Identical Medical Evidence Ignored By Multiple MetLife Agents and Doctors From Network Medical Review and MES
Introduction – Three Sentences
MetLife pays millions of dollars a year to corporations named Network Medical Review (NMR) and MES. These corporations pay doctors who write reports that MetLife uses to deny claims.
Multiple doctors from NMR and MES ignored the exact same medical evidence in separate reports they wrote in 2010 and 2011. Then MetLife ignored the exact same evidence and used these doctors’ reports to deny the claim.
Index of Full Evidence
Example 1 –
Urgent Quotes From My Eye Cancer Surgeon Are All Omitted in Five Separate Reports Written By Two Ophthalmologists From Network Medical Review, One MES doctor, and Two MetLife Claims Specialists in 2010 and 2011 !!
The surgeon quotes that were ignored include :
“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”
Example Two –
Extensive History of My Bloody Falls and Accidents Completely Ignored By Two Ophthalmologists From Network Medical Review, One MES doctor, and Two MetLife Claims Specialists in 2010 and 2011 !!
The two NMR Ophthalmologists’ and MES doctor made profound comments about my psychological conditions while they ignored all the eye problems mentioned in all five examples in this document and much more !!
Example Three –
Dyslexia, Unable to Fixate on Objects, Sudden Image Shifts, Tilted Image, Brain Spasm Feeling, Seeing Things That Aren’t There, Pixelization, Wavy Image, Print Moving and Much More Completely Ignored By Two Doctors From Network Medical Review, One Doctor From MES and Two MetLife Claims Specialists in 2010 and 2011
They ignored hundreds of statements in my medical records including :
“It’s like my brain shifts in sync with my vision shifts. My whole world shifts unexpectedly”
** That’s a very small percentage of the evidence ignored. It has taken many painful years to finalize this report and I’m only doing this to stop the destruction of many more lives !!
Example Four –
I'm legally blind in my right eye because of cancer.
My left eye was removed from the socket during surgery. I provided a DVD that shows the left eye pulsing in sync with every heart beat.
The record reviewed by MetLife and NMR and MES’s Doctors in 2011 shows I repeatedly told them it is my left eye pulsing in the DVD.
Here’s one example sent to Metlife in 2011 :
“Three consultants paid by MetLife have ignored the fact that my left eye pulses in sync with every heart beat. This is very significant because I am legally blind in my right eye. In spite of extensive documentation Metlife’s consultants have repeatedly ignored the fact that it is my left eye that is seen pulsing in the video I have submitted. They repeatedly write it is the right eye and act like this is not a problem since I am legally blind in the right eye.”
(end of quote)
MetLife did nothing to correct the error after seeing that quote and many more large font notices I sent them and many phone calls telling them about this dangerous error !!
Please remember U.S. District Judge Nancy Gertner wrote this in Whitehouse verse 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.”
Example 5 –
A Third NMR Ophthalmologist Completely Ignores Four Years of Medical Records in 2008 !!
(Full evidence begins two sentences below)
**** All of these medical professionals have committed identical violations of U.S. Title 29 which requires the claims determination will :
“Provide for a review that takes into account all comments,
documents, records, and other information submitted by the claimant relating to the claim”
Full Evidence
Example One of Five
Important Quotes From My Eye Cancer Surgeon Are Omitted in Five Separate Reports Written By Two NMR Ophthalmologists, One MES doctor, and Two MetLife Claims Specialists in 2010 and 2011
They all ignored the following quotes that my melanoma eye cancer surgeon Dr. Wallace wrote in a one page letter that MetLife specifically asked him to write !!
Dr. Wallace is Chief of Ophthalmology at Baptist Hospital in Nashville. Here are his quotes :
“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)
In 2010 -
NMR’s Dr. Weber wrote this in the report MetLife used to deny my claim :
“The conversation with Dr. Wallace was very thorough and we agreed that this was a case of subjective complaints without objective findings.”
Metlife’s Christine Dewey wrote this in the 2010 denial letter after she had read the quotes seen in Dr. Wallace’s letter above :
“Dr. Wallace and Dr. Weber agreed that yours was a case of subjective complaints without objective findings.”
In 2010 and 2011 –
The claims record shows that I repeatedly told MetLife and NMR’s Ophthalmologists in writing that they were omitting those exact sentences from Dr. Wallace !! I also told them they were completely ignoring my bloody falls and accidents and other specific evidence and this put me in danger !! They did nothing to correct this !!
In 2011 –
Another NMR Ophthalmologist named DR. Osbahr wrote :
“All this documentation was viewed in great detail”
Then Osbahr wrote :
“he has had previous surgery in the left eye but he has had no problems with impairment with the left eye”
This quote from my surgeon Dr. Wallace proves Osbahr is lying:
“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”
My Optometrist Dr. Jessup wrote this after seeing those quotes from Dr. Wallace :
“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.”
After seeing that NMR’s Dr. Osbahr wrote :
“The medical information from his Optometrist and Ophthalmologist suggest that his visual ability was restored back to normal in the left eye.”
Here is exactly how the letter began including the bullet point :
Dr. Wallace,
#1
My left eye is so unstable I think we should reconsider unplugging the right eye because it is causing such distortions in the image I see, and my left eye is already struggling with nystagmus and images that pulse in sync with every heart beat.
Please remember after seeing that NMR’s DR. Osbahr wrote :
“he has had previous surgery in the left eye but he has had no problems with impairment with the left eye”
Example Two of Five
Bloody Falls and Accidents Completely Ignored in 2010 and 2011
NMR’s Ophthalmologist Dr. Weber did not write one word about my extensive medical history of bloody falls and accidents !!
Metlife’s Christine Dewey did not write one word about my history of bloody falls and accidents !!
In 2011 –
MES’s Dr. Goetz did not write one word about my extensive medical history of bloody falls and accidents
These three people committed identical violations of U.S. Title 29 which requires the claims determination will :
“Provide for a review that takes into account all comments,
documents, records, and other information submitted by the claimant relating to the claim”
Here’s the second sentence of an urgent letter I wrote to my surgeon Dr. Wallace and it is a part of the record that the NMR and MES doctors and MetLife have reviewed :
“The large number of serious falls and accidents that my visual problems have caused me to have since 2001 have not been stopped by the limitations recommended my treating surgeons and Physicians and Metlife’s consultant Ophthalmologists. Some examples are seen in the exhibit titled Falls and Accidents Short List”
(end of quote from the letter)
Also in 2011-
“Associated falls and accidents” was listed in the diagnosis section of the official one page referral that NMR’s Ophthalmologist Dr. Osbahr received from MetLife.
Osbahr did not write one word about falls and accidents in the lengthy assessment he wrote for MetLife !!
The denial written by MetLife’s Sharon Atkins in 2011 has “Associated falls and accidents” written as the last words in the first paragraph. That paragraph lists some of the diagnosis I have received from my doctors but there is no discussion of any of the diagnosis. Ms. Atkins never mentioned falls and accidents again.
I have seen Federal Judges refer to this as mentioning medical problems in name only, without providing any meaningful discussion !!
These three doctors and MetLife’s Ms. Dewey and Ms. Atkins all ignored any consideration of my falls and accidents even after reading my psychologists reports about the traumatizing stress and destabilization that occurs when doctors paid by MetLife ignore medical evidence !!
The two Ophthalmologists from NMR and the doctor from MES all made profound comments about my psychological problems, but these eye specialists never mentioned the following quote from my psychologist’s report :
“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.”
(end of quotes)
Example Three of Five
Dyslexia, Unable to Fixate on Objects, Image Shifts, Wavy Image, Tilted and Wavy Image, Seeing things That Aren’t There, Pixelization, Metamorphopsia, Print Moving and Much More Completely Ignored By Two Doctors From Network Medical Review, One Doctor From MES and Two MetLife Claims Specialists in 2010 and 201.
** That is a small percentage of evidence ignored. It has taken many painful years to finalize this report and I’m only doing this to stop the destruction of many more lives !!
Example Four of Five
I'm legally blind in my right eye because of cancer.
I had orbital surgery on the left eye and provided a DVD that shows it pulsing in sync with my heart beat.
The record reviewed by MetLife and NMR and MES’s Doctors in 2011 shows I repeatedly told them it is my left eye pulsing in the DVD. I also repeatedly told them they were making a mistake by continuing to say it is the right cancerous eye that is pulsing in the DVD.
I also wrote this multiple times in 2010 when MetLife’s consultant Dr. Weber (from NMR) also falsely wrote it is the right eye seen in the DVD.
MetLife never corrected the error and they used the reports from NMR and MES’s doctors to deny the claim !!
Here is one quote from the one page letter declaring my appeal in 2011 :
“The DVD is my left eye pulsing, not the right eye. I shot the video in a mirror, either the camera or the mirror reverses the image. It is my left eye that pulses, I see and feel the pulse inside even when it can’t be seen outside. I’ve reported this since the orbital surgery. It causes a very significant distracting pulse in my image all day everyday.”
(end of quote)
MetLife received the following 12 paragraphs before they denied my claim in June 2011 but they did nothing to correct the error !!
“Three consultants paid by MetLife have ignored the fact that my left eye pulses in sync with every heart beat. This is very significant because I am legally blind in my right eye. In spite of extensive documentation Metlife’s consultants have repeatedly ignored the fact that it is my left eye that is seen pulsing in the video I have submitted. They repeatedly write it is the right eye and act like this is not a problem since I am legally blind in the right eye.
In 2010 Metlife’s consultant Dr. Weber saw the video and referred to this as “a blink, and followed by a down gaze and this was done repeatedly”.
In 2011 Metlife’s consultant Dr. Goetz saw the video and referred to the movement as “the right eye in straight and downgaze”
I have repeatedly made it very clear it is my left eye that is pulsing in the video. My medical records and letter to my left eye surgeon Dr. Wesley also prove this.
I can feel the pulse and see numerous distortions, including a wavy rippling affect that radiates from the pulsing image like a ripple caused by a rock thrown into water !!!
The image jump I actually see is much more pronounced than the pulse seen on the video. I would guess that is because the source of the pulsing is closer to my optic nerve or whatever is causing the image to jump with every pulse. I noticed it and reported it to my surgeon right after the surgery.
How am I supposed to survive and have the energy and stamina and speed of a normal person when I cannot fixate on objects because I am legally blind in my right eye and my left eye image pulses with every heart beat ? I am not doing well with it now as evidenced by my extensive records of falls and accidents and near falls and accidents.
This is not voluntary, my left eye pulses in sync with my heart beat. I have reported this to my surgeon Dr. Wesley since the left eye orbital surgery in 1989.
My left eye was removed from the socket and a large mass and part of the bone by the brain was removed. Before the surgery my eye bulged and I saw a big dark circle in the eyes image, so it’s not surprising that I still have problems with the eye.
Dr. Wesley told me not to worry about the pulsing so I didn’t, and I received 7 management promotions over the next ten years. Right before the right eye cancer I was promoted to be National Field Manager on Mosaic's Epson Project and was transferred to be National Field Manager on Mosaic's LEGO Toy Merchandising Project, where I received a commendable performance evaluation and a raise while managing 200 employees and created and wrote training manuals and did the final edit that was sent to LEGO’S top managers.
I also received two Awards of Excellence when I worked for PIA Merchandising representing Disney movies. My managers told me that Disney implemented an idea I had regarding the design of their beautiful 3D movie displays that are seen in stores nationwide.
It’s easy to see the pulsing jumps in my non dominant left eye image were not a vocational or safety issue until I got cancer in my dominant right eye”
Example Five –
A Third NMR Ophthalmologist Ignores Four Years of Medical Records !!!!!!!
NMR Ophthalmologist Dr. Yanik wrote a report evaluating my medical condition in 2008 without seeing me or my medical records from 2004 until 2008 !! He made multiple fraudulent statements about my limitations and omitted consideration of the great majority of medical evidence !! Dr. Yanik did not call any of my current doctors but he called my right eye surgeon Dr. Trent Wallace who had not seen me since 2003.
My medical records were in storage so Dr. Wallace did not even view the medical records from when he performed eye cancer surgery in 2002 and 2003.
No one had a valid authorization to discuss my medical records !!
MetLife’s Dr. Yanik never saw me and never spoke to me !
Without my knowledge he wrote a report and quoted Dr. Wallace as saying that I would have no limitations in 2008 !!
How would he know without having seen me or my medical records during the last five years !!
Without my knowledge he wrote a report and quoted Dr. Wallace as saying that I would have no limitations in 2008 !!
How would he know without having seen me or my medical records during the last five years !!
The thing I hate most is all this happened when my father needed me during his four month illness and death, including the time when I tried to comfort him as he struggled for breath during his last hours.
Metlife’s violations caused me nausea and tremendous sleep problems during this time !!
Now my mother has advanced Alzheimer’s and MetLife’s crimes to distract me from doing the best I can to help my mother while also trying to take care of my own medical problems and avoid additional falls and accidents.
I have many more specific examples of fraudulent misrepresentation and fraud by omissions where NMR, MES and MetLife ignored the exact same evidence after I sent them large font notices of their dangerous errors.
