Published
This month's Friday Five highlights recent decisions addressing the scope of permissible discovery outside of the administrative record, the admissibility of certain evidence in an LTD benefits termination trial, the role social media posts played in supporting the decision to terminate benefits, and what evidence and discovery may be considered in an ERISA appeal. The cases also reaffirm that determinations of disability by social security are not dispositive, and that the opinion of a treating physician is not due special weight.
The Saul Ewing ERISA Litigation Team
- Scope of permissible discovery under arbitrary and capricious standard of review addressed. In a dispute over termination of LTD benefits, the plaintiff sought to conduct discovery beyond the administrative record. The defendant insurer did not oppose the request. Nevertheless, the court engaged in an analysis of the appropriate scope of discovery, finding that it was dependent upon the standard of review. The parties did not agree on the standard of review but agreed to conduct "limited discovery as if the 'arbitrary and capricious' standard of review" applied. The court granted the plaintiff's request for limited discovery so as to support her claim that the termination decision was tainted by self-interest and/or was arbitrary and capricious. Consistent with the standards set out in Cerrito v. Liberty Life Insurance Co. of Boston, 209 F.R.D. 663, 664 (M.D. Fla. 2002), the plaintiff was permitted discovery on: (1) the exact nature of the information considered by the fiduciary in making its decision; (2) whether the fiduciary was competent to evaluate the information in the administrative record; (3) how the fiduciary reached its decision; (4) whether, given the nature of the information in the record, it was necessary for the fiduciary to seek outside technical assistance to ensure a "full and fair review" of the claim; (5) whether a conflict of interest existed; (6) determination of the proper standard of review; (7) whether the defendant followed proper procedures in reviewing and denying the plaintiff's claim; and (8) whether the record was complete. Miller v. American United Life Insurance Company, No. 8:25-cv-1670-KKM-AAS, 2025 WL 3269397 (M.D. Fla. Nov. 24, 2025).
- Admissibility of evidence relating to disability, medical conditions, and calculation of damages addressed on motions in limine prior to LTD termination trial. In anticipation of a trial on the propriety of the insurer's decision to terminate LTD benefits, the parties filed various motions in limine. Plaintiff sought to preclude opinions by various medical professionals proffered by the defendant to prove that the plaintiff was not disabled. Because the evidence was concededly relevant, the Court denied the motion. Plaintiff also sought to limit the defendant's defense to the bases articulated in its denial letters. The court rejected the contention that equitable estoppel or the "mend the hold" doctrine applied and denied the plaintiff's motion. The court granted in part and denied in part plaintiff's motion to preclude evidence of income from other sources. The court held that the probative value of discrete income amounts received by the plaintiff from sources outside of his regular occupation was outweighed by a substantial risk of unfair prejudice, but that evidence of his professional endeavors generally was permissible. For its part, the defendant sought to preclude evidence suggesting that the plaintiff had suffered a brain injury and had a brain condition on the basis that the claim was not supported by medical evidence. The court denied that motion, holding that it was inappropriate to bar mention of the potential injury or condition. On defendant's motion, the court precluded testimony regarding the plaintiff's ability to function as a patent attorney but allowed testimony regarding the ability to perform various types of cognitive tasks. Finally, the court partially granted defendant's motion to preclude the plaintiff from presenting a calculation of residual disability, barred plaintiff from relying on evidence of damages provided months after the close of discovery and barred plaintiff from introducing evidence of defendant's gross profits and executive compensation as it related to liability. The court held, however, that such evidence was permissible to the extent that the issue of punitive damages came before the jury. Husick v. Unum Life Insurance Co. of America, NO. 21-cv-5599, 2025 WL 3266123 (E.D. Pa. Nov. 21, 2025).
- Decision to terminate Plaintiff's long-term disability benefits based, in part, upon social media posts upheld. Plaintiff received LTD benefits beginning in 2011 under a policy that allowed for benefits for twenty-four months if she was unable to perform her regular occupation due to sickness or injury, and beyond that period, only if she was unable to work in any gainful occupation for which she was reasonably fitted by education, training, or experience. In 2021, the insurer obtained social media evidence showing the Plaintiff traveling, catering food events, attending long performances, and participating in activities allegedly inconsistent with her reported limitations. The insurer terminated her benefits on the basis of the posts. Applying an arbitrary and capricious standard of review, the district court upheld the termination, and the Eleventh Circuit affirmed. The court cited, among other things, the plaintiff's social media activity, which "indicated improved functional capacity." Eggleston v. Unum Life Ins. Co. of Am., No. 24-13678, 2025 WL 3472834 (11th Cir. Dec. 3, 2025).
- Finding of disability by SSA insufficient to support challenge to termination of LTD benefits under "any occupation" standard. The plaintiff was a former software engineer who applied for LTD benefits in 2019 due to chronic back pain and lumbar degenerative disease. The LTD policy defined disability for the first 24 months as the inability to perform one's "own occupation." Thereafter, an individual was disabled if they could not perform the material duties of "any occupation." Following a medical file review, transferrable skills analysis and any occupation review, the defendant denied the plaintiff's claim for continued LTD benefits after 24 months. The plaintiff appealed the decision and submitted additional medical and Social Security Administration ("SSA") records showing that the claim for disability benefits was approved. Applying an abuse of discretion standard of review, the court found that reasonable grounds supported the insurer's decision; the medical evidence and vocational assessments indicated Plaintiff could perform sedentary work. The court also held that the SSA's decision was not dispositive under ERISA standards. Forbus v. Standard Insurance Company, 2025 WL 3541545 (S.D. Fla. Nov. 17, 2025).
- Termination of LTD benefits upheld because Plaintiff did not meet the Plan's definition of disability, and no special weight was to be afforded opinion of treating physician or results of FCE. The Plaintiff worked as a registered nurse when she developed symptoms generally attributed to "post-COVID long hauler syndrome" and other related conditions. Plaintiff was initially approved for LTD benefits from August 16, 2021 through December 15, 2021. Based on multiple reviews of the plaintiff's updated medical records, the defendant determined that the plaintiff was no longer precluded from performing her job duties and terminated benefits. The defendant upheld its decision on appeal. Applying an abuse of discretion standard of review, the court held that the denial of benefits was "not wrong." The court recognized that "no special weight [is] to be accorded the opinion of a treating physician and further noted that the treating physician's opinion relayed self-reported symptoms which were unsupported by the medical records in their totality. The court also rejected the contention that plaintiff's functional capacity evaluation (FCE) should be afforded "special weight." Finally, the court held that the termination decision was not influenced by a conflict of interest. The court held that financial considerations did not guide the medical consultants' opinions and, instead, they were supported by the record as a whole. Stewart v. Unum Life Insurance Company of America, 2025 WL 3551882 (N.D. Ga. Feb. 6, 2025).
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