Monday, April 4, 2011

MetLife’s Deadline for My Doctors to Respond Expired Three Days Before MetLife Even Demanded Their Response !! This Has Occurred in Other Claims !!

Two weeks after MetLife received medical records of my severe visual problems, bloody falls and accidents and near collapses (combined with extreme stress, major depression, and PTSD that was caused by MetLife ignoring my LTD eye cancer claim for five years) MetLife  engaged in the following complex frauds : 

February 9, 2010

Metlifes Procedure Analyst Anna Monaco claims to have sent faxes to three of my doctors that I have not seen in the last eight years.

February 6th 2010

was the deadline for my doctors to respond if they did not agree with the lengthy report that was prepared by Metlife’s consultant Dr. Weber.  (Dr Weber never saw me and never spoke to me)

** Please note the deadline for my doctors to respond occurred three days before the faxes were even sent to my doctor’s.

My doctors were told “if you are not in agreement with the independent consultants opinion, please submit clinical evidence in support of your conclusions.”

Since I had not seen these doctors in the last eight years they had not seen my medical records for the last eight years.

Later I learned that only one of these doctors actually received the fax from Metlife.  

On February 9th Procedural Analyst Ms. Monaco also mailed me two letters from the West Coast that I did not receive until Saturday February 13th

One letter instructed me that a special circumstance had been declared in my claim and the decision was being delayed because MetLife wanted my treating Physicians to comment on a report written by an independent Physician consultant paid by MetLife.

The second letter I received on February 13th gave me until February 16th to contact the three doctors that I have not seen for many years. Metlife lied when they told me that they had given the doctors until February 16th to respond.

When I saw the actual faxes sent to my doctors MetLife had actually given them a deadline of the 6th to respond but as mentioned the fax was not sent to them until the 9th.

My doctors only allow me about ten minutes per visit, they had not seen me for 8 years, and there is no way they would respond to Metlife’s crazy demands.

I had big visual and mental problems before this occurred !  Here’s what caused an extreme PTSD attack 2/13/10 that destroyed my mind and still persists today.

I received the letter Saturday the 13th and Monday the 15th was Presidents Day. Ms. Monaco gave me a deadline of February 16th.

I had zero business days to find and contact doctors I had not seen in many years, and they would have zero business days to read and respond to the extensive information !!

MetLife did not send me a copy of the consultant’s report but expected me to call doctors I had not seen for years and confirm their response if they disagreed.

I requested a copy but Ms. Monaco refused to send it until she had a written request. 

I felt certain this report was fraudulent like the other ones and if my doctors did not disagree with the report MetLife would use that in court as an affirmation of their consultants report.

When I finally received the consultant’s report it showed that a large company known as Network Medical Review paid an Ophthalmologist named Dr. Alan Weber to evaluate my claim.

 I have seen court documents that prove Network Medical Review makes millions of dollars providing consultants who write reports that Metlife uses in their denial of claims

 Consultant Dr. Weber never saw me and never spoke to me. 

In his report he wrote quotes that he attributed to my right eye surgeon Dr. Wallace.

** MetLife’s Procedure Analyst omitted Dr. Wallace’s name in the letter where she told me to have three of my doctor’s respond if they disagreed with their Consultant’s report !!

Metlife’s Consultant Weber wrote : 

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

I could not believe that Dr. Wallace would say this considering the fact that I have had cancer removed from my right eye and orbital surgery removing the large mass part of the orbital bone from my left eye. 

I engaged in many very panicked communications and faxes with Dr. Wallace’s staff over the next six weeks. I told them about Weber’s quotes and I provided them with medical evidence omitted by Dr. Weber.

Dr. Wallace wrote a letter to me that has the following quote regarding my left eye :
“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”.

“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”

(end of quotes)

Dr. Wallace is Nashville Baptist Hospitals Chief of Ophthalmology !!!!

When Metlife’s Christine Dewey denied my appeal regarding visual disability in May 2010 she completely ignored every one of the quotes from Dr. Wallace that you have just seen !

Instead she wrote this in her denial :

“Dr. Wallace and Dr. Weber agreed that yours was a case of subjective complaints without objective findings.”

Ms. Dewey knows that is a lie.  Dr. Wallace and my Ophthalmic Neurologist Dr. Patrick Lavin both documented seeing left eye nystagmus.  That is very objective.

Ms. Dewey and Dr. Weber have both seen a DVD that shows my left eye pulsing.  That is very objective.  

 Dr. Wallace’s response was only one page long with three closing sentences on a second page. It is very fraudulent for Ms. Dewey to omit his important statements.

In Ms. Dewey’s denial letter she wrote a false list of respondents and non respondents even though were only four doctors involved.
Ms. Dewey completely omitted Dr. Jessup from the list.

Ms. Dewey and Metlife’s consultant Dr. Weber never mentioned that Dr. Jessup wrote :

“I do not disagree with the letter dated April 1, 2010 you recently received from Dr. Wallace.”

“I have made no changes in the recommendations given to you while you were under my care.”

 Ms. Dewey also wrote these deceptive quotes about the list :

“Dr. Arrindell provided no response.”

The truth is I sent Ms. Dewey a response from Dr. Arrindell’s office that stated he never received the consultant’s report from MetLife or any request for response.

Ms. Dewey willfully omitted that information.

Ms. Dewey also omitted the fact that Dr. Head wrote that he did not receive the report either.

She omitted that Dr. Head wrote his lack of response did not mean that he agreed with Metlife’s consultant. 

Ms. Dewey only mentioned that Dr. Head wrote that “he did not feel comfortable sharing any medical opinions, as you had not been seen in his office since June 2002.”

Dr. Head would not have known a report existed unless a handicapped patient frantically called because his life depends on fair treatment.

An addition to the fraud is the fact that the Vocational Consultant that Metlife used wrote that she was told to only consider the limitations set by Metlife consultant Dr. Weber.

That means the Vocational Consultant omitted consideration of Dr. Wallace’s comments seen above. She also omitted my Opthalmologist Dr. Ganaway’s restriction of no balancing.

The Vocational Consultant omitted consideration of my bloody falls and accidents, vertigo, near collapses, nearly falling out of chairs due to balance and vertigo problems, and she omitted so much more.

She omitted consideration of everything that the Social Security Adminsitrative law Judge wrote about my vision and the fact I was consistent and believable.

Later you’ll  see how Ms. Dewey dissected and fraudulently reconstructed Dr. Wallace’s sentences omitting the quotes above.

I think most people will need a break before reading about how I think this was an intentional attempt to cause me to commit suicide. It was certainly reckless endangerment !!

Part Two

I had an extreme panic attack that began when I received the letters from Metlife’s Procedure Analyst on February 13th. This panic attack continues today.  I have had a return of nausea and problems sleeping and have lost all hope because my life depends on fair treatment from Metlife.

Metlife inflicted this complex fraudulent scheme while knowing I’ve had cancer burned from one eye and am legally blind in that eye, and my other eye was removed from the socket during orbital surgery. I have an orbital defect that includes a hole in the bone that contains the brain. 

I also have the psychological problems mentioned above that were caused by MetLife and my employers inhumane treatment over many years since my cancer occurred.

 Metlife’s Procedure Analyst gave me zero days to respond even though she had just received a report where Metlife’s consultant psychiatrist Dr. Sugerman wrote :

“he cannot effectively communicate his opinions when stressed and may become affectively destabilized around such interactions.”

“He used to be a high functioning person”

I believe the Procedure Analyst and Metlife were trying to cause me to commit suicide by giving me zero business days to respond, because Ms. Monaco had also seen my letters where I told Metlife the following :

"Your companies intentional delays and obfuscations are adding greatly to my extreme stress and depression to the point I often wish I were dead. Your company might as well be straight out of HELL !” 

“I could not hate your company any more if you were proven to be straight out of Hell. Your intentional delays of my claim are continuing to destroy my life. The stress is beyond belief because of your inactions, lies, and intentional burial of my claims in quicksand."

U.S Magistrate Judge Bryant has many quotes (in his decision on my case) about Metlife’s numerous repeated violations, but Metlife continued these violations even though they were aware that I often had no money for medical treatment.

Metlife has a pattern of endangering mentally ill claimants, as seen in quotes from the case of Brenda Zanny where U.S. District Judge Richard Alan 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 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.

(end of quotes)

 The Procedure Analyst was also aware that Dr. Sugerman quoted my treating psychologist Dr. Carpenter as saying the following :

“His writing difficulties stem in part from his eye problems, which are severe.”

“He has suffered profoundly over the years due to having eye problems.”

“His gait is not straight.”

“He has a lot of anxiety stemming from the eye problems, but he is never been psychotic in her opinion.”

“She has found his formulation regarding the workplace to be entirely consistent over a long period of time”

“Dr. Carpenter also argues for difficulty with task completion due to difficulties with concentration.”

 The records seen by Metlife right before they gave me zero business days notice to respond include documentation of recent serious falls, accidents, near collapses, nearly falling out of a chair due to balance problems, many more visual problems, and severe psychological problems which are all dangerous conditions to inflict stress upon.  The suicide rates for PTSD and depression are much higher than the norm, and PTSD and depression patients are prone to outbursts when placed in stressful situations.

Ms. Monaco also has a DVD that shows my left eye pulsing in sync with my heart beat and she knows that I am legally blind in my right eye.

I believe in her position of Procedural Analyst she inflicted an intentional assault on my psychological conditions and visual problems.  Even if MetLife declares this was not intentional it is certainly reckless endangerment by a fiduciary that is required to operate the plan with care, skill, diligence, and prudence, solely for the participants.

I feel certain Ms. Monaco would defend herself by saying she offered me more time after I made panicked responses to Metlife, but it was too late because my panic had already been created.

Part Three

Ms. Dewey dissected and fraudulently reconstructed Dr. Wallace’s sentences

Dr. Wallace wrote :

“In the left eye, the macular region was healthy and the retina was completely attached. I did notice the eye movements and Nystagmus in 2008.”

Here is what Ms. Dewey wrote in her May 2010 denial letter :

In the left eye, the macular region was healthy and the retina was completely attached , and your vision was 20/25.

As you can see Ms. Dewey removed Dr. Wallace’s sentence “I did notice the eye movements and Nystagmus in 2008.”

She took “your vision was 20/25” from another paragraph and precisely placed it in her sentence while removing Wallace’s sentence “I did notice the eye movements and Nystagmus in 2008.”

This is very important because my right eye has no central vision due to eye cancer surgery ! Dr. Wallace is writing about the left eye movement and nystagmus in the sentences above, but Ms. Dewey has extracted that in her reconstruction of the sentence.

Adding to the fraud of omissions, in Ms. Dewey’s denial letter and Dr. Weber’s reports they briefly mention left eye problems and Dr. Lavin’s documentation of seeing Nystagmus, but in their specific analysis of disability they completely ignore any mention or consideration of the left eye problems that are very well documented throughout my medical records, observed by two of my treating Physicians, and documented in the DVD.

In her denial letter Ms. Dewey wrote that she sent Dr. Wallace’s one and ¼ page letter to Dr. Weber. In his addendum report Dr. Weber completely omitted any mention of the quotes from Dr. Wallace you have just seen.

In his two page addendum report, Dr. Weber has two paragraphs regarding office visit notes from Dr. Ganaway, and Dr. Weber writes that these two notes do not indicate any clinical or ocular pathology.

My purpose for submitting these new notes was not for occular  pathology and Ms Dewey and Dr. Weber know this.

More important is the fact that Dr. Weber completely omitted consideration of the ocular pathology that Dr. Wallace mentioned regarding my left eye when he wrote “I did notice the eye movements and Nystagmus in 2008”

In his addendum Dr. Weber also fails to mention the office visit note I found where Dr. Jessup wrote about left eye pulsing in 2002. Ms. Dewey never mentioned that either.

Dr. Weber also failed to discuss the ocular pathology that is seen in the DVD I provided that shows my left eye pulsing in sync with my heart beat.

In Weber’s addendum he wrote “the DVD was reviewed allegedly showing the right eye of Philip Schmittou, then a blink, and followed by a down gaze and this was done repeatedly”.

In her denial letter Ms. Dewey wrote in his addendum Dr. Weber indicated “it did not establish a disabling condition”

I made a written request to MetLife asking if Dr. Weber is indicating that my eye movement is voluntary, but MetLife has failed to answer as they often do.

This is not voluntary, my left eye pulses in sync with my heart beat.

My right eye had cancer removed and I’m legally blind in it and have very distorted vision that merges with my left eyes image.

MetLife and Dr. Weber should know that I have repeatedly written that it is my left eye that pulses and my medical records indicate this too. 

My left eye orbital surgeon Dr. Ralph Wesley referred me to a neuro surgeon after he saw the video.  I have delayed seeing the neurosurgeon because I do not want to allow MetLife to intentionally destroy my relationship with any more of my doctors.

In other documents I’ve sent to MetLife recently I have provided evidence that proves MetLife omitted the discussion of very important evidence including every sentence that the social security administrative law judge wrote about my vision, and my doctors in my documentation about falls and accidents I’ve had.

In my experience having the fiduciaries at MetLife disability in my life has been much more dangerous and devastating than numerous surgeries for eye cancer, skin cancer, and many more medical problems.

The record shows that MetLife has a responsibility for the causation of my psychological problems and they are their primary reason that they continued and increase.  I believe there’s a high probability that the stress and psychological problems caused by MetLife, and willfully continued by MetLife, will lead to my sudden death from increased risk of medical problems or intentionally increasing my psychological problems with Metlife’s inaction and refusal to resolve their proven pattern of multiple violations and fraud, or an earlier death from these. 

Mutiple units and employees of Metlife have intentionally subjected me and many more severely handicapped claimants to an unreal world that can be like a living hell.

MetLife is like an anti fiduciary, instead of operating the plan with care skill diligence and prudence as Federal law requires they have acted with absolutely no human conscience.  It is obvious their only concern is avoiding payment of the claims and they don’t care how many laws they violate or how many they damage or kill in the process.

Barry Schmittou

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