Tuesday, April 5, 2011


Numerous Judges’ and Doctors’ quotes seen below prove MetLife’s doctors’ ignore Multiple Sclerosis, brain lesions, and cardiac conditions of many patients !!

One Judge wrote “Metlife and its henchmen”,

A Psychologist wrote Metlife's actions seem irresponsible, inhumane, dangerous, and reckless”

You’ll see quotes written by the Obama Administrations Directors in Washington that prove they have reviewed this evidence about MetLife and other insurance companies.

They even wrote their “top priority is to protect the benefits of participants and to make sure that providers of those benefits obey the law.”

BUT Obama's Directors have taken no action to stop this destruction of very sick patients !!

Introduction to Quotes and Evidence :


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."

“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.”

“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.”

Judge William Acker asked Metlife this question about cardiac patient Frank Blankenship :

"Can a heart patient with angina, working under severe stress, be expected to earn up to 60 percent of what he earned before his heart condition, that is, until he drops dead?"

In the case of Wright verses Metlife U.S. Magistrate Judge Jennifer Guerm wrote these quotes :

"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. 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. Indeed, Mr. Wright has ongoing cardiac disease including ischemia and loss of function due to previous myocardial infarctions."

In the case of Joanne Vick verses MetLife, Honorable U.S. District Judge Robert Cleland wrote that Metlife and their paid consultant Dr. Greenhood ignored a foot that Ms. Vick broke in 5 Places after she developed diabetic kytoacedosis following childbirth.

Here are two exact 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

Here’s Dr. Greenhood again !

In the case of Jacquelyn Addis U.S. District Judge Timothy J. Savage wrote that Metlife and their paid 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. (Judge Savage’s exact quotes are seen in Section 2 below)


As you read this please remember the quotes from the first case where Judge Enslen wrote “This record is an open indictment of MetLife’s practices and treatment of the mentally-ill and long-term disability benefits."

One of my medical doctor's requested that I see a Psychologist because of the extreme stress and depression that I experienced as Metlife, their Dr. Greenhood, and my employer ignored my eye problems and I was forced to work with pains that felt like I was being jabbed in my eyes with a needle.

My Psychologist wrote this about the violations MetLife committed while they knew I often had no money for medical treatment after having eye cancer surgery :

“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)

Here are quotes from another urgent letter that my Psychologist wrote to Assistant Secretary of Labor Ms. Borzi and Metlife Senior Management on December 2nd, 2010.

“His intense emotional misery is a daily struggle. His thoughts and emotions are so troubled he describes feeling “like my brain is on fire”. I think he struggles to express the fullness of his distress. The fact that he has not sought recommended medical treatment for a variety of physical symptoms because he “doesn’t see the use” is evidence of the severity of his depression, in my opinion.”

“He recently reported having 5 accidents (e.g. bumping and bloodying his head on a table, walking into a door frame) in the last month. He says falls or near falls are not uncommon experiences. These incidents are consistent with recommendations of his own doctor and the Social Security Judge who concluded Mr. Schmittou is unable to balance, kneel, crouch, crawl or stoop. I myself have witnessed his unsteady gait and tendency to bump into things. Even the casual observer could quickly discern this gentleman has vision problems.”

 “I have deep concern for my patient if he has to repeat the appeals process. He needs for this claim ordeal to be over.”

(end of quotes)

As you’ll see later, Obama’s DOL Director of Participant Response Ms. Sharon Watson in Washington saw this report and all the other evidence here, and she wrote that the DOL takes my allegations of patterns of fraud in my claims and other claims very seriously.

They have done nothing to stop MetLife’s attacks on me and others, they haven’t even asked Dr. Greenhood to stop ignoring Multiple Sclerosis and broken feet, and on January 26, 2011, Director Watson wrote “At this time, there is nothing further this agency can do to assist you.”


My Psychologist also wrote this in her report :

"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."

(end of quote)

(I would like to add that Dr. Yanik did this at the exact time of my father’s four month illness and death, and they caused me nausea and tremendous sleep problems, including during the time I was at my fathers bedside as he struggled desperately for breath during his last hours)

There are many more quotes from numerous Judges, Doctors and Professors seen in black print below !! It is very important to be aware of the following laws and facts that are printed in red :


** The patients may die due to lack of money for medical treatment and other necessities while they wait years for the Judges’ rulings.

** The Judges' who write the case quotes do not have the authority to stop these crimes. Federal Court Judges’ have written :

"the enforcement of such provisions “is the exclusive prerogative of the Attorney General.” West v. Butler 621 F.2d, 244 ( 6th Cir. 1980)

Five paragraphs below you’ll see how multiple crimes are being committed simultaneously.

I have tried everything possible to get the Obama and Bush administrations to stop MetLife and numerous other insurance companies from endangering so many lives. I have done this while having numerous surgeries including melanoma cancer painfully burned out of my eye with  no anesthesia.

It took four years of visits and communications with the F.B.I., DOJ and DOL to even get my evidence acknowledged.

On 12/10/2010 the Atlanta Regional Director of the DOL EBSA wrote the following to me :

“Please be assured that EBSA’s top priority is to protect the benefits of participants and to make sure that providers of those benefits obey the law.”

On January 26, 2011 Department of Labor Director of Participant Response Ms. Sharon Watson wrote sent a letter from Washington saying :

“At this time, there is nothing further this agency can do to assist you.”

Multiple crimes being committed simultaneously and repeatedly.

** The insurance company doctors' who ignore medical conditions are violating the Hippocratic Oath they took to protect patients from harm !

In exchange for agreeing to the following five laws, the insurance companies cannot be sued for punitive damages and they get every other law in their favor!!
They make trillions of dollars selling these health policies that 150 million Americans receive as a benefit of their employment !

U.S. Title 29 1104 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”

U.S. Title 29 also mandates :

“The claims procedures contain administrative processes and safeguards designed to ensure and to verify that benefit claim determinations are made in accordance with governing plan documents and that, where appropriate, the plan provisions have been applied consistently with respect to similarly situated claimants.” (Title 29 CFR 2560.503-1 – section  (b)(5)”

“The claims procedures do not contain any provision, and are not administered in a way, that unduly inhibits or hampers the initiation or processing of claims for benefits.” (Title 29 CFR 2560.503-1 – section (b)(3)

“Provide for a review that takes into account all comments, documents, records, and other information submitted” (Title 29 CFR 2560.503-1 Section (h)(2)(iv)

Title 29 U.S.C. 1141  also mandates :

 "It shall be unlawful for any person through the use of fraud to restrain or attempt to restrain any participant or beneficiary for the purpose of interfering with or preventing the exercise of any right to which he is or may become entitled under the plan, this title. Any person who willfully violates this section shall be fined $10,000 or imprisoned for not more than one year, or both. The amount of fine is governed by 18 U.S.C. § 3571.

* Metlife has been given three non prosecution agreements regarding the sales of these policies including one crime where Metlife admitted to multiple million dollar frauds and concealment in the sales of these policies !!

No one was charged with a crime !!

While admitting to multiple frauds in the sales of the policies the Judges’ and Doctors’quotes prove Metlife is still endangering many lives by ignoring serious medical conditions in the claims determinations on the policies that Metlife committed frauds to sell !!!!!

Here are quotes from two acclaimed Professor’s followed by shocking quotes from numerous Judges’ and Doctor’s :

This quote was written by Joseph Belth, Professor Emeritus for Insurance at Indiana University :

"They've turned Erisa on its head,"  "It was supposed to protect employees, and it's being used to protect insurers."

John Marshall Law School Professor Mark Debofsky wrote :

“empirical evidence is now available that shows insurers operating under ERISA have systematically engaged in the wrongful denial of claims. Cases of abusive benefit denials involving other disability insurers abound. Unum turns out to have been a clumsy villain, but in the hands of subtler operators such misbehavior is much harder to detect.''

(ERISA is the U.S. Title 29 Employee Retirement Income Security Act that regulates health benefits for 150 million Americans who work for privately owned businesses and corporations)
Please note that Professor Debofsky wrote “insurers” in the plural.

Most of the case quotes I’ve searched for are about MetLife but I’ve seen examples that prove numerous insurance companies are engaged in the exact same crimes in five different types of insurance !!

Here’s an example of how patients may die due to lack of money for medical treatment and other necessities while they wait years for the Judges’ rulings.

In January 2007 Metlife had completely ignored my Long term disability claims for five years !! They continued to violate numerous laws repeatedly even after reading this quote I filed in a Court document :

 "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."

(More quotes seen below)

 A short time after this was filed I began having extreme pain in my stomach, leg and back but I waited to seek treatment and surgery because I had already borrowed $20,000 from my parents when my savings ran out. I told my family and close friends if they found me passed out in the floor to take me to an emergency room and tell them where my pains were. I was trying a part time job and one night my pains were so bad I was about to call an ambulance.

After reading that I had surgery and “no money for follow up treatment”, MetLife has continued to violate numerous laws including :

After the Court ordered MetLife to conduct a full and fair review in 2008 Metlife and their paid consultant Dr. Yanik (who works for Network Medical Review) ignored four years of medical records regarding my right eye cancer and left eye orbital surgery problems !!

In 2010, MetLife and their paid consultant Dr. Weber (who also works for Network Medical Review) requested information from my surgeon Dr. Wallace who is the Chief of Opthamology at Baptist Hospital.

Metlife’s Consultant Dr. Weber wrote : 

“The conversation with Dr. Wallace was very thorough and we agreed that this was a case of subjective complaints without objective findings.”

My surgeon Dr. Wallace wrote a one page letter to correct Dr. Weber, and after MetLife and Weber read the letter their reports completely removed the following statements Dr. Wallace wrote:
 
“I did notice the eye movements and Nystagmus in 2008”

 Dr. Wallace also wrote this correction of Dr. Weber’s report :

 “I hope I have not been misunderstood.  I did not mean to say that you did not have any problems with your right eye from the treatment of the tumor.  You have a large blind spot in the right eye with a large area of loss of central vision. I am sure that this loss of central vision causes a considerable loss of depth perception and difficulties in many areas of your life every day”.
Dr. Wallace also wrote this :

“loss of vision in one eye and Nystagmus in the other eye can greatly affect someone’s lifestyle and someone’s ability to work in many occupations” 

 After seeing that MetLife’s Procedure Analysts and Dr. Weber completely ignored it and in her denial of my claim MetLife’s Analyst repeated Dr. Weber’s quote that said : 

“The conversation with Dr. Wallace was very thorough and we agreed that this was a case of subjective complaints without objective findings.”

In spite of all the laws and evidence, the DOL/DOJ Directors have done nothing about Dr. Greenhood ignoring Multiple Sclerosis, brain lesions, sphincter incontinence of Jacquelyn Addis, a foot that new mother Joanne Vick broke in five places, the great majority of my eye cancer problems, and the overwhelming evidence seen in the Judges’ and Doctors’ quotes you have seen and are about to see :

More Judges’ Quotes !!


** Please remember I found all of these case quotes searching Google, and less than one percent of cases are even posted on the internet !!!!

U.S. District Judge Nancy Gertner won the Thurgood Marshall Award of the American Bar Association in 2008. 

Here’s three important quotes Judge Gertner wrote about 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.”

(The Anderson mentioned above is Mrs. Whitehouse’s psychological counselor.



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 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.”

Here are three important quotes from Judge Judge Terrence McVerry in the case of SCHWARZWAELDER verses Metlife :

 “Her treating/evaluating physicians assessed the stressful nature of that position, deemed it causal to her mental health symptoms and diagnoses, and concluded that (a) Plaintiff was unable to continue to perform under the conditions of that occupation and (b) to attempt to do so would risk serious further consequences to her health. The Administrator's failure to meaningfully address these considerations was arbitrary and capricious.”

“The Court is also highly concerned by the Administrator's rejection of evidence self reported by Plaintiff to her treating/evaluating physicians where (a) MetLife had no basis for rejecting those observing-physicians' conclusions that Plaintiff's evidence was credible”

 Judge Terrence McVerry wrote this about another psychiatric cases quotes written by Judges in another Court:

“In Sheehan, the Court concluded that where MetLife's determination of the claimant's psychiatric condition was limited to obtaining a paper-review opinion from Dr. Givens, it was procedurally flawed. 368 F.Supp.2d at 255.”

Most of my research has been focused on Metlife but here’s another company doing the same crimes at the same time, and another non prosecution agreement that the Department of Labor was involved in :

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.”
(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."
(end of quotes)

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


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.”

Here are more extensive quotes written by Honorable U.S. District Judge Richard Alan Enslen in the case of Zanny verses MetLife :

“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.”

“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.”

“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.”

“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.

“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.”


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 !! 

During the next four years I had more surgeries and continued contacting the DOL and Department of Justice and no one would take action. When I placed a video on YouTube that showed a DOL representative saying we can’t go against the insurance company, the DOL asked me to send in extensive evidence, which I did, but they are still allowing the insurance companies to destroy lives !!
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

No comments:

Post a Comment