Opinion ID: 168760
Heading Depth: 4
Heading Rank: 2

Heading: First-level Appeal

Text: Kemper received M s. M eraou’s first-level administrative appeal on August 29, 2002. On September 17, 2002, M s. M eraou faxed to Kemper three medical records to be considered in connection with her appeal: an initial-officevisit-and-evaluation report from Dr. Tomecek dated January 22, 2001; an operative report from Dr. Tomecek dated February 9, 2001; and a letter from Dr. W elden to Kemper’s Appeals Division dated August 22, 2002, concerning M s. M eraou’s diagnoses and treatment. In addition, on August 16, 2002, Dr. W elden telephoned in a report to the Appeals Division, which reached them before the appeal had actually been filed. On September 23, 2002, Kemper wrote -5- to M s. M eraou, requesting a 30-day extension to supply her with a written decision, in order to permit K emper to review all the information in her file. At this point in the appeals process, the emphasis seems to have expanded from the procedural issue of M s. M eraou’s failure to supply the requested medical records to include the additional, substantive question of whether she remained disabled. Thus, on September 23, 2002, Kemper referred the case to a consulting physician specializing in internal medicine and endocrinology, Dr. Tamara Bowman, to prepare a peer-to-peer review designed to answer the following question: “Does the medical evidence submitted support a disability from 8/1/02? If does not support, please indicate detailed reasons why and what can be sent on appeal that would support a functional impairment.” Aplt. Supp. App., Vol. I, at 234. After examining statements from M s. M eraou, medical records from Dr. W elden and Dr. Royal, an anaesthesiologist, and clinical records from the W elfit M edical Clinic and the Pain Evaluation and Treatment Center, Dr. Bowman determined that the evidence “[f]ail[ed] to support [disabling] functional impairment(s),” id. She suggested that “[i]f additional documentation were to be submitted on appeal, then a functional capacity evaluation and recent comprehensive musculoskeletal, joint, and neurologic examinations would be most relevant.” Id. at 237. On October 28, 2002, Kemper requested an additional 30-day extension to review its file, promising a decision by November 22, 2002. Kemper then -6- obtained an employability-assessment report and a labor-market survey, which indicated that M s. M eraou could do sedentary skilled and semi-skilled work, and that within 50 miles of her home there were jobs available of the type that she had previously performed. On December 6, 2002, Kemper notified M s. M eraou that it had completed its review of her appeal. It upheld the decision to deny her LTD benefits, because of “a lack of medical evidence to support [her] inability to perform sedentary work.” Id. at 256.