Published
This month’s Friday Five covers recent decisions considering credibility of disability evidence—including a treating physician who “walked back” his opinion on work restrictions and differing approaches to Plaintiffs’ subjective statements of disability—as well as an interpleader case involving a failed attempt to invoke ERISA preemption to salvage a legally invalid marriage.
The Saul Ewing ERISA Litigation Team
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District of Massachusetts is unpersuaded by Plaintiff’s everything-but-the-kitchen-sink litigation approach. Plaintiff, a former registered nurse, submitted a claim for long-term disability (LTD) benefits, due to abdominal pain. The insurer terminated Plaintiff’s benefits when the definition of “Disability” changed from requiring disability from “Your Occupation” to “Any Occupation” because Plaintiff was capable of performing sedentary work. Plaintiff alleged the benefit termination was arbitrary and capricious for a number of reasons, including that the insurer:
- failed to provide adequate guidance on what to include in his appeal letter—the court explained that the administrator is not required to suggest the type of information that might be helpful in an appeal;
- engaged in impermissible post-hoc rationalization by raising new arguments in litigation which were not raised during the administrative review—the court acknowledged the insurer consistently indicated it had terminated LTD benefits under the “Any Occupation” definition in the policy;
- inappropriately relied on a peer review containing allegedly inconsistent recommendations for driving and sitting—the court agreed with the insurer that sitting and driving are different experiences that could have different restrictions;
- did not credit Plaintiff’s reports of subjective pain and medication side effects—the insurer and the peer-reviewing physicians did indeed consider the subjective reports “but they simply ‘determined that the evidence did not satisfactorily prove that [Plaintiff] was eligible for LTD benefits under the Plan.’” (quoting Santana-Diaz v. Metropolitan Life Ins. Co., 919 F.3d 691, 696 (1st Cir. 2019));
- improperly refused to consider a physician report Plaintiff submitted nine months after the insurer’s decision on appeal to uphold the denial—the court noted that evidence collected after the final administrative decision is inadmissible;
- illegally relied on physicians not licensed to practice in Massachusetts—the federal regulations do not require a consulting physician to be licensed in the state in which a claimant resides; and
- acted unfairly due to the insurer’s structural conflict of interest—the “bald fact” that the insurer made an adverse benefit determination is not evidence of structural conflict, bias, or unfair claim processing
As noted in response to the individual arguments above, the court rejected each of Plaintiff’s arguments, denied Plaintiff’s motion for summary judgment, and granted summary judgment in favor of the insurer. Germana v. Hartford Life and Accident Ins. Co., No. CV 23-30065-MGM, 2026 WL 2823567 (D. Mass. Sept. 21, 2026)
- Northern District of California finds insurer is not required to accept Plaintiff’s subjective complaints “at face value.” Plaintiff received LTD benefits after leaving work due to autoimmune hepatitis, which carried with it a “constellation of symptoms,” including fatigue, ear ringing, headaches, liver pain, “brain flutter,” nausea, and shortness of breath. The insurer terminated LTD benefits upon transition to the “Any Occupation” definition of “Totally Disabled” under the policy. To support the severity of her symptoms, Plaintiff provided a letter from her treating physician and a personal statement detailing her struggles with fatigue and other symptoms. However, the treating physician noted continuous improvement of Plaintiff’s symptoms and focused on the demands of Plaintiff’s own occupation, rather than the demands of “Any Occupation.” Regarding Plaintiff’s personal statement, the court explained the insurer is not required to accept Plaintiff’s reported symptoms at face value and could “take the lack of objective evidence into account in making its decision.” (quotation omitted). The court determined Plaintiff failed to carry her burden of establishing total disability and found in the insurer’s favor. Bachand v. Reliance Standard Life Ins. Co., No. 25-CV-02061-MMC, 2026 WL 2723471 (N.D. Cal. Sept. 15, 2026)
- District of Oregon credits treating physicians and personal statements as persuasive evidence of total disability. In contrast to the Bachand case discussed above, the District of Oregon determined that statements from Plaintiff and her partner and friend describing subjective complaints—such as problems with processing speed, concentration, and fatigue—to be persuasive. Plaintiff stopped working due to physical and mental symptoms that were ultimately diagnosed to be young-onset Parkinson’s disease when Plaintiff was 37 years old. She received LTD benefits, but the insurer terminated the benefits, finding she was not disabled from “Any Occupation.” In addition to the personal statements, the court relied on reports from Plaintiff’s treating physicians, which the court found to be more credible and probative of Plaintiff’s condition than the insurer’s consulting physicians—none of whom personally examined Plaintiff. The court found Plaintiff was totally disabled from performing the duties of any occupation and granted Plaintiff reinstatement of the LTD benefits at issue, as well as back benefits and attorney fees and costs. Zayn v. Unum Life Ins. Co. of Am., No. 3:25-CV-01190-JR, 2026 WL 2719813 (D. Or. Sept. 15, 2026)
- Eighth Circuit finds treating physician “backtracked” Plaintiff’s recommended restrictions. Plaintiff was a sheet metal fabricator before he injured his shoulder. He received LTD benefits until the definition of “disabled” changed to the “Any Occupation” standard of being “unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience.” Plaintiff’s physician performed an arthroscopic procedure on Plaintiff’s shoulder and anticipated he would need four months to recover. The physician then reported that Plaintiff could perform sedentary work; he remained steadfast in his opinion that Plaintiff was capable of sedentary work from June 2020 to May 2022. However, the physician changed course after the insurer terminated Plaintiff’s LTD benefits and began to opine that Plaintiff could not return to work. The Eighth Circuit found the District of Minnesota did not clearly err in refusing to credit the physician’s “attempt to walk back [Plaintiff’s] restrictions after-the-fact.” Halloran v. Unum Life Ins. Co. of Am., No. 25-2550, 2026 WL 2545315, -- F.4th -- (8th Cir. Aug. 28, 2026)
- Northern District of Alabama considers interpleader action on competing claims for life insurance proceeds. After the insured died, his purported wife and three daughters from a prior marriage made competing claims to the life insurance proceeds. The insurer filed an interpleader action. The daughters contended that the wife was not a valid beneficiary because the insured designated the wife as beneficiary over the telephone rather than in writing as required by the terms of the policy. The court agreed and determined the telephonic beneficiary designation for the wife was invalid. Next, the daughters argued that they were entitled to the proceeds rather than the wife because the “wife” was not the insured’s lawful spouse. Indeed, the wife was already married to another individual at the time of her marriage to the insured. Applying Georgia law (the state in which the purported marriage to the insured took place), the court found the marriage to be void and thus, the wife was unable to receive the insurance proceeds as the insured’s spouse. The court was unpersuaded by the wife’s argument that ERISA preempts state law regarding marriage validity—“preemption is not an issue here because ‘federal courts routinely rely on state law to identify a participant's spouse’ in an ERISA plan.” (quoting IBEW Pac. Coast Pension Fund v. Lee, 462 Fed. Appx. 546, 549 (6th Cir. 2012)). Accordingly, the court denied the wife’s motion for summary judgment and granted the daughters’ motion, finding the daughters were the rightful beneficiaries. Metro Life Ins. Co. v. Williams, No. 4:24-CV-00357-CLM, 2026 WL 2569485 (N.D. Ala. Aug. 31, 2026).
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