Opinion ID: 168760
Heading Depth: 4
Heading Rank: 3

Heading: Second-level Appeal

Text: M s. M eraou obtained the services of counsel, who submitted a second-level appeal (motion for reconsideration) on January 22, 2003. M s. M eraou requested an extension of 30 days to submit additional evidence and arguments in support of her appeal. She thereafter requested, and Kemper granted, further extensions to permit her to submit additional evidence. Kemper granted a final extension to July 7, 2003, stating that no further extensions would be granted. On M ay 29, 2003, M s. M eraou sent Kemper her videotaped statement together w ith a transcript, and on July 3 she sent records from Dr. Crass, a psychologist. During July 2003 Kemper obtained additional peer reviews, from a doctor of internal medicine, Dr. Russell Superfine; a rheumatologist, Dr. Sheldon Zane; an orthopedic surgeon, Dr. Ira Posner; and a psychologist, Dr. Elana M endelssohn. Each of these doctors opined, based on a review of M s. M eraou’s medical records, that she was not disabled. Additionally, by August 4, 2003, -7- Dr. Bowman had conducted a supplemental peer review, based on additional records from Drs. Anthony, W eldon, and Royal, and additional hospitalization and office-visit notes, that reached the same conclusion as her previous peer review: M s. M eraou was not functionally impaired. On August 13, 2003, M s. M eraou requested an additional delay of Kemper’s decision for 35 days, in order to obtain a three-day functional capacity examination. She also requested that Kemper pay for the examination. Kemper rejected the request for payment but granted the postponement. On September 5, 2003, M s. M eraou requested that Kemper further delay its decision on her claim until its October 2003 meeting. Counsel explained that M s. M eraou had arranged for neuropsychological testing but would be financially unable to have a functional-capacity test performed. On October 7, 2003, M s. M eraou notified Kemper that she had postponed the neuropsychological exam until October 28, 2003, and requested a delay of the review of her claim until December 11, 2003. On October 28, 2003, M s. M eraou was seen by Dr. Sherman, who conducted a neuropsychological examination. By November 14, 2003, however, Kemper had not received the record of this examination, and on that date it advised M s. M eraou that she should submit the record of the examination by November 26, 2003, to be available for consideration at the December 11, 2003, meeting. Kemper stated that if the record were submitted after November 26, -8- 2003, her appeal would be considered at the January 2004 meeting; and if the record w as not submitted by December 18, 2003, her appeal would nevertheless be decided at the January meeting without consideration of the additional information. M s. M eraou forw arded the record on November 21, 2003. On December 11, 2003, the Plan’s Administrative Committee met and considered M s. M eraou’s appeal. After thoroughly reviewing and discussing the medical and other evidence provided, the Committee unanimously voted to deny the appeal. In a letter to M s. M eraou’s attorney, the Committee explained that based upon its review of the medical information and documentation provided, “the Committee has concluded that M s. M eraou is capable of engaging in a gainful occupation as defined in the Plan, and therefore is not ‘totally disabled’ under the Plan’s definition, as applicable to M s. M eraou.” Aplt. Supp. App., Vol. II, at 397.