Met Life 1) Met Life contacted Whole Foods and elicited a non-current work description and was utilizing this as their method of determination over the course disability determination until this month August 2009. a. I didn’t discover this mistake until I personally contacted Met Life (around August 4th or 5th ) to inquire why they thought I was physically able to perform job duties requiring 8 hours standing/walking, when two physicians have certified (neurologist and primary care physician) that I cannot stand or walk for long periods of time. i. It was at this point that the Met Life case manager revealed that Met Life was utilizing a older, sedentary, administrative job description. ii. I had to send Met Life updated information clearly showing in two different sets of documentation that my last position worked was not a sedentary, sitting position, but in fact my last position worked was a standing position that required 8 hours of continuous walking and standing per shift, and given the full time status of my position, this would have equaled to 40 hours of standing and walking per week. iii. It was at this time that Met Life shifted the claim to an appeals process. iv. My only concern here is that according to Met Life, my plan policy only allows one formal appeal, and given the high degree of miscommunication and high frequency of misinformation, I’m have serious doubts regarding the care and consideration of Met Life’s staff. 2) Barriers to communication a. According to Met Life, I cannot discuss medically specific information (essentially everything in my file) with anyone other than a case or appeal manager. Thus, most of the representatives who answer my calls are unable to provide assistance in virtually any way, and I am forced to leave messages which are irregularly returned, and I am unable to communicate with anyone in a timely fashion. I find this last point to be most critical, as Met Life currently has my case on a deadline, however, at times, I am unable to obtain critical information for days or even weeks. i. For example, 8/14, I contacted Met Life for assistance regarding records in my file. I left a message for Stephanie Melin, the case manager handling my case at the time. ii. I did not receive any return phone calls, so I called Met Life on 8/19 and was told that I was no longer able to speak with my case manager, who I’d been informed was my primary contact. Instead, I was to speak with the appeals manager (now my new primary contact). iii. It took several attempts on my part, and on 8/19 I spoke with an appeals manager regarding my case. All told, it was nearly a week of attempts, only reaching someone after serious effort on my part. 3) Unfair/Undue practices a. According to the last Met Life appeals manager with whom I spoke, Met Life is demanding that all physician statements be fully supported by regular routine records (like office charts, physician notes, etc.). Thus, I am now required to compile a very massive body of information from a large number of doctors at a wide number of locations in essentially a month or less (I was notified of this fact 8/19 and must have the paperwork to Met Life by 9/15 – need to double check date). This seems to place an undue burden upon me as this is a very large amount of paperwork to compile within a small time frame i. between 2006-2009, number of doctors is about ten or more, and some doctors are from out of state in RI, where I used to live ii. thus this task is quite large b. At one point I was attempting to send Met Life the updated information regarding my job description. Four previous attempts to fax the information had failed, and thus I contacted Met Life and asked if it was possible to email the file to someone as an attached PDF (a common business practice). The representative with whom I spoke, Joyce told me that this was not possible. Her reasoning was that Met Life had no method for transferring the PDF into their system. I specifically asked her why it was not possible to print a copy of the PDF and then upload the file (as they do use a scanning system). She simply refused to cooperate so I left a complaint with the case manager Stephanie Melin. Stephanie later contacted me and informed me that she was in fact able to receive an email of the file. c. When I routinely request assistance with understanding what type of documentation or what form of documentation is necessary, the Met Life agents constantly tell me that they “cannot not tell me what type of documentation to provide.” I find this behavior to be clearly disingenuous and purposefully preventing me from understanding how to properly prepare the documentation of my disability. 4) Biases a. Dr. Chang on 8/4 sent a letter to Met Life Disability with statements regarding my health. These statements were not founded or based on any factual information (i.e. lab results) nor were these statements based on an actual office visit or patient interaction. i. For example, Dr. Chang asserted that I was tolerating treatment fine. This is not true. For the first 3-4 weeks I had daily diarrhea and this was often on an hourly basis. I continue to deal with intestinal distress. He had not seen me or spoken to me for assessment purposes since issuing the new prescription on 7/13/09. Furthermore, this was my starting phase for retrovirals, so he had no prior information on which to make this assertion. ii. Also as an example, Dr. Chang stated that “there are no HIV related complications that limit work activities.” Dr. Chang has been informed of chronic pain and fatigue issues that have been consistently documented and verified by other physicians and he has been given copies of this information and he continues to maintain that there is no connection. Be that as it may be difficult to clearly articulate interactions between the nervous system and the immune system, there is still the simple matter of 1. Significant weigh loss of about 15 pounds in the last 1.5 year which is about 8.5% of my original 175 (I need to get the exact numbers from my primary care physician which I will do this coming Mon 8/24 – also need this info for some other things). 2. Serious and chronic opportunistic infections in the form of sinus infections on a regularly, basis (i.e. several times a month). iii. Dr. Chang also relayed invalid information regarding my exercise habits when he informed Met Life that I was routinely cycling long distances and thus completely and physically fit. 1. This is not true. The last instance that I cycled long distance was in the middle of June, and in the roughly two months since then, I have been unable to make such long distance rides because of chronic fatigue and issues with refractory fatigue that lasts for days after the bike ride. 2. Also, I am unable to drive at present, and therefore my options are walking or using a bike (in addition to bus/train/subway options). Therefore, it is true that on a weekly basis there may be one or two days where I have to ride 5-10 miles between the train station and where I’m staying or between my place and my doctors office, and I do this out of necessity and sometimes even though I might be sick. 3. Met Life literally emphasized this erroneous information in their initial denial letter to me, which would suggest that this completely singular instance was over exaggerated in importance due to the unprofessional behavior of Dr. Chang (i.e. reporting such circumstantial information as overly significant is like saying that because there was a slight breeze today, tomorrow there will be a hurricane). b. According to Met Life, their own policy stipulates that all physician statements be supported by office visits and clear documentation. i. Dr. Changs 8/4 communication to Met Life is not based on any factual evidence, conversations with the patient (myself), lab results, office vists – nothing – he merely wrote an opinion and faxed it to Met Life. ii. Although I have alerted Met Life to the fact that this 8/4 communication is unfounded and false, Met Life refuses to remove it from the record. 5) Specific Examples of misinformation and miscommunication a. Contact number for California Insurance Office i. In the documentation that I have received from Met Life the contact number that is listed as the agency to direct complaints is in fact erroneous 1. The contact agency is listed as the California Insurance Office 2. However the contact number is actually the toll-free number for the California Employment Disability Office. b. Unclear Information regarding the appeals process i. Although I was advised that the case was moving to an appeals process around 8/4/09, I was not advised until 8/19/09 that I would need to provide a highly significant amount of additional medical documentation before a deadline by 9/15/09. This is problematic for a number of reasons, one being that I will not be seeing my infectious disease doctor until around 9/2/09 to discuss my most recent blood work (documenting CD4 count and other important health information), and this gives him very little time to address the matter. 6) Lack of clarity/communication regarding process of documentation of disability and necessity of supporting information. a. As pointed out earlier Met Life’s agents have consistently provided vague information or refused to provide any information regarding the documentation process (for example what kind of records should I be providing, time frames, etc). b. Most recently (8/19/09), I have been given more clear descriptions of the necessary documentation, however this information should have been given to me much earlier (as in at the very beginning of this disability process, rather than at the very last minute just before the appeals deadline). 7) General Concerns a. Met Life thus far has demonstrated a irrational, unfounded, and illogical insistence on denying a legitimate disability claim. i. Required job duties of previous job 1. 8 hours standing 2. 8 hours walking ii. iii. iv. v. 3. Lift up to 40 pounds unassisted Both a neurologist and a primary care physician have certified that I am unable to fulfill these duties for a number of reasons 1. Compromised immune system a. i.e. low CD4 count of 280 (where 200 is the benchmark for AIDS) 2. Chronic fatigue (limiting ability to stand and walk to short period of time) 3. Chronic pain (also limiting ability to stand and walk to short periods of time). My previous rate of pay was 18.50 per hour, and if I were to return to work now, I would not be able to take a standard work shift, thus meaning that I would most likely only be eligible for a limited number of positions for fraction of my original net pay, the amount of which would a fraction of my pre-disability income. The purpose of having a long term disability policy is to compensate me for the loss of my job at the time of the disability. I should not be held to a standard of consideration relevant to my original position which was 1. 8 hours standing/walking 2. Lift 40 pounds unassisted I cannot fulfill these job requirements thus Met Life is obligated to fulfill my disability based on the terms of the plan policy.