This month’s Friday Five explores decisions (1) upholding a choice of law provision in a long-term disability policy, (2) granting an administrator’s request for reimbursement after overpaying a claimant for years, (3) denying cross-motions for summary judgment in light of conflicting credible physicians’ reports, (4) applying a de novo standard of review due to an administrator’s untimely decision during the administrative appeal process, and (5) affirming an administrator’s termination of long-term disability benefits based on insufficient evidence connecting the claimant’s symptoms to her physical condition.
- Court Upholds Choice of Law Provision in Long-Term Disability Policy. The U.S. District Court for the Northern District of California upheld a Massachusetts choice of law provision in a long-term disability policy. The plaintiff filed her case in California and invoked Cal. Ins. Code § 10110.6(g), which voids discretionary clauses in disability insurance policies. However, the policy at issue contained a Massachusetts choice of law provision, and Massachusetts law does not similarly void discretionary clauses. According to the federal choice of law rule in the Ninth Circuit, courts should honor contractual choice of law provisions in ERISA contracts if they are “not unreasonable or fundamentally unfair” when “viewed from the time when the contract was made.” Here, the court held that it was fair and reasonable to apply Massachusetts law because the policy was entered into in 1972 (long before § 10110.6(g) took effect), the plaintiff’s employer is based in Massachusetts, and the employer has thousands of employees around the world, making it reasonable for the parties to agree to a uniform application of Massachusetts law. Moorhead v. Unum Life Ins. Co. of Am., No. 25-cv-01826-HSG, 2026 WL 874398 (N.D. Cal. Mar. 30, 2026).
- Administrator Entitled to Reimbursement After Overpaying Long-Term Disability Claimant for Years. After being overpaid LTD benefits for several years, the plaintiff filed a lawsuit to prevent her plan administrator from seeking reimbursement and reducing her benefits. The defendant previously approved the plaintiff’s claim for LTD benefits subject to an offset for “other income benefits,” including any disability benefits from the Social Security Administration. The plaintiff received two types of Social Security benefits: monthly disability benefits and disabled divorced widow’s benefits. Due to an error in the defendant’s internal calculations and the plaintiff’s inaccurate reporting, the defendant failed to account for the plaintiff’s disabled divorced widow’s benefits and overpaid her a sum of $16,000 over the course of approximately three years. The court, in reviewing the defendant’s decision under an arbitrary and capricious standard of review, determined that the defendant was reasonable in concluding that the plaintiff’s disabled divorced widow’s benefits qualified as an offset under the policy, and that it was entitled to reimbursement. Harling v. Hartford Life & Accident Ins. Co., No. 6:24-cv-1237-ACA, 2026 WL 837100 (N.D. Ala. Mar. 26, 2026).
- Court Denies Cross-Motions for Summary Judgment in Light of Conflicting Credible Physicians’ Reports. In an ERISA long-term disability dispute, the court denied the parties’ cross-motions for summary judgment where several credible doctors came to opposite conclusions regarding the severity of the plaintiff’s medical condition. The plaintiff contracted COVID-19 and was thereafter diagnosed as a “COVID-19 long hauler.” In their summary judgment briefing, the parties marshaled conflicting medical opinion evidence regarding the severity of the plaintiff’s symptoms and whether she qualified as “disabled” under the terms of the policy. According to Second Circuit precedent, summary judgment is inappropriate where two or more potentially credible physicians’ reports conflict, as credibility determinations should be reserved for trial. Thus, the court denied the parties’ cross-motions for summary judgment, finding a genuine dispute of material fact regarding the plaintiff’s eligibility for LTD benefits. Delvalle v. Unum Grp. Corp., No. 22-CV-07717-LTS, 2026 WL 878595 (S.D.N.Y. Mar. 31, 2026)
- Administrator’s Untimely Decision on Claimant’s Appeal Warranted De Novo Review. The plaintiff filed a motion for summary judgment and argued that the court should apply a de novo standard of review because the defendant’s decision during the administrative appeal process was untimely. An administrator typically has 45 days to render a decision once an administrative appeal is filed; here, the defendant’s decision was 66 days late. The court rejected the defendant’s argument that it successfully invoked a 45-day extension while waiting for an independent medical review, as this did not constitute a “special circumstance” under the applicable regulations. After reviewing the administrator’s decision de novo, the court granted plaintiff’s motion for summary judgment, finding that she met the definition of “Totally Disabled” under the policy. The court held that the defendant erred in concluding that the plaintiff could perform some sedentary work that required occasionally lifting ten pounds while simultaneously conceding that the plaintiff could not lift more than five pounds. Booth v. First Reliance Standard Life Ins. Co., No. 24 Civ. 3927 (KPF), 2026 WL 861640 (S.D.N.Y. Mar. 30, 2026)
- Administrator Properly Terminated Claimant’s Long-Term Disability Benefits Due to Lack of Evidence Connecting Symptoms to Physical Condition. Where the claimant argued that her long-term disability benefits were wrongfully terminated, the issue was whether the claimant’s disabling symptoms stemmed from her physical or mental condition during the relevant time period. The claimant was diagnosed with acromegaly after doctors discovered a pituitary adenoma growing on her brain. The adenoma was completely removed and did not reoccur; however, the plaintiff went on to develop debilitating conditions related to the removal, such as hormonal deficits, chronic fatigue, cognitive disfunction, and severe headaches. The plaintiff separately suffered from major depressive disorder, social anxiety, and PTSD. The policy provided long-term disability benefits for total disability resulting from “sickness or injury,” and separate benefits for total disability resulting from “mental or nervous disorders,” which were capped at twelve months. While there was no dispute that the plaintiff was disabled, the court reviewed the medical record to determine whether the plaintiff’s disabling symptoms were a result of her physical or mental condition. The court concluded that the available evidence did not demonstrate a link between the plaintiff’s symptoms and her physical condition, and that the defendant did not err in ultimately terminating the plaintiff’s benefits. King v. Reliance Standard Life Ins. Co., No. 1:23-CV-443-GSL, 2026 WL 873872 (N.D. Ind. Mar. 31, 2026)