11 ,25, 28, 33, 81 )”
“the record reflects that Plaintiff did not receive timely notice of the initial denial of his STD claim ( AR 8-10); nor of the denial of his administrative appeal, nor of certain documentation upon which the denial was based, in particular the report of independent physician consultant Dr. Greenhood. In addition Metlife failed to make a timely response to several attempts by plaintiff to ascertain the status of his claims.”
“The record does not reflect that Metlife, at any point, during the Administrative process, disclosed to plaintiff Dr. Greenhood’s identity as a consulting medical expert or the content of his narrative report, despite Metlife’s apparent reliance on that report (AR 15), verses the restrictions imposed by plaintiff’s treating sources, and despite plaintiff’s repeated requests for same. Metlife apparently even failed to produce this information after issuing its decision on his appeal, when it purported to mail plaintiff “copies of the information which was used to make a decision on your claim.”
“In addition, the “Diary Review – Report” contained in the record reveals that Dr. Greenhood was consulted in connection with the initial determination of plaintiff’s disability claim ( AR 6) as well as the determination on appeal. Contrary to defendant’s argument, the undersigned finds that these violations by Metlife of the claims procedures prescribed by ERISA and its interpretive regulations must in fact be corrected in further administrative proceedings, as further justified below.”
“Moreover Defendants’ claim that “both the short-term and long-term disability Plans require that a claimant be unable to work” is patently erroneous.”
“However, but for the application of the “Actively at Work” provision, the undersigned would recommend finding the two-page denial decision arbitrary and capricious, inasmuch as it is nearly devoid of any meaningful analysis of the medical evidence and thus fails to reflect any “deliberate, principled reasoning process . . . Glenn, 461 F.3d at 666.”
“In sum, the undersigned finds that Metlife’s total disregard for Plaintiff’s LTD claim, despite his repeated efforts to call their attention to said claim, was arbitrary and capricious.”
(end of case quotes)
Unum Provident
Here is more information I wrote and/or compiled that is included in my motion that was read by the U.S. Supreme Court Justices :
Multiplying the damage to ERISA participants is the fact that Metlife is engaged in these conflicts not long after Unum Provident was involved in a highly publicized settlement with 48 states regarding their inappropriate claims handling practices. Here are excerpts from the website of the Attorney General of New York :
The investigations focused on assertions that UnumProvident had inappropriately denied claims for benefits under individual and group long-term disability insurance policies.”
“The settlement announced today requires UnumProvident and its subsidiaries: (1) to reassess approximately 200,000 claims that previously had been denied; (2) to completely restructure their claim handling procedures to ensure objectivity and fairness; and (3) to pay a $15 million fine.”
The quotes written by the U.S. Judges, and the settlement with Unum Provident prove that two separate multibillion dollar insurance companies are involved in similar violations. Unum had numerous affiliates that were also charged with the same violations.
In their Brief supporting Metlife, Blue Cross Blue Shield wrote the following on Page 25 :
“ERISA already includes necessary safeguards to prevent an administrator from acting on a conflict of interest. There is no need separately to address the purported conflict of interest on judicial review of discretionary benefits determinations, because ERISA includes multiple safeguards to ensure that plan administrators will not act upon any potential conflict.”
The American Council Of Life Insurer’s Brief In Support Of The Petitioner Metlife wrote the following :
“The functional organization and regulation of insurers preclude employees who determine claims from wearing two hats. In rendering benefit determinations claims personnel must comply with regulatory requirements under both ERISA and state insurance law”
In their Brief Supporting Metlife, AMERICA’S HEALTH INSURANCE PLANS, THE AMERICAN BENEFITS COUNCIL, AND THE CHAMBER OF COMMERCE OF THE UNITED STATES wrote the following :
“ERISA’S FRAMEWORK PERMITTING A SINGLE ENTITY TO PERFORM FIDUCIARY AND NON-FIDUCIARY FUNCTIONS HAS OPERATED EFFECTIVELY AND FAIRLY”
“Market Incentives And ERISA Regulations Ensure That Funding Entities Provide Proper Fiduciary Service”
I believe all these statements are very incongruous with what is occurring in numerous claims as evidenced in the quotes from the Honorable U.S. Judges.
The Judges quotes in this Brief were found with a search of the internet after having cancer removed from my eye; think what else may be found if skilled persons with normal vision had access to the Court records of all the cases where Metlife and other insurance companies were found to be arbitrary and capricious.
The fact Metlife’s Dr. Greenhood is involved in multiple cases of ignoring symptoms makes his reports very suspect in cases where the Court’s have not determined that he ignored symptoms, because the Court’s may allow his opinions to have standing and overrule the recommendations of the treating physicians.
When I learned that Metlife had a case before the U.S. Supreme Court where they were claiming they have no profit motivated conflict in their actions, I successfully learned the rules of the U.S. Supreme Court and filed a motion to intervene and had the evidence of Judges quotes placed on the docket of the U.S. Supreme Court in the case of Glenn v. Metlife.
It was very difficult and painful to successfully learn the strict rules for docketing and then file the motion. I have no legal training, and I have had cancer removed from one eye and orbital surgery on the other eye and this kind of work can greatly exacerbate my existing problems including a tendency to fall and almost fall. Since filing the motion my vision has worsened and not recovered. It has taken me years to compile the evidence in these webpages. These are very desperate times for millions of Americans seeking health care and treatment for work injuries so did what I believed I had to do. Before my eyes give up completely I pray someone in government will perform their duty and stop insurance companies from endangering so many lives.
After seeing my Supreme Court filing Metlife's most prominent attorneys did not file any denial of my allegations.
Sincerely,
Barry Schmittou
Barryschmittou@live.com
“Metropolitan Life Insurance Company has arrived at a formula for operating a profitable insurance business. It simply does not allow piddling things like facts to intrude upon its employee benefit claims decisions. Witness Zanny v. Kellogg Company and Metropolitan Life Insurance Co.”
“What is most shocking about the Report is the underlying context. In this instance, Mr. Kooi made the object of videotaped surveillance and spying at her home, on the road, and at her therapist’s offices a woman suffering extreme depression, paranoid symptoms, anxiety toward strangers and a history of repeated suicide attempts.”
“MetLife and its henchmen should appreciate that such conduct may itself precipitate the suicide death of a person who has placed implicit trust in their organization to foster mental health. MetLife should investigate the conduct of Mr. Kooi to insure that its agents are not either wittingly or unwittingly subjecting mentally-ill claimants to untoward risks of suicide death or other preventible injury.”
“This record is an open indictment of MetLife’s practices and treatment of the mentally-ill and long-term disability benefits. In this case, MetLife regularly reviewed the client’s file with an open intention to deny benefits despite the profound and compelling evidence of serious and prolonged mental illness.”
“On May1, 2002, MetLife requested Ann Tacl (a rehabilitation counselor) to provide a written report concerning Plaintiff’s employability. The Tacl report, for the most part, completely ignored medical information supporting disability, psychiatric hospitalization records, or the reports of examining psychologists and previous rehabilitation counselors who concluded that Plaintiff was not employable at any occupation nor able to operate a for-profit business. (Id.)”
“Tacl’s report is dated May 14, 2002. In it, she concludes that there is “no objective evidence that she [Plaintiff] has cognitive deficits . . . .” This conclusion is wildly inaccurate and wholly ignored the opinions of every psychiatrist or psychologist who has physically examined Plaintiff, including the most recent such examinations.”
“And What About those “Independent” Medical Exams and Reviews? Overall, the Tacl report is explainable only as the product of a professional who has been directed to reach a conclusion, has focused on data only in support of such conclusion, and who has scrupulously ignored all contrary data.”
(Quotes from Case 4:05-cv-00074-RAE Document 55 Filed 06/30/2006
UNITED STATES DISTRICT COURT WESTERN DISTRICT OF MICHIGAN SOUTHERN DIVISION, Case No. 4:05-CV-74 BRENDA ZANNY v. KELLOGG COMPANY and METROPOLITAN LIFE INSURANCE CO.)
The following quotes were written by Honorable U.S. District Judge Honorable Timothy J. Savage in the case of JACQUELINE ADDIS v. THE LIMITED LONG-TERM DISABILITY PROGRAM :
“MetLife relied almost exclusively upon the report of Dr. Gary Greenhood, an internist specializing in infectious diseases hired by MetLife, who did not examine Addis and did only a records review. Dr. Greenhood selectively viewed Addis’s medical records, and MetLife then selectively adopted parts of Dr. Greenhood’s report to support denial of the claim.”
“Although the denial letter listed reports of several physicians, it relied exclusively on Dr. Greenhood, the internist it had retained, and gave little consideration to Addis’s treating neurologist, Dr. Tatarian. There is no discussion of the reports or findings of any of the other physicians who are listed.”
“Dr. Greenhood selectively extracted portions of Dr. Tatarian’s treatment notes to support his conclusions, which are contrary to those of Dr. Tatarian. At the same time, he ignores parts that bolster Addis’s complaints and support her doctor’s diagnosis and prognosis.”
“In his report, Dr. Greenhood states that Addis’s physical examinations were “either unremarkable or demonstrated increased tone in the lower extremities.” Implying that these were normal findings, he ignored Dr. Tatarian’s observation that the increased tone in the lower extremities was a spinal cord abnormality.”
“Dr. Greenhood states that there were no objectively abnormal findings in the materials he reviewed, creating the impression that the absence of such findings rules out a disabling condition. He also ignores the MRI reports evidencing MS, November 2, 2000, and December 9, 2003. To the contrary, Dr. Tatarian documents a variety of spinal problems; and, MRIs consistently showed the presence of lesions and plaque on the brain. Dr. Greenhood ignores Dr. Tatarian’s report of a positive Babinski sign, which is indicative of nerve damage consistent with Addis’s complaints of stumbling and falling.”
“Both MetLife and Dr. Greenhood ignored the Multiple Sclerosis Medical Source Statement of Functional Abilities and Limitations completed by Dr. Ana Lavdas, one of Addis’s treating doctors. Dr. Lavdas reported that her patient’s prognosis was poor and she had significant functional limitations. Among the symptoms were pain in the lower extremities, fatigue, weakness and shaking in lower and upper extremities, poor coordination, bladder and bowel problems, blurred vision, and other physical problems. She noted that Addis had “significant and persistent disorganization of motor function in two extremities resulting in sustained disturbance of gross and dexterous movement or gait and station.” Dr. Lavdas concluded that her patient was “unable to work,” and could not sustain a job.”
“Significantly, there is no discussion of the records of Doctors Lavdas, McDonald, Gray, Files and McCarel, which he lists as having been submitted to him. Dr. Greenhood simply ignores them.”
“MetLife assigned reconsideration of Addis’s claim to Tammi Phillips, who was not a physician and whose qualifications are unknown.” “Her assessment ignores Dr. Tatarian’s unequivocal diagnosis that Addis was suffering from “relapsing, remitting MS with possible repeat exacerbation.”
“Disturbing, in light of the clear evidence to the contrary, is Phillips’s conclusion that Dr. Tatarian did not provide “any specific restrictions and limitations” that would prevent Addis from performing her own job. On the contrary, Dr. Tatarian specifically recommended that due to her unpredictable weakness, fatigue, sphincter incontinence, visual difficulties, and cognitive problems, Addis could no longer work.”
Civil Action No. 05-357 in The United States District Court For The Eastern District Of Pennsylvania on March 30, 2006
Here’s Dr. Greenhood again. In the case of Joanne Vick verses MetLife, Honorable U.S. District Judge Robert Cleland wrote that Ms. Vick developed diabetic kytoacedosis following childbirth.
Ms. Vick’s treating physician noted that she fell and broke her foot in 5 places. Metlife’s Dr. Greenhood never saw Ms. Vick, and he reviewed the medical evidence and wrote, "there is no indication of seizures or falls."
Here are two quotes Judge Cleland wrote in this case :
“Noticeably missing from Dr. Greenhood's report is any mention of Dr. Al-Kassab's November, 2001 office notes, Dr. Churchill's November 13, 2001 office notes, and Dr. Churchill's March 14, 2002 office notes. This is particularly significant in that Dr. Greenhood's August 2, 2004 report specifically noted that "[t]here is no indication of seizures or falls." Dr. Churchill's March 14, 2002 report, however, indicates that as a result of her right sided weakness, Plaintiff broke her left foot in January 2002--in five places, no less.”
“Moreover, both Dr. Greenhood’s and Dr. Gosline's reports contained numerous errors and inherent inconsistencies, which should have been noted by the plan administrator and resulted in less weight being given to them. (E.D. Michigan, Southern Division. No. 03-CV-73124-DT)
The next quotes concern Dr. Tracey Schmidt who is paid by Metlife. Dr. Schmidt is certified by the American Board of Internal Medicine that certified Dr. Greenhood who is mentioned in multiple cases in this Brief.
Here are quotes written by the Honorable Judges in the UNITED STATES COURT OF APPEALS FOR THE FIFTH CIRCUIT :
“Dr. Schmidt's analysis was unsatisfactory in other aspects as well. Contrary to her assertion that the file lacked mention of "any restricted ROM of joints other than the right foot abnormality," a February 2002 exam revealed that Audino's "wrists [were] swollen bilaterally with pain on range of motion of the left wrist" and her "left ankle was swollen with pain [on] range of motion." Although she noted in summarizing the evidence that Audino's physician had observed severe arthritis around the trapezius in August 2002, Dr. Schmidt failed to evaluate that finding in her analysis of whether Audino's impairments constituted disability under the plan.”
“Regarding Audino's rheumatoid arthritis and optic neuritis, Schmidt concluded that Audino's file lacked "objective evidence of a physical functional capacity impairment to a full time sedentary job."
GLORIA AUDINO versus RAYTHEON COMPANY SHORT TERM AND LONG TERM DISABILITY PLAN; METROPOLITAN LIFE INSURANCE COMPANY; No. 04-10729
You’re about to see quotes written by Honorable Judge Malachy Mannion in the case of JAMES KNOBLAUCH v. METROPOLITAN LIFE.
Judge Mannion wrote the first quotes regarding the questionable relationship Metlife has with the company Metlife pays to perform FCE’s that evaluate the claimant’s ability to work. Judge Mannion also details how there are far more limitations on the patients than Metlife is reporting :
“The court has noted, however, that there are several documents in the file which appear to contradict the defendants’ assertion that there was no questionable relationship between Isernhagen and Metlife or Synchrony. For example, there is a document titled “Isernhagen Work Systems Functional Capacity Report” which is on Metlife letterhead.”
“There is another document titled “Isernhagen Quality Providers/
MetDisAbility (sic) Referral Form” which gives specific directions to the FCE provider as to how Metlife FCEs are to be handled procedurally. This form requires the reviewer to“[C]ontact MetDisability with a verbal report 1 day after the FCE is completed.”
“There is a Metlife/Synchrony log entry dated April 5, 2002, which states:
...telephone call on voice mail from Cindy from Isernhagen
at 2:52 pm. FCE done 4/3 and 4/4...ee (sic) did pretty well. He
was compliant, cooperative, no self limiting. Unstable BP first
day, said she had to call MD his pressure was so high. On the
second day his heart rate was unstable and he was having
abdominal pain, so limitations were more medical [than] strength
factors...” (Doc. No. 20, p. 42)(emphasis added).”
“This more contemporaneous statement of the FCE results is telling in that it suggests far more limitations on the part of the plaintiff than later statements made by Metlife/Syncrony to the plaintiff in support of its decision to terminate benefits.”
“Also disturbing is the fact that Ms. Oxendine testified that she had not been provided with a copy of the plaintiff’s job description prior to performing the FCE. Ms. Oxendine stated, “...I did not have available to me at the time of his FCE a job description...[It] was not available at the time I performed the FCE.”
“Ms. Oxendine’s testimony also undermines the post-termination, post- appeal records review performed on July 9, 2002, by Joseph M. Nesta, M.D. For example, Dr. Nesta assumed that the plaintiff’s job description was before Ms. Oxendine at the time the FCE was performed.”
“After the plaintiff appealed the determination, the
defendants had a physician consultant, Joseph M. Nesta, M.D., review the
record. No independent medical examination was performed.”
“When Dr. Nesta did his records review, he stated, “...[B]y July 20, 2001
this individual was cleared by his surgeon to return to work.” He either did not know, or failed to include, the fact that the plaintiff’s surgeon, Dr. Scagliotti, released the patient “to return to light physical activity...as tolerated,” and that the plaintiff was “instructed to progress as tolerated.”. No interpretation of Dr. Scagliotti’s records could suggest that he was released to return to unrestricted full time work.”
“Dr. Nesta further stated in his report, “This individual also has had a
chronic pancreatic insufficiency. This is treated with pancreatic replacement
therapy.” As can be seen from Dr. Brislin’s above referenced report, the plaintiff’s ongoing pancreatic insufficiency was stated to be very difficult to control despite high doses of pancreatic supplements, and enzyme supplements.”
“There was never any discussion concerning the plaintiff’s other medical
complications including the inability to control the pancreatic insufficiency with medications, or fatigue. Fatigue is documented profusely in the FCE, but never mentioned by the defendants. There is no acknowledgment that
neither of the plaintiff’s treating physicians ever released him to full time work. In fact, the only treating, or examining physician who released him without restrictions was the orthopedic physician, whose actual name was never mentioned, and who clearly was referring only to the plaintiff’s shoulder capsulitis problem.”
MIDDLE DISTRICT OF PENNSYLVANIA CIVIL ACTION NO. 3:02-1801
The following quotes were written by the Honorable Judges from the 6th Circuit in the case of Wanda Glenn verses Metlife, (Case Number 05-3918)
“This inappropriately selective consideration of Glenn’s medical record was compounded by the fact that the occupational skills analyst and the independent medical consultant were apparently not provided with full information from Dr. Patel on which to base their conclusions.”
Here are quotes written by the Honorable Judges in the 6th Circuit in the case of Janice Spangler, v. Lockheed Martin Energy Systems, Inc.; Metropolitan Life Insurance Co., No. 01-5770, File Name: 02a0424p.06.
“Why Met Life did not also send Dr. Rice's report or the rest of Spangler's file to Crawford for review by the vocational consultant is inexplicable. Indeed, we can only conclude that Met Life, as Spangler contends, "cherry-picked" her file in hopes of obtaining a favorable report from the vocational consultant as to Spangler's ability to work.”
“Met Life's action in sending only Dr. MacKay's September 14, 1999, report to Crawford was arbitrary and capricious. Met Life should have provided Crawford with all of the medical records relevant to Spangler's capacity to work. As a result, the report by Crawford's vocational consultant was an incomplete and inaccurate representation of Spangler's ability to work.”
Reimer and Associates website shows the court wrote this quote in the case of Winkler v. MetLife, 2006 U.S. App. LEXIS 5447 (2d Cir. 2006).
“An administrator may, in exercising its discretion, weigh competing evidence, but it may not, as MetLife did here, cherry-pick the evidence it prefers while ignoring significant evidence to the contrary.”
In the separate case of Palmiotti V. Metlife, 2006 U.S. Dist. Lexis 13598 (S.D.N.Y. 2006) Reimer and Associates quoted the court as writing the following :
“MetLife's decision on Palmiotti's appeal was unsupported by substantial evidence because it was not based on a full and fair review of the initial decision and because material information was either ignored or was not solicited, and the information upon which MetLife did rely was fraught with errors.”
You are about to see quotes from my personal case, Barry Schmittou v. Metlife.
Even though I have had cancer removed from one eye and orbital surgery on the other eye I had to learn how to file a federal lawsuit for myself because of the following :
* * Metlife delayed the claim until the statute of limitations to file a lawsuit was within two months
* * They did not send a denial letter to my correct address
* * When I learned the claim had been denied all the attorney's I contacted said there was not enough time.
Filing the lawsuit was so difficult there were times I thought I might go completely blind and I had a return of the sharp pains in both eyes that felt like being jabbed in the eye with a needle.
As you will see I actually won the federal lawsuit, but I assert under oath with penalty of perjury my life has been destroyed in this process.
One of my biggest problems and concerns is seeing Metlife endanger so many very sick people, and the fact they are doing this to women including a woman who recently had a baby, one who has severe mental problems, one who has MS, and one who has actually died and been brought back to life, makes me so upset I am so obsessed in stopping them I am delaying treatment for what is probably a skin cancer that hurts and appears to be growing.
On January 25th 2007 U.S. Magistrate Judge Bryant wrote the following about fraud committed against me by the Defendant’s at Metlife disability :
“In particular, plaintiff has already more than sufficiently alleged defendants’ “fraudulent” abuse of prescribed claims procedures”
In 2008 U.S. Magistrate Judge Bryant wrote the following,
“Metlife’s administration of plaintiff’s claim and appeal is troubling, particularly when compared to the regulations which govern such administration.”
“the record is utterly devoid of any glimmer of recognition by Metlife of plaintiff’s attempt to assert an LTD claim, despite plaintiff’s repeated attempts to ascertain the status of the claim(e.g. AR 10, 11 ,25, 28, 33, 81 )”
“the record reflects that Plaintiff did not receive timely notice of the initial denial of his STD claim ( AR 8-10); nor of the denial of his administrative appeal, nor of certain documentation upon which the denial was based, in particular the report of independent physician consultant Dr. Greenhood. In addition Metlife failed to make a timely response to several attempts by plaintiff to ascertain the status of his claims.”
“The record does not reflect that Metlife, at any point, during the Administrative process, disclosed to plaintiff Dr. Greenhood’s identity as a consulting medical expert or the content of his narrative report, despite Metlife’s apparent reliance on that report (AR 15), verses the restrictions imposed by plaintiff’s treating sources, and despite plaintiff’s repeated requests for same. Metlife apparently even failed to produce this information after issuing its decision on his appeal, when it purported to mail plaintiff “copies of the information which was used to make a decision on your claim.”
“In addition, the “Diary Review – Report” contained in the record reveals that Dr. Greenhood was consulted in connection with the initial determination of plaintiff’s disability claim ( AR 6) as well as the determination on appeal. Contrary to defendant’s argument, the undersigned finds that these violations by Metlife of the claims procedures prescribed by ERISA and its interpretive regulations must in fact be corrected in further administrative proceedings, as further justified below.”
“Moreover Defendants’ claim that “both the short-term and long-term disability Plans require that a claimant be unable to work” is patently erroneous.”
“However, but for the application of the “Actively at Work” provision, the undersigned would recommend finding the two-page denial decision arbitrary and capricious, inasmuch as it is nearly devoid of any meaningful analysis of the medical evidence and thus fails to reflect any “deliberate, principled reasoning process . . . Glenn, 461 F.3d at 666.”
“In sum, the undersigned finds that Metlife’s total disregard for Plaintiff’s LTD claim, despite his repeated efforts to call their attention to said claim, was arbitrary and capricious.”
(end of case quotes)
Unum Provident
Here is more information I wrote and/or compiled that is included in my motion that was read by the U.S. Supreme Court Justices :
Multiplying the damage to ERISA participants is the fact that Metlife is engaged in these conflicts not long after Unum Provident was involved in a highly publicized settlement with 48 states regarding their inappropriate claims handling practices. Here are excerpts from the website of the Attorney General of New York :
The investigations focused on assertions that UnumProvident had inappropriately denied claims for benefits under individual and group long-term disability insurance policies.”
“The settlement announced today requires UnumProvident and its subsidiaries: (1) to reassess approximately 200,000 claims that previously had been denied; (2) to completely restructure their claim handling procedures to ensure objectivity and fairness; and (3) to pay a $15 million fine.”
The quotes written by the U.S. Judges, and the settlement with Unum Provident prove that two separate multibillion dollar insurance companies are involved in similar violations. Unum had numerous affiliates that were also charged with the same violations.
In their Brief supporting Metlife, Blue Cross Blue Shield wrote the following on Page 25 :
“ERISA already includes necessary safeguards to prevent an administrator from acting on a conflict of interest. There is no need separately to address the purported conflict of interest on judicial review of discretionary benefits determinations, because ERISA includes multiple safeguards to ensure that plan administrators will not act upon any potential conflict.”
The American Council Of Life Insurer’s Brief In Support Of The Petitioner Metlife wrote the following :
“The functional organization and regulation of insurers preclude employees who determine claims from wearing two hats. In rendering benefit determinations claims personnel must comply with regulatory requirements under both ERISA and state insurance law”
In their Brief Supporting Metlife, AMERICA’S HEALTH INSURANCE PLANS, THE AMERICAN BENEFITS COUNCIL, AND THE CHAMBER OF COMMERCE OF THE UNITED STATES wrote the following :
“ERISA’S FRAMEWORK PERMITTING A SINGLE ENTITY TO PERFORM FIDUCIARY AND NON-FIDUCIARY FUNCTIONS HAS OPERATED EFFECTIVELY AND FAIRLY”
“Market Incentives And ERISA Regulations Ensure That Funding Entities Provide Proper Fiduciary Service”
I believe all these statements are very incongruous with what is occurring in numerous claims as evidenced in the quotes from the Honorable U.S. Judges.
The Judges quotes in this Brief were found with a search of the internet after having cancer removed from my eye; think what else may be found if skilled persons with normal vision had access to the Court records of all the cases where Metlife and other insurance companies were found to be arbitrary and capricious.
The fact Metlife’s Dr. Greenhood is involved in multiple cases of ignoring symptoms makes his reports very suspect in cases where the Court’s have not determined that he ignored symptoms, because the Court’s may allow his opinions to have standing and overrule the recommendations of the treating physicians.
When I learned that Metlife had a case before the U.S. Supreme Court where they were claiming they have no profit motivated conflict in their actions, I successfully learned the rules of the U.S. Supreme Court and filed a motion to intervene and had the evidence of Judges quotes placed on the docket of the U.S. Supreme Court in the case of Glenn v. Metlife.
It was very difficult and painful to successfully learn the strict rules for docketing and then file the motion. I have no legal training, and I have had cancer removed from one eye and orbital surgery on the other eye and this kind of work can greatly exacerbate my existing problems including a tendency to fall and almost fall. Since filing the motion my vision has worsened and not recovered. It has taken me years to compile the evidence in these webpages. These are very desperate times for millions of Americans seeking health care and treatment for work injuries so did what I believed I had to do. Before my eyes give up completely I pray someone in government will perform their duty and stop insurance companies from endangering so many lives.
After seeing my Supreme Court filing Metlife's most prominent attorneys did not file any denial of my allegations.
Sincerely,
Barry Schmittou
Barryschmittou@live.com
