BENEFITS DIGEST

The Federal Reserve's disability plan falls outside ERISA, but that did not save the claim administrator from an ERISA-style loss last Thursday. Borrowing the deferential arbitrary-and-capricious standard from ERISA case law, the court still found the benefit termination could not stand. The administrator never obtained records from the spine specialist treating what it acknowledged was the primary disabling condition, quoted favorable excerpts while omitting the same providers' conclusions that the claimant was totally disabled, described as unremarkable the MRI films that reviewing physicians read to show herniations needing surgery, and disposed of the entire appeal in one conclusory paragraph. The claim goes back for reconsideration rather than an award, and the lesson travels beyond the Fed, since courts reach for ERISA's playbook even where ERISA does not apply.

Equitable cut off long-term disability benefits when the policy shifted from own-occupation to any-occupation coverage, relying on a report listing jobs the claimant could supposedly perform. Reviewing the record fresh, the court found a gap it could not overlook. The insurer's medical review said no cognitive testing had been done and never mentioned mental health treatment, even though the file documented an anxiety disorder, its treatment, and the medications. Ignoring treating-provider evidence that way denied the claimant a full and fair review, so the claim goes back to the insurer. The win was not total, though. The court read the policy's education, training or experience language to mean that any one of the three can qualify a person for a job.

Not every disability ruling last week went the claimant's way. Reviewing the record fresh, with the burden on the claimant, a California federal court granted judgment for Lincoln National even though the tinnitus, hearing loss, and depression diagnoses were undisputed. A diagnosis is not the same as functional impairment, the court reasoned, and the claimant's own treating physician agreed he could perform his sedentary job with restrictions that did not touch its duties. An earlier short-term disability approval under a separate contract did not carry over.

The Eleventh Circuit affirmed summary judgment for Aetna, holding the insurer did not act arbitrarily in terminating long-term disability benefits after the claimant ignored seven requests for updated tax returns and income documentation, including two more chances during the administrative appeal. The plan conditioned benefits on proof of continued loss, and a circuit-level reminder emerges that the duty to cooperate with reasonable information requests runs both ways.

This week's roundup, a short-handed edition with no case of the week, flags two decisions as most notable. In Central States v. McClain the Seventh Circuit held that Arkansas's latest pharmacy benefit manager regulation survives ERISA preemption, and in Liu v. Kaiser the Ninth Circuit extended the substantial compliance doctrine to benefit elections. The edition also collects the week's decisions on arbitration, attorneys' fees, fiduciary breach, disability claims, preemption, exhaustion, and pleading.

Insurer properly terminated long-term disability benefits where the treating physician's assessments established the claimant could perform sedentary work, satisfying the plan's "any gainful occupation" standard.

In Halloran v. Unum Life Insurance Company of America, No. 25-2550, 2026 WL 2545315 (8th Cir. Aug. 28, 2026), a panel of Chief Judge Colloton and Circuit Judges Gruender and Kobes, with Judge Kobes writing, affirmed the termination of a claimant's ERISA long-term disability benefits. The slip opinion appears in Court Decisions above.

In Grice v. Metropolitan Life Insurance Company, No. 25-50566, 2026 WL 2519457 (5th Cir. Aug. 26, 2026), a per curiam opinion, the Fifth Circuit affirmed the district court's grant of summary judgment to Metropolitan Life Insurance Company in this ERISA action challenging the denial of long-term disability benefits.

Kantor & Kantor's weekly survey leads with Laurel Hill Management Services v. La-Z-Boy, where the Sixth Circuit held a provider's claims preempted, reinforcing the circuit split with the Ninth Circuit's Healthcare Ally decision covered here last week. The same edition rounds up the week's district courts, including Kovacs v. Moradi, holding that restricted stock units are not ERISA plans, and Cregan v. Unum, finding that a voluntary accident plan failed the safe harbor on three of four prongs and is therefore ERISA-governed.

The New Jersey Department of Labor and Workforce Development has issued new guidance confirming its position that employees who receive Temporary Disability Insurance or Family Leave Insurance benefits are entitled to job protection.

In Mason v. New York Life Insurance Company, a magistrate judge in the Southern District of New York let a long COVID disability claimant pursue narrow discovery outside the administrative record, allowing targeted requests for the financial incentives and performance reviews of the employees who handled her claim while declining broader asks like aggregate denial-rate statistics. The takeaway: conflict-of-interest discovery fares better aimed at the specific people who decided the claim than framed as a search through the administrator's overall track record.

In Cregan v. Unum Life Insurance Company of America, No. 24-CV-340-DES, 2026 WL 2427920 (E.D. Okla. Aug. 19, 2026), United States Magistrate Judge D. Edward Snow addressed whether a voluntary accident policy offered through an employer falls under ERISA.

A Michigan federal court denied a disability claimant's motion for appellate attorney fees as untimely, holding the clock ran from the circuit's mandate rather than the district court's later action. Roberts on the timing trap in fee practice after a successful appeal.

A California federal court awarded an ERISA disability claimant every dollar of a $227,348 fee request, rejecting the insurer's demand for a 90 percent across-the-board cut despite only partial success on the merits. Roberts walks through the Hummell factors and the lodestar math in a dispute that turned on how covered earnings were calculated.

A Minnesota district court refused to dismiss a disability claimant's STD and fiduciary claims where the defendants changed their denial rationale along the way. Roberts on why a moving-target denial keeps claims alive past the pleading stage.

The Middle District of Florida dismissed most of a pro se participant's LTD underpayment claims as time-barred under the clear-repudiation rule: the limitations clock started when the underpayment was first communicated, not when payments ended. Roberts on the accrual trap that catches long-running benefit disputes.

The Ninth Circuit affirmed First Unum's denial of long-term disability benefits, holding that prior payment of short-term disability benefits creates no presumption of continuing disability and rejecting the claimant's new-rationale challenge.

This month's Friday Five highlights recent court decisions interpreting the ERISA long-term disability any-occupation standard, with practical takeaways for claim administrators and litigators.

In Stempel v. Unum Life Insurance Company of America, No. 24 C 6077, 2026 WL 2241244 (N.D. Ill. Aug. 4, 2026), the court dismissed an ERISA disability suit for failure to exhaust administrative remedies after the claimant could not establish that he actually mailed his appeal.

Federal courts have long applied a highly deferential “abuse of discretion” standard of review to claims for benefits under ERISA Section 502(a)(1)(B)—in other words, a court will uphold a discretionary fiduciary’s decision to deny benefits unless the decision was arbitrary or capricious.

In O’Connor v. Metropolitan Life Insurance Company, No. 4:24-cv-08723-YGR, 2026 WL 2220173 (N.D. Cal. July 29, 2026), Chief United States District Judge Yvonne Gonzalez Rogers granted Plaintiff’s motion for judgment under Federal Rule of Civil Procedure 52 and denied Defendant’s cross-motion.

Roberts Disability Law, P.C. secured a procedural win for its client in Goldman v. Unum Life Insurance Company of America, No. 3:26-cv-01022-LJC, —F.Supp.3d—-, 2026 WL 2184768 (N.D. Cal. July 21, 2026), where United States Magistrate Judge Lisa J.

Ajeti v. Life Insurance Company of North America, No. 26-3249, 2026 WL 2150163 (E.D. Pa. July 27, 2026), addresses whether ERISA governs, and preempts, state-law claims brought by foreign nationals seeking disability benefits under a plan established by their American employer.

In Scorzo v. Unum Life Insurance Company of America, No. 23-cv-3836 (N.D. Ill. July 17, 2026), the court upheld Unum’s denial of long-term disability benefits under the any-occupation standard on de novo review.

Following a bench trial on the administrative record, a California federal court found in favor of a long-term disability claimant whose ERISA benefits Reliance Standard Life Insurance Company had paid for two decades before cutting them off.

Judge Lewis J. Liman of the Southern District of New York denied an ERISA long-term disability claimant’s motion to compel discovery into matters outside the administrative record.

The United States District Court for the District of New Jersey, per U.S. District Judge Esther Salas, granted the defendants’ motions to dismiss a pro se ERISA claimant’s short-term disability suit and to compel arbitration of his retaliation claim.

In Wang v. Metropolitan Life Insurance Co., No. 25-11527, 2026 WL 1960673 (11th Cir. July 7, 2026), the Eleventh Circuit affirmed the entry of judgment for MetLife on a pro se participant’s ERISA claim for long-term disability benefits under a General Electric plan.

Lawson granted judgment to a former automotive production worker whose ERISA-governed long-term disability benefits MetLife had terminated, holding that MetLife improperly denied the claim by applying the wrong plan definition of disability.

This month’s Friday Five discusses decisions (1) allowing a bad faith claim to proceed against a long-term disability insurer based on its handling of a claim for benefits, (2) enforcing a forum-selection clause in an ERISA plan against the plan’s insurers that were not parties to the plan, and more.

Court ruled that General Obligations Law § 5-335 bars an insurer's subrogation lien for short-term disability benefits paid to an injured employee, invalidating the insurer's lien.