eable Reviewers in Disability Case DIBLE ABOUT-FACE nst Unjust Benefit Termination
Amazing Honeybee Facts!
Security Administration declared him totally disabled from any gainful employment, and is currently paying him full disability benefits.
So what gives? It’s hard to imagine that a person would voluntarily end a lucrative career to create a consistent record of extreme complaints, frequent doctor visits voicing those complaints, therapy, and medication trials to perpetrate fraud. MetLife Policy Definition Changes MetLife’s policy had a common provision providing that for the first two years of coverage, “disabled” was defined as the inability to engage in his “own occupation” as IT administrator when he first became disabled. But after two years, that definition changed to the inability to engage in “any occupation.” The provision states: You are not able to engage with reasonable continuity in any occupation in which You could reasonably be expected to perform satisfactorily in light of Your age; education; training; experience; station in life; and physical and mental capacity that exists within [certain geographical locations irrelevant to our issues]. Hired Gun Record Reviewers OK, I get it. Someone can be prohibited from working in their former occupation, but still be fit to work in another occupation, and MetLife isn’t bound by the Social Security Administration’s finding that William is totally disabled from any gainful employment. But here’s what doesn’t make sense. Despite William’s medical condition being progressive, and actually deteriorating over the two years since MetLife itself found, through opinions by its own physician medical record reviewers, that his medical records supported restrictions and limitations prohibiting him from working in his former occupation, MetLife’s newly retained record review doctors claim to have found no evidence in those same records to support any restrictions or limitations at all. It’s no mystery why MetLife didn’t engage its original record- reviewing physicians to opine on disability at the two-year mark. We all know what they would have said. But unfortunately, under ERISA and its weird procedures, we can’t depose MetLife’s experts. Our hope is that the court will agree that MetLife’s decision to engage different physician medical review physicians, then rely on those opinions, which are at odds with MetLife’s original experts, lacks good faith, and the outlier opinions of MetLife’s new experts lack credibility.
I didn’t know any of this until recently, but I thought the following was pretty amazing.
Honeybee Facts and Roles by Sex
Workers: Sex: Female
Role: Perform all the work of the colony, including foraging for nectar and pollen, caring for the queen and larvae, cleaning the hive, and protecting the colony. Can they sting? Yes, workers can sting but die once they do because their stinger is barbed and gets stuck in the skin of mammals, causing fatal injury to the bee. Interaction with others: Workers can sting invaders or threats to the hive but do not sting their hive mates. Drones: Sex: Male Role: Their primary role is to mate with a virgin queen. They do not forage for food, care for larvae, or participate in other colony duties. Can they sting? No, drones do not have a stinger and are completely harmless. Interaction with others: Drones are dependent on the workers for food and are often expelled from the hive in the autumn to conserve resources. Queen: Sex: Female Role: The queen’s primary role is to lay eggs. She is the mother of all bees in the colony. Can they sting? Yes, the queen has a stinger, but it is smooth and not barbed, allowing her to sting multiple times without dying. However, she typically only uses it to sting rival queens. Interaction with others: The queen is attended to by worker bees who feed and groom her. She rarely leaves the hive except for her mating flight or if the colony swarms to establish a new hive. Egg Laying: In spring and summer, the peak season for egg laying, a healthy queen can lay up to 1,500–2,000 eggs per day. This high rate of egg laying is essential for the rapid growth and sustainability of the colony during the seasons when resources are abundant and the colony is preparing for winter.
We’ll see.
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