Friday, April 27, 2012

Fraud Pattern 1 of 2

Federal Judge Writes MetLife Trained To Ignore SSA Judges Determinations -

Four More U.S. Judges Write Metlife Ignores SSA Judge's Profound Determinations‏ -

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.”

(end of quote)

In the case of RUDZINSKI v. METLIFE, U.S. Magistrate Judge Arlander Keys wrote the following quotes on Sept. 14, 2007 :

“MetLife hired Dr. Jeffrey Lieberman, a rheumatologist, to review Plaintiff's medical file.”

“Dr. Lieberman is affiliated with Network Medical Review, an organization that receives over one million dollars in business annually from MetLife.”

“In rejecting Plaintiff's claim that she was disabled, Dr. Lieberman mentioned, but did not discuss, dispute, or distinguish, the reports by the numerous physicians that supported Plaintiff's claim that, she was unable to work.”

“Like Dr. Lieberman in his review, MetLife made no attempt, to explain why it was rejecting these physicians' findings, and made no mention whatsoever of the SSA's determination, when informing Plaintiff that her final appeal was being denied.”

“Instead, it curtly informed Plaintiff that Dr. Lieberman, a physician who had never examined Plaintiff and apparently reviewed only a portion of the file, determined that she was capable of performing her former position and, therefore, her application was being denied.”

“MetLife's decision to credit Dr. Lieberman's Physician's Review, to the exclusion of all evidence supporting Plaintiff's claim, is particularly troubling, because the Court finds that Dr. Lieberman's Review was wholly unreliable.”

“Dr. Lieberman based his opinion on a selective review of the evidence, neglecting to distinguish the parade of medical opinions and test results that support Plaintiff's claim of disability.”
(End of quotes)

On August 4, 2010, U.S. Court of Appeals Judges Kanne, Wood, and Hamilton wrote the following quotes in the case of Holmstrom v. Metlife:

“Metlife’s selective consideration of the evidence not only indicates that its decision was arbitrary, but also demonstrates the effects of a conflict of interest.”

“A second indication is Metlife’s conduct regarding the Social Security award”

“A third indication of the effect of MetLife’s conflict of interest is the repeated moving of the target”

(end of quotes)

Here’s a note from Professor Mark Debofsky regarding the Courts ruling and quotes in the case of Blankenship v. Metropolitan Life Insurance Co., December 30th 2009

“In addition, the court was struck by the conflict between the reviewing doctors' findings and the findings made both by the treating doctors and by the Social Security Administration, suggesting that "MetLife's decision was the culmination of a structurally conflicted process."

(end of quotes)  

I have provided evidence to the DOL/DOJ Directors that proves MetLife completely ignored every quote that was written by the SSA Judge in my case !! They did this twenty days after they signed their third Non Prosecution agreement for rigging bids to increase sales of these exact policies !!
In the agreement the DOJ wrote they would not prosecute anyone because :
“all MetLife employees to comply with all laws rules and regulations affecting MetLife’s business and its conduct in business affairs.”

"MetLife shall (A) commit no crimes whatsoever"

Here are some of Judge Miller's quotes :

“At the hearing, the claimant testified that he wears a patch over his right eye.  He has visual problems with his good eye (his left eye).  Specifically, he has double vision, experiences “pulsing”, and his vision “jumps”.  He also sees things that are not there.”

“In June 2004, ophthalmologist Phil Gannaway M.D., evaluated the claimant due to complaints of diplopia, decreased visual acuity, and pain; Dr. Gannaway was “at a loss to explain the symptoms.”

“The claimant underwent a neuro-ophthalmology evaluation in October 2004, at which time he reported problems with balance and objects moving.  He was diagnosed with Oscillopsia and nystagmus.”

Fraud Pattern 2

Six Cases Prove MetLife’s Complex Fraud Regarding Vocational Determinations‏ and They Continue Now

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.”

(2)            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.”

(3)            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?"

(4)            Here are quotes from the Report and Recommendation written by U.S. Magistrate Judge Jennifer Guerm in the case of Wright verses Metlife :

"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."
"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)

(5)            The following quotes are from the Opinion written by Honorable U.S. District Judge Richard Alan Enslen in the case of Zanny v. MetLife :

“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.”

“This record is an open indictment of MetLife’s practices and treatment of the mentally-ill and long-term disability benefits.
(6)            Here are 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/ (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 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.”

In My Personal Case MetLife Also Continued This Second Pattern of Fraud After MetLife Signed Their Third Agreement Where No One Was Prosecuted For Rigging Bids To Increase Sales of These Policies.
In the agreement the DOJ wrote :

 "MetLife shall commit no crimes whatsoever"

MetLife has established a Code of Business conduct and Ethics that applies to all employees of MetLife and its affiliates. Among other things, the Code requires all MetLife employees to comply with all laws rules and regulations affecting MetLife’s business and its conduct in business affairs.”

MetLife signed that agreement on 4/15/10. Twenty days later, on 5/5/10 MetLife had evidence excluded from the vocational determination just like they did in the other cases you’ve just seen. They did this after reading about all the bloody falls and accidents I’ve had, but the doctors paid by MetLife and the MetLife agents and vocational consultant never mentioned them either !!

Here are excerpts from an email that I sent to Ms. Maria Rivera who is the contact person for Metlife’s CEO.

These lengthy quotes provide details of multiple frauds by omissions and fraudulent statements committed during the vocational determination :

Subject: Metlife's Instructions Caused Vocational Consultant To Ignore Judge Millers Assessment For Social Security
Date: Mon, 30 Aug 2010 09:40:30 -0500
The Employability Assessment was very prominently used as a reason to deny my claim, but since MetLife instructed the vocational consultant to base the assessment solely on the report of Metlife’s paid consultant Dr. Weber, the following quotes from Judge Ronald Miller and orders from my treating physicians were completely ignored : 

Here are some of Judge Miller's quotes :

“At the hearing, the claimant testified that he wears a patch over his right eye.  He has visual problems with his good eye (his left eye).  Specifically, he has double vision, experiences “pulsing”, and his vision “jumps”.  He also sees things that are not there.”

“In June 2004, ophthalmologist Phil Gannaway M.D., evaluated the claimant due to complaints of diplopia, decreased visual acuity, and pain; Dr. Gannaway was “at a loss to explain the symptoms.”

“The claimant underwent a neuro-ophthalmology evaluation in October 2004, at which time he reported problems with balance and objects moving.  He was diagnosed with Oscillopsia and nystagmus.”

(End of Quotes)

( I will add that my Ophthalmic Neurologist Dr. Patrick Lavin conducted the evaluation just mentioned)

Returning to Quotes from Social Security Administrative Law Judge Ronald Miller

“Dr. Ganaway completed a medical source statement in November 2006, indicating that due to his visual problems, the claimant could never climb, balance, kneel, crouch, crawl, or stoop.”

“I also conclude that the opinion of Dr. Ganaway is well supported by the record as a whole, and therefore, accord his opinion significant weight.”

(End of Quotes)

Judge Miller also evaluated my psychological records and he wrote the following conclusion :

“Accordingly, I conclude the record supports a finding that the claimant as a marked limitation in his ability to deal with stressful situations or in interpersonal relationships.  Further, due to visual problems, he can not climb, balance, kneel, crouch, crawl, or stoop.  In reaching this conclusion, I have considered the claimant’s allegations and found them generally credible in light of the objective medical records."

"The description of the symptoms and limitations which the claimant has provided throughout the record has generally been consistent and persuasive, and they are reasonably supported by the objective medical evidence and consistent with the established range of daily activities.”

(End of Quotes)

It was months after I received the denial letter when I learned that Metlife’s Employability Assessment ignored 100% of my treating Physicians records.

I only learned this after I requested and finally received a huge disorganized box of all the records MetLife said it had on the claim. It took me several hours over a few days to find the assessment that was written by Vocational Consultant Kristi Waterfield.

Many claimants might not think to look for the actual report from the vocational consultant and they might give up and possibly become homeless or lose their lives due to lack of money for medical treatment. 

This report that was buried in the disorganized box that contained numerous multiple copies from nine years. The order of the materials in the box had dates very jumbled from top to bottom.

It is important to note that MetLife has ignored so many quotes from my treating Physicians, and ignored my surgeon Dr. Wallace’s written statements about the difficulties nystagmus and my other visual problems causing me. At the same time MetLife is quoting their consultant Dr. Weber as saying that he and Dr. Wallace agreed my case is subjective.

(Because of Metlife’s misleading statements about my symptoms being subjective, I provided MetLife with a statement from my Ophthalmologist Dr. Ganaway who wrote that he has no reason to doubt me as a patient)

U.S. title 29 mandates the fiduciary must consider all information including the quotes from Judge Miller you have just seen, but here again is the evidence that proves this law was intentionally violated by yet another unit of MetLife disability :

Here are the quotes from the vocational consultant Kristi Waterfield followed by the quotes that Metlife’s Christine Dewey wrote in her denial letter :

“The Appeals Specialist has requested an Employability Assessment/Any Occupation Evaluation for the time period beyond October 5 2003, based on the physical restrictions and limitations provided by Dr. Weber only.”

Here are the quotes from Metlife’s denial letter, I have underlined some of the lines that prove fraud :

“In evaluating your ability to perform any occupation after October 4, 2003, we had an employability analysis and labor market analysis performed, which was completed on March 1, 2010.  That assessment considered your training, education and experience along with your physical restrictions.  Based upon review of their file it was determined that you have the ability to perform full time work with the restrictions and limitations listed above.  It was further found that you have the necessary training, and experience to perform the alternate occupations identified and there were an adequate number of employers who would potentially hire for these occupations in your geographical area.”

“In summary, benefits must be administered in accordance with the terms of the plan and this requires that your condition(s) is medically substantiated by the providers with comprehensive and specific information.  This is not to say to you are not experiencing difficulty.  However, with the medical records available for review, we concluded that the information in the file did not contain any severity of impairment that resulted in physical functional limitations and restrictions preventing you from performing an alternate job identified in the employability assessment, beyond October 4, 2003.”

(End of Quotes)

MetLife did not assess “your physical restrictions” as they stated, they only assessed the restrictions that their paid consultant wrote about, and there are hundreds of pages of medical records and documentation that Metlife’s consultant obviously ignored.

It is very false and fraudulent for MetLife disability to send me a denial letter that indicates the employment assessment was based on “the medical records available”, and they have done this even after they have been ordered by a Federal Court Judge to conduct a full and fair review of my claim !!

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