BENEFITS DIGEST

A warehouse associate who represented himself largely lost his benefits case against Amazon after a bench trial before Judge Drew Tipton over the company’s Texas occupational injury benefit plan, but won two rulings that other employers should notice. First, the plan’s one-year limitations period, though reasonable under Heimeshoff, was unenforceable for all three injury claims; two appeal denials never disclosed the period, and the third stated the period but omitted the calendar date it expired, which the disability claims regulation has separately required since April 2018. The court noted no circuit has decided the calendar-date question and declined to enforce the deadline anyway. Second, Amazon owes a $6,050 statutory penalty for furnishing the plan document as an email attachment the claimant credibly testified he could not open; emailing a document is not delivery reasonably calculated to ensure actual receipt unless the electronic disclosure safe harbor is actually satisfied, and nobody followed up. Claims teams should pull a sample denial letter this week and check for a concrete expiration date, and make sure requested plan documents actually reach the employee.

In its June 17 decision in Justman v. Accenture, now drawing commentary, the Third Circuit held that a denial of benefits claim under ERISA section 502(a)(1)(B) must be brought against the entity obligated to pay benefits or the one that controls the benefit determination, not merely the employer designated as plan administrator. Prudential denied the accidental death claim and later settled; Accenture, which retained administrative duties but no authority over claims decisions, was dismissed, and a separate fiduciary claim failed because the complaint did not adequately allege a missed disclosure deadline or resulting harm. For sponsors the decision is a reason to make sure plan documents and summary plan descriptions say plainly who decides claims, and that practice matches the paper. Clean allocation of authority is what got Accenture out.

December 31, 2026 is the deadline for most calendar-year retirement plans to document, in a formal amendment, the CARES, SECURE and SECURE 2.0 changes they’ve been operating under, from Roth catch-ups for high earners and long-term part-time eligibility through super catch-ups, higher RMD ages and the optional early-withdrawal provisions. Informal IRS guidance from September 16 suggests some SECURE 2.0 amendment deadlines may slip, but the firm still recommends documenting everything implemented as part of this year-end. The discretionary review is where the litigation lessons show up. The firm suggests forfeiture language that makes the allocation choice a plan-design decision rather than a fiduciary one, claims procedures with limitations and venue provisions, a look at arbitration language, and beneficiary procedures that answer what happens after a divorce or when a beneficiary dies before being paid.

Whether a severance program is an ERISA plan decides where and how disputes over it get fought, and John Deere is arguing its program is not one. Two former employees claim they were entitled to payments from the program the company offered in its 2024 layoffs, a one-time lump sum based on years of service and pay. Deere's motion to dismiss rests on the Supreme Court's Fort Halifax decision: a single payment from a single event, calculated with fixed inputs, requires no ongoing administration and so is not an ERISA plan at all. The company also argues neither plaintiff qualified regardless, one because he was terminated individually rather than in a layoff, the other because he resigned, signed a waiver in exchange for three months of pay, and kept the money. This is a motion, not a ruling. But sponsors design severance on both sides of the Fort Halifax line, sometimes deliberately, and the case is a reminder that the design choice controls everything from claims procedures to which court hears the fight.

In Germana v. Hartford, a registered nurse's benefits ended when his policy's test moved from inability to do his own job to inability to do other work the policy covers. The court upheld the termination and rejected each of his challenges. A denial letter has to explain the decision, the court held, not coach a winning appeal. Hartford could require objective evidence of his functional limits. And a psychiatric report submitted nine months after the final appeal decision came too late to count, because pandemic-era extensions gave claimants more time to file appeals, not a longer window to add evidence afterward.

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.

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.

Roberts Disability Law analyzes the October 20 [decision](https://digest.theinnerfirm.com/docs/wong-v-metlife-order-2026-10-20.pdf) awarding long-term disability benefits to a research scientist after a trial on the record. Reviewing the benefit claim independently, without deferring to the insurer, the court found the policy’s own-occupation standard turned on the scientist’s actual job duties, which demanded sustained concentration and analysis, and credited providers who had actually interacted with the claimant over MetLife’s paper reviewers. The ruling establishes entitlement back to November 2023 and leaves the amount for the parties to agree on or litigate. For administrators, the weight given to interactive evaluations is the practical lesson.

A retroactive Social Security award can leave a disability-plan participant owing money back to the insurer. Roberts Disability Law analyzes the October 20 [decision in Doolittle](https://digest.theinnerfirm.com/docs/doolittle-v-hartford-decision-2026-10-20.pdf) upholding Hartford’s recovery of a $43,890 overpayment by withholding benefits. The policy and the participant’s signed reimbursement agreement supported that treatment, and two promptly corrected errors did not make Hartford’s decision unreasonable under the deferential review the court applied. Hartford had completed recovery and resumed payments, including a $780 refund, before the ruling. For disability-plan administrators, the case shows the importance of clear offset terms, signed reimbursement elections and a defensible calculation.

Hartford missed a disability-appeal deadline and lost the benefit of deferential court review. In Farley v. Hartford, a Missouri federal judge [ruled September 30](https://digest.theinnerfirm.com/docs/farley-v-hartford-order-2026-09-30.pdf) that the insurer’s late response required an independent review of its denial, using the record as it stood when the appeal deadline expired. The court also found substantive flaws. Hartford identified jobs requiring retraining that the policy didn’t require, and its vocational analysis conflicted with the physical restrictions its own reviewing doctor imposed. The judge vacated the denial and sent the claim back to Hartford for a renewed review, without ordering immediate payment of benefits.

In Klusmann v. AT&T Umbrella Benefit Plan No. 1, the claims administrator took its full 45-day extension, promised a decision by July 29, and issued it July 31. The missed deadline meant the judge reviewed the denial independently, without deferring to the administrator’s decision. The Northern District of Ohio held that the 2017 claims-procedure amendments displaced the Sixth Circuit’s old tolerance for late decisions, and that while a two-day miss was small, the administrator had everything it needed three weeks earlier and the scheduling lag was its own doing. Looking at the record fresh, the court treated the functional capacity evaluation and a neuropsychological report as objective medical evidence no physician in the record rebutted, observed that defense counsel’s arguments aren’t themselves medical evidence, and awarded benefits outright, retroactive to November 2023, rather than give the administrator a second chance. Claims teams should read this one next to their deadline calendars.

Patrick Hawkins sued Wells Fargo and its short-term disability plan over denied benefits, and separately claims he was fired for pursuing those benefits and for providing information to the Labor Department. Wells Fargo’s arbitration agreement covers employment claims broadly but carves out ‘claims for benefits under the Employee Retirement Income Security Act.’ In a September 28 opinion, Magistrate Judge Andrew Edison in Galveston read the carve-out narrowly. The claim seeking the unpaid disability benefits stays in court, and both sides agreed it should. The claim that Wells Fargo fired him for pursuing those benefits, brought under ERISA section 510, goes to arbitration along with his disability discrimination claims, because it attacks the termination rather than seeking benefits. The opinion collects decisions from other courts reading similar language the same way. Anyone who assumed an ERISA carve-out keeps every ERISA claim in court should reread their arbitration agreement with that distinction in mind.

Michelle Roberts breaks down Macpeak v. Unum, a September 28 decision of the Eastern District of Pennsylvania. The plan’s own words decided the case. For attorneys, this Unum plan defined ‘regular occupation’ as the lawyer’s specialty in practice, yet Unum’s vocational review and all three of its reviewing physicians measured the claimant, a securities lawyer with migraines and cyclical vomiting syndrome, against the generic duties of an attorney from a national database, trial work and patent applications included. Even under deferential review an administrator can’t read the plan’s language away, and the court leaned on Third Circuit precedent about diluting a specialty with generalized occupational data. The remedy followed from the history. Because Unum had paid benefits for six years before cutting them off, the court ordered those benefits restored retroactively rather than sending the claim back to Unum for another review.

Lockton runs one of the country’s largest insurance brokerages, and two of its employees now claim it put itself on both sides of its own benefits plan. Lockton sponsors its welfare plan and serves as the plan’s named fiduciary, and the complaint alleges it also installed itself as the plan’s broker. In that role, the suit says, Lockton picked the carriers for employee-paid products from life insurance to long-term disability, set its own commission and fee structure, and let carriers build that compensation into the premiums employees paid by payroll deduction. The complaint puts that compensation at $3.3 million from 2020 through 2024, drawn from the plan’s own government filings, with some fees routed through a benefits-communication firm Lockton fully acquired in 2025. The claims accuse Lockton of using its position to benefit itself at employees’ expense, and the relief sought includes repayment of the allegedly improper compensation and appointment of an independent person to oversee the plan. Capozzi Adler filed October 1 in Kansas City federal court, the latest in a wave of voluntary-benefits suits filed since December 2025. Lockton hasn’t yet responded in court.

Kathleen Macpeak is a securities lawyer at Morgan Lewis who suffers from migraines and cyclic vomiting syndrome. Unum paid her long-term disability claim for six years, then terminated it in 2023 after its reviewers assessed whether she could perform the duties of an attorney in the national economy, trial work, patents, and teaching included, none of it her practice. The plan's own terms define an attorney's regular occupation as her specialty in the practice of law. Judge Mary Kay Costello held that ignoring the specialty and treating the claimant as a generalist conflicted with the plan's plain language and was an abuse of discretion. The court ordered Unum to reinstate her benefits retroactive to the November 2023 termination, with interest.

Roberts Disability Law analyzes the September 18 Schuyler decision. Sun Life's first vocational expert said the claimant's sales job required standing and walking about six hours a day; its second expert, on appeal, called the same job sedentary, and Sun Life denied benefits on the second description without explaining the switch. Judge Ronnie Abrams held that failing to explain a disagreement with the insurer's own expert violates the Department of Labor's claims regulation, so Sun Life lost the deferential review its plan terms would otherwise have earned, and the court looked at the claim fresh. The record was too disputed for summary judgment, and the court sent the claim back to Sun Life to consider in full, including the claimant's favorable Social Security award.

A former registered nurse received benefits under his plan's own-occupation standard, but when the definition shifted to any occupation, Hartford's reviewing physicians (and his own primary care doctor) said he could handle full-time seated work. Judge Mark Mastroianni upheld the termination, giving the insurer's judgment the leeway the plan provides, and holding that Hartford could require objective evidence of functional limits, that its denial letter gave adequate notice of what an appeal needed, and that adding evidence for the same rationale in litigation isn't an improper new justification.

Roberts Disability Law analyzes the Young decision. The claimant argued that a Maine law banning discretionary clauses in disability policies stripped Aetna of deferential review. Judge Patrick Schiltz held the statute reaches only policies issued, continued, or renewed after it took effect in 2019, and that paying an existing claim is a legal obligation, not a renewal, so the 2014 policy kept its discretionary clause. The court also rejected the argument that seven years of payments shifted the burden to Aetna to prove improvement: under the plan, proving continued disability stayed the claimant's job at all times.

Lincoln stopped paying disability benefits to a longtime Duke Energy worker whose job involved operating and repairing natural gas equipment, and a federal judge has now ordered the insurer to reconsider. Lincoln's three medical reviewers never examined Melinda Oliver-Smith, even though the policy allowed an examination and her psychiatric symptoms raised serious questions about working safely. Lincoln also failed to adequately explain why it disagreed with a Social Security disability award based on overlapping evidence, an award it had required her to pursue and that reduced what Lincoln itself owed. The court sent the claim back for another review rather than awarding benefits, because the record didn't clearly establish entitlement throughout the disputed period.

A lead mechanic suffered a stroke at home, fell, struck his head, and died three days later. The autopsy called the death an accident caused by the fall, with the stroke contributing. His widow sought the accidental death benefit under the employer's group policy, which pays only for injuries independent of illness, and Hartford denied the claim because the fall followed an acute stroke. The court ruled for Hartford on September 25, concluding that the denial was correct even when reviewed independently. A medical examiner's finding that a death was accidental did not settle the insurance question, because this policy also required the injury to be independent of illness. Participants rarely learn that distinction until a claim, which makes it worth a line in benefits communications.

Aetna paid Maree Young's long-term disability claim for seven years after cyclic vomiting syndrome and a metabolic brain injury ended her career as a TD Bank business management specialist, then terminated it in 2023 when her treating doctors' notes showed the episodes coming under control and an independent examiner found no objective basis for restrictions. [The September 24 summary judgment order](https://digest.theinnerfirm.com/docs/young-v-aetna-order-2026-09-24.pdf) upholds the termination. Years of payments did not lower what Young had to prove: the plan requires proof of disability at all times, not proof of improvement, so the burden stayed hers. Two factors cut in Young's favor, and the court gave each "some weight, but not much." Aetna both decides claims and pays them, a conflict of interest courts take into account. And the Social Security Administration found Young disabled in 2018, but that finding was five years old by the time Aetna ended her benefits. The order is no rubber stamp. The court found Aetna's surveillance "not terribly useful," since grocery shopping says little about someone's ability to do her job, and it had some sympathy for the memory and concentration claim. What decided that claim was the file: her newest neuropsychological evaluation was three years old, Aetna had warned it wanted current testing, and she stood on the old results. The court dismissed the case permanently. For claimants and plans alike, the freshness of the medical record can decide the case.

Milliman's annual market survey puts group disability and statutory leave coverage at $24.4 billion of in-force premium for 2025, up from $23.4 billion, with paid family and medical leave the fastest growing piece at 8.7 percent. The sales picture is softer. New sales premium fell from $3.2 billion to $3.0 billion, long-term disability sales dropped 6.6 percent, and paid family and medical leave sales dropped 20.3 percent, while average new-business premium per covered life rose 15.9 percent for long-term disability coverage. For employers, the survey is context for disability and statutory leave renewals.

In Bachand v. Reliance Standard, a Medtronic engineer with autoimmune hepatitis lost her benefits when the policy shifted from her own job to any suitable work. Even reviewing the claim independently, without deferring to the insurer, the court sided with Reliance. Her doctor's disability letter was contradicted by his own contemporaneous notes ("some fatigue and muscle aches but improved"), and he never returned four voicemails from the insurer's reviewing physician, which the court said supported rejecting his opinion.

In DiGeronimo v. Unum, the court upheld Unum's denial of a demolition executive's disability claim. He had worked full-time with nighttime seizures for sixteen years before claiming his epilepsy became disabling in 2020. His treating neurologist's letters never discussed how often the seizures occurred and came after a nineteen-month gap in visits, and he drew a $42,000 salary from his house-flipping company after claiming disability. On his "cherry-picking" accusation, the court held the charge cuts both ways, and that relying on reviewers who disagree with a treating physician isn't cherry-picking.

A federal judge upheld Unum's termination of a corporate lawyer's disability benefits after reviewing the claim independently rather than giving the insurer's decision extra weight. In Syed v. Unum, the claimant still had to prove that she couldn't perform her job under the policy's terms. Her records showed that her condition had stabilized, and later diagnoses of POTS and chronic fatigue didn't establish the necessary work limitations. Roberts Disability Law explains that a diagnosis alone doesn't prove entitlement to disability benefits.

Two courts reviewed disability terminations this week under opposite rules, and the treating doctor's letter lost both times.

Siobhan Haldeman's lawyer asked Mass General Brigham for the plan documents governing her long-term disability claim on September 18, 2024, and received them 230 days later, after this lawsuit was filed. Judge Burroughs ordered MGB to pay a $5,000 penalty under ERISA's document-request provision, which now authorizes up to $110 a day, describing the award as a middle route between precedents. MGB's defense was that Haldeman's counsel already had the documents from representing other participants. The court's answer: “MGB never told Haldeman's counsel that she already possessed the Plan Documents; to the contrary, it repeatedly promised to promptly deliver the Plan Documents, then failed to do so.” Being deprived of plan terms while preparing an appeal is inherently prejudicial, the court held. Haldeman is entitled to attorney fees, with the amount to be set after a fee motion due in fourteen days. The plan itself escaped liability on an important distinction: the penalty applies to the administrator, not the plan. [Roberts Disability Law's same-day commentary](https://robertsdisability.com/what-happens-when-an-erisa-plan-administrator-ignores-your-request-for-documents) reads the case from the claimant side.

Saul Ewing's monthly roundup runs procedural this time, and usefully so. A California court kept a long COVID disability case in the plaintiff's chosen district even though she lived, and most of her doctors practiced, in another one, deference that carries extra weight in ERISA cases. A Florida plaintiff won leave to dismiss and refile elsewhere after seventeen months of litigation, on condition she pay the insurer's costs. A Minnesota court refused to let defendants swap in a new rationale for a denial once litigation began. An Illinois court rejected a claimant's oral testimony that he mailed a timely appeal, drawing a negative inference from his failure to produce the letters themselves. And a South Carolina court held an eighteen day review was enough where the denial turned on eligibility rather than disability.

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.

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.

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.

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 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.

Saul Ewing’s recap of an October 6 discussion with Maryland officials covers the choice employers face between the state’s Family and Medical Leave Insurance program and approved private arrangements. Even a small employer with one Maryland-based employee can be covered. The work the discussion maps out runs through payroll withholding, HR administration, existing leave policies and disability benefits, which all have to line up behind whichever route the employer picks.

An employee’s payment of every premium didn’t keep her supplemental disability policy outside ERISA. In Whitlock v. Provident, the court found that Lockton’s role included negotiating a discount, presenting the policy as part of its benefits package and receiving commissions. That involvement defeated the regulatory exemption for certain voluntary insurance arrangements. The court separately ruled that Whitlock hadn’t proved entitlement to partial-disability benefits. PLANSPONSOR reports on the decision. The two results answer different questions about the policy’s legal status and the evidence supporting the claim.

Roberts Disability Law’s analysis of Whitlock v. Provident reaches beyond the label on a voluntary benefit. The employer’s endorsement and receipt of commissions brought the supplemental disability policy under ERISA, but the claimant still had to prove that she met its partial-disability definition. A reduction in earnings satisfied one element; it didn’t establish the required limits on her ability to work. The court also found that the final appeal decision used the appropriate disability standard despite a problem in the initial denial. The insurer won on the record, including evidence about the claimant’s continued work in her own business.

Comments closed September 21 on DOL's proposed electronic-disclosure option for group health plans. Under the proposal, plans could email a notice that documents are available online, but couldn't use that option to email the documents themselves because they may contain sensitive health information. Participants could request unlimited free paper copies. A single summary plan description covering medical, life, and disability benefits presents a complication. The new option would cover the medical benefits, while life and disability benefits would remain subject to the existing delivery rules, which allow workplace computer access or the recipient's agreement to electronic delivery. DOL requested comments on how to address the gap.

Roberts Disability Law's summary of Doe v. The Signature Benefits Plan, the decision that led yesterday's Court section, adds a point our writeup didn't reach: the court reviewed the entire administrative record, including documents from the independent external review, because the plan itself made external review final and binding. Here, the court treated the external review as part of the claims process, so it considered those documents too. The full findings of fact are in yesterday's issue.

Gardening and an occasional astrology reading didn't establish that a project manager with young-onset Parkinson's disease could sustain a job. In Zayn v. Unum, No. 3:25-cv-01190-JR (D. Or. Sept. 15, 2026), Magistrate Judge Jolie A. Russo ordered the insurer to restore her long-term disability benefits. Unum relied on surveillance, online activity and doctors who reviewed records without examining her, and two of those reviews used information from another claimant's file. Reviewing the evidence independently rather than deferring to the insurer, the court found that her treating providers' findings supported continuing disability and that her limited activities didn't outweigh evidence of cognitive impairment and fatigue that prevented reliable work. The court reinstated benefits effective November 27, 2024, with back benefits, interest, fees and costs to be worked out. The case illustrates why a claim review needs to connect observed activities to the demands of sustained employment. [Roberts Disability Law's summary](https://robertsdisability.com/parkinsons-doesnt-improve-district-of-oregon-reinstates-erisa-long-term-disability-benefits-unum-terminated-after-surveilling-a-claimants-astrology-hobby/) brought the decision to our attention.

A former player's fiduciary breach claims against the two physicians who reviewed his neurocognitive disability claim ended at the pleading stage, with prejudice. The plan makes a medical advisory physician's determination final and binding on medical issues the board refers, but the court read that authority as exactly what it says, medical judgment on a discrete question, while the board keeps full and absolute discretion over plan interpretation and benefit entitlement. Advising professionals become fiduciaries only through an unusual degree of influence over the plan, and neither co-authoring an examiner manual nor an alleged pattern of claim-unfriendly findings supplies it. The benefits claim against the plan itself continues.

A question mental health claimants increasingly ask, answered down the middle. In J.W. v. Quantum Health, a Southern District of Ohio magistrate judge let a family litigating a residential treatment denial proceed under first names and last initials while refusing full pseudonymity, finding only one of the Sixth Circuit's Porter factors satisfied, the utmost intimacy of a child's behavioral health history. The practical read is that partial anonymity may be reachable in benefits cases where the full pseudonym bar is not, decided case by case. It also mattered that the defendants already knew exactly who the plaintiffs were.

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.

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.

Sun Life's first vocational expert described Schuyler's sales job as requiring walking or standing six hours a day. On appeal, a second expert cut that to about two and a half hours, and Sun Life adopted the lighter standard without ever explaining why it abandoned its own earlier expert, as the claims regulation requires. In Schuyler v. Sun Life, the court found the unexplained switch could affect the outcome, so it will no longer defer to the insurer's judgment, and the brain-injured claimant's case heads back to Sun Life to be decided on the full record, including a favorable Social Security award.

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.