Citi Wealth Management Executive With Wrist Osteonecrosis and Knee Meniscus Tear Wins New York MetLife LTD Insurance Appeal
MetLife approved our client’s long-term disability (LTD) insurance claim, paid benefits for a year, and then cut him off, even though nothing about his condition had improved. He was a Citi Wealth Management Executive in New York, responsible for about 14 branches. Ligament ruptures in both wrists, osteonecrosis in his right wrist, and a torn meniscus in his left knee had forced him out of work.
Our long-term disability lawyers have taken apart terminations like this many times: an approved claim, no medical improvement, and a sudden insistence that the claimant can work after all. We appealed, and MetLife reinstated his benefits back to the day it stopped paying.
MetLife’s reasoning deserves a close look, because it rested on a theory any claimant could face: that technology can stand in for a body that no longer works. If MetLife or any other disability insurance company has denied or terminated your benefits, speak with one of our lawyers. We represent claimants nationwide, and there is no fee unless we recover benefits for you.
Table Of Contents
- 1. Why this case matters for every MetLife claimant
- 2. A wealth management job MetLife already agreed he could not do
- 3. MetLife cuts him off with Zoom, the subway, and dictation software
- 4. Why MetLife’s theory collapsed against the real job
- 5. The evidence MetLife never gathered, so we did
- 6. Can MetLife cut off benefits when nothing has changed?
- 7. MetLife reinstates benefits with no gap in coverage
- 8. Speak with one of our lawyers today
Why This Case Matters for Every MetLife Claimant
This MetLife termination of a wealth management executive’s wrist and knee disability insurance claim holds five lessons for anyone whose benefits have been cut off.
If nothing has improved, the insurer owes you an explanation. MetLife approved this claim based on the same diagnoses it later said no longer supported disability, and his surgeon’s most recent wrist x-ray showed the condition unchanged. When a disability insurance company terminates benefits it previously approved, it should be able to point to evidence that the claimant’s condition improved. Insurers do try to deny benefits when your medical condition has not changed, and when that evidence does not exist, the decision is vulnerable.
Your doctor’s silence will be read as “no restrictions.” MetLife leaned on an orthopedic office note that listed no restrictions and on a phone message to the surgeon’s office that went unreturned. Neither proved our client could work, yet both became evidence against him. Make sure your treating doctors write specific functional limits into their notes and respond when the insurer calls. The support of your treating physician is the backbone of every strong claim.
A paper review loses to objective testing your doctor stands behind. Before the termination, his surgeon told MetLife he could not keyboard or travel between branches, and MetLife brushed it aside. What moved the needle was a valid Functional Capacity Evaluation that measured his stamina across a workday, followed by the surgeon’s written endorsement of its findings.
The insurer’s own restrictions can prove your case. MetLife’s reviewer limited our client to occasional keyboarding, fine manipulation, and grasping. His job demanded continuous computer work all day. Hold the insurer’s restrictions up against the real demands of your occupation; the gap between them is often the strongest argument in the file.
A workaround is not work capacity. Zoom, rideshares, and dictation software do not restore sitting tolerance, hand function, or endurance. When an insurer claims technology can absorb your job duties, answer with a detailed account of how the job is actually performed and objective proof of what your body can sustain.
A Wealth Management Job MetLife Already Agreed He Could Not Do
What the Job Actually Required
Our client was not a desk worker. Citi’s own position summary describes a primarily field-based role overseeing about 14 branches in Lower Manhattan, with 18 to 20 financial advisors and a team of licensed bankers reporting to him. The job required him to:
- Conduct daily branch visits to coach advisors and support branch operations
- Travel regularly throughout the branch network by public transportation or car
- Document every interaction with advisors, bankers, staff, and clients in the firm’s Salesforce CRM system
- Review and approve advisor securities transactions every week
- Investigate compliance issues, client complaints, and trade errors
- Recruit new advisors and run weekly training and team meetings
- Stay on call for urgent branch and advisor matters
The Medical Picture
His body was failing on two fronts: his hands, which the job demanded all day, and his left knee, which carried him from branch to branch. His orthopedic records documented:
- Ligament ruptures in both wrists, following earlier wrist and hand surgeries
- Scaphoid nonunion advanced collapse (SNAC wrist) on the right, a pattern of progressive arthritis that develops when a fractured scaphoid bone fails to heal
- Avascular necrosis (osteonecrosis) of the scaphoid and lunate, meaning bone tissue in two key wrist bones was dying from a lost blood supply
- A partial scapholunate ligament tear and a triangular fibrocartilage tear, damage to the structures that hold the wrist stable
- Complex meniscus tears in the left knee (the meniscus is the cartilage that cushions the joint), treated surgically with partial meniscectomy and chondroplasty (trimming the torn cartilage and smoothing damaged joint surfaces)
- Patellofemoral stress syndrome (pain where the kneecap glides over the thighbone), internal derangement (mechanical damage inside the joint), and osteoarthritis in the same knee
Wrist pain and weakness on both sides affected his daily life, with numbness and tingling in his right hand. He took anti-inflammatory and pain reliever medication, went through months of physical therapy, and his surgeon was weighing further surgery on both wrists. His most recent wrist x-ray showed the condition unchanged.
We have represented many knee disorder disability insurance claimants, and the combination here mattered. The wrists made sustained computer work impossible. The knee made a commuter’s day of stairs, platforms, and standing impossible to manage.
Approved by MetLife, Then by Social Security
An own-occupation definition of disability asks whether you can perform the duties of your own job, not whether you could do some other kind of work. Under his group plan, once the elimination period (the waiting period before benefits begin) had passed, he was disabled if he could not earn more than 80% of his pre-disability earnings in his own occupation.
MetLife approved the claim. In doing so, it acknowledged that his occupation required frequent travel between branch locations and significant computer use, the two things he could no longer do. The Social Security Administration later reached the same conclusion and awarded him Social Security Disability Insurance benefits.
MetLife Cuts Him Off With Zoom, the Subway, and Dictation Software
After about a year of payments, MetLife terminated the claim. Claim Specialist Katie Barry signed the letter, which concluded there was “no evidence of any severe limitation that would restrict and prevent you from performing your own occupation.” The path to that conclusion ran through three weak links.
An Office Note and an Unreturned Phone Call
MetLife built its case on the absence of evidence. It pointed out that his orthopedic surgeon’s most recent office note did not list any restrictions or limitations. A MetLife Nurse Clinician then left a message with the surgeon’s physician assistant asking for clarification. When no one called back, MetLife treated the silence as an answer.
We have watched MetLife do this before. In our MetLife appeal for a financial planner with restless leg syndrome, the insurer cut off benefits largely on the strength of one office note saying he was sleeping better, a termination MetLife also reversed on appeal.
A Paper Review From a Doctor Who Never Met Him
A paper review, also called a file review, is an opinion from a doctor the insurance company hires who reads the medical records but never examines the claimant.
The file went to a MetLife Nurse Clinician, a MetLife Vocational Rehabilitation Specialist, and Dr. Kraig Pepper, a third-party orthopedic surgeon consultant. Dr. Pepper never examined our client and never spoke with his doctors. He acknowledged chronic wrist pathology, weakness, and an ongoing knee impairment, then concluded our client could work full time. MetLife adopted these limits:
- Sitting: unrestricted
- Standing and walking: frequently, up to four hours a day each
- Lifting, carrying, pushing, and pulling: occasionally, no more than 20 pounds
- Fine manipulation, simple and firm grasping, and keyboarding: occasionally, with both hands
- Climbing ladders, crouching, and crawling: never
Leaning on its own doctor’s review is a familiar MetLife move. It did the same to a dentist with De Quervain’s tenosynovitis in the wrist, a cut-off that ended with benefits reinstated and nearly a year of back pay.
MetLife’s Answer to His Surgeon
MetLife sent the review to the treating orthopedic surgeon. He responded that our client could not travel between branch offices, could not travel with his laptop, and could not keyboard, use a mouse, or do desk work. Rather than engage with those limitations, MetLife redefined the job:
- Meetings: MetLife’s letter stated, “It was confirmed by your employer that Zoom was a resource available to all managers to use when meeting with staff.”
- Travel: he did not need to drive, because subways, Lyft, Uber, and taxis were available.
- Typing: he already used voice-activated software, his computer had built-in dictation, and his employer offered Dragon NaturallySpeaking.
That was the entire termination: a silent office note, a reviewer who never met our client, and a list of apps.
Why MetLife’s Theory Collapsed Against the Real Job
Can a disability insurance company decide you can do your job with Zoom and dictation software? Not when the job itself says otherwise. Rachel Alters, a partner at our firm, built the appeal around a point MetLife never confronted: the job it imagined was not the job our client did. As she wrote, “The presence of a technological tool does not equate to functional capacity.”
Zoom Does Not Visit 14 Branches
The position required daily, in-person presence across the branch network, direct coaching of advisors, and real-time compliance oversight. An email saying Zoom was available to managers did not say travel was optional or that branch visits could be replaced. The same employer communication confirmed that he traveled by subway, which proved the opposite of what MetLife intended.
Subway travel means standing on platforms, walking between stations and branches, climbing stairs, and carrying a laptop and work materials. MetLife’s own letter classified the position as a light occupation, and under the federal regulations that define exertional levels of work, light work includes jobs that require a good deal of walking or standing. For a man still rehabilitating a surgically repaired knee, that is not an accommodation. It is a physical demand.
Dictation Is Not Data Entry
The record showed continuous, time-sensitive computer work: real-time CRM documentation during and after advisor meetings, performance spreadsheets, compliance reports, trade approvals, and training presentations. Dictation does not navigate multiple platforms, enter precise data, or format a compliance report. It also does nothing for the underlying problem. The medical evidence showed he could not sustain repetitive hand use of any kind, whether typing, mousing, or moving between systems.
Occasional Keyboarding for a Full-Time Keyboard Job
Dr. Pepper’s own restrictions limited our client to occasional keyboarding, which in vocational terms means no more than one third of the workday. He never explained how that fits an occupation built on continuous computer use, because he never evaluated the occupation at all. He assessed physical abilities in a vacuum, and MetLife adopted the result without ordering an Independent Medical Examination (an in-person exam by a doctor the insurer selects) or a Functional Capacity Evaluation of its own.
Put plainly, MetLife’s own reviewer described a man who could not do this job.
The Evidence MetLife Never Gathered, So We Did
ERISA, the federal law that governs most employer-sponsored disability insurance plans, requires every plan to offer a full and fair review of a denied claim. An ERISA administrative appeal is the written request for that review, and it is usually the claimant’s last chance to add evidence before a lawsuit, so we used it to build a record MetLife could not dismiss.
The appeal also put MetLife on notice that, under the Department of Labor’s ERISA disability claims regulations, our client was entitled to see any new reviewer report before a final decision, so his doctors could respond.
The Functional Capacity Evaluation
A Functional Capacity Evaluation (FCE) is a series of standardized physical tests that measures what a person can do and, just as important, how long they can keep doing it. MetLife never ordered one, so our client paid for his own. The testing was rated valid and reliable, meaning the results accurately reflect his true capacity. It found that:
- He could not sustain prolonged sitting, the baseline requirement of any full-time desk job
- Repetitive use of his hands, including handling (gripping and holding objects), fine finger work, and keyboarding, was severely limited and possible only in brief intervals before pain, weakness, and measurable decline set in
- Post-activity testing showed his function deteriorated with use
- He lacked the endurance for an eight-hour workday
- Limits in standing, walking, balance, and endurance ruled out the travel his job required
In practical terms, he could not do sustained computer work, could not keep an executive’s pace, and could not get himself around the branch network. The evaluator compared these results directly against the demands of his occupation and concluded he could not return to work as a Wealth Management Executive. Anyone deciding whether to attend a Functional Capacity Evaluation should understand how much weight a valid one can carry.
His Orthopedic Surgeon Signs On
An Attending Physician Statement (APS) is a form on which a treating doctor records diagnoses and specific work restrictions. His orthopedic surgeon reviewed the FCE and completed a new APS that:
- Confirmed the FCE was a valid, objective measure of his functional capacity
- Agreed he could not sustain work activity on a full-time basis
- Rejected MetLife’s findings, including that he could keyboard even occasionally or sustain prolonged sitting and standing
- Stated he could not perform frequent or continuous keyboarding or repetitive hand use
- Explained that such activity would increase pain, decrease function, and reduce productivity over the course of a workday
This closed the gap MetLife had exploited. The surgeon’s earlier objection was an opinion. Now it was an opinion anchored to objective testing.
His Psychologist on Pain, Fatigue, and Reliability
Chronic pain had taken a toll beyond his hands. His treating psychologist diagnosed major depressive disorder (clinical depression), single episode, mild (ICD-10 F32.0), and saw him weekly. Her APS described hand pain that was chronic, fluctuating, and unpredictable, interfering with his concentration and endurance.
She explained that he would need rest periods beyond standard breaks, would function inconsistently, and would likely miss work. An executive who cannot show up reliably cannot hold the job, no matter what software is installed on his laptop.
In His Own Words, and His Wife’s
Our client’s personal statement described a dramatic decline in the use of his hands. Brushing his teeth, bathing, and even drinking a glass of water had become difficult. He had been recognized as one of the top wealth management executives in his region, and losing that career had been devastating.
His wife saw the struggle every day: opening a jar, tying a shoe, holding a fork, turning a doorknob. Her letter closed with a line no reviewer’s checklist captures: “a hand injury does not merely limit a person’s capability; it redraws the contours of a life, the contours of a marriage, and the contours of a family’s daily existence.”
Can MetLife Cut Off Benefits When Nothing Has Changed?
MetLife tried, and it ran into two facts it never explained. The first was the absence of any improvement. As attorney Rachel Alters put it in the appeal: “MetLife previously determined that these same impairments rendered him disabled. There has been no change in his condition that would justify a different conclusion. If anything, the evidence is now stronger.”
The second was Social Security. About two and a half months before MetLife cut him off, the Social Security Administration found him disabled under a far stricter test. Social Security’s definition of disability requires an inability to engage in any substantial gainful activity, not just one’s own occupation. A Social Security award does not bind a private insurer, but MetLife never meaningfully reconciled its conclusion with a federal finding that our client could not work at all.
MetLife Reinstates Benefits With No Gap in Coverage
MetLife reviewed the appeal and reversed course. Its approval letter was brief: “We received additional information and have determined that you are Disabled.”
The decision reinstated our client’s benefits back to the date MetLife had cut them off, leaving no gap in coverage. MetLife issued $42,540 in back benefits, and monthly payments resumed going forward.
Had MetLife held its ground, our next step would have been a lawsuit in federal court under ERISA’s civil enforcement provision. It never came to that, because the appeal left MetLife with nothing to stand on.
Attorney Rachel Alters has made MetLife undo terminations before, including in her appeal for an American Express delivery director whose physical conditions MetLife ignored, which also ended with benefits reinstated.
Speak With One of Our Lawyers Today
The question was never whether MetLife could name a piece of technology. As our appeal put it, “The issue is not the availability of tools or accommodations; it is the inability to sustain the physical demands of work activity at any meaningful level.”
If MetLife has terminated your benefits on the strength of a paper review, a silent office note, or a theory about how your job could be done differently, the clock is already running. Most employer-sponsored plans give you 180 days from the denial letter to appeal, and what you submit in that window is usually the record a court will review if your case ever reaches one.
Our long-term disability lawyers have represented disability insurance claimants since 1979, helping tens of thousands of people and recovering more than $2 billion in benefits. We handle claims against MetLife and every other disability insurance company nationwide, and there is no fee unless we recover benefits for you. Contact our office for a free consultation today.
