This month’s Friday Five explores recent ERISA disability benefit decisions involving key issues such as when attorney’s fees should be decided and factors used in determining venue transfer. It also explores retroactive long-term disability claims, when courts will award or deny benefits, and what happens when a plan misapplies its own terms.
- Will a court stay a motion for attorney’s fees pending appeal? No, a pending appeal is not itself sufficient to justify staying consideration of a post-judgment motion for attorney’s fees. After Pooja Mundrati (“Plaintiff”), prevailed on summary judgment in her ERISA suit for long-term disability benefits against Unum Life Insurance Company of America (“Defendant”), she filed a motion for attorney’s fees. Defendant appealed the judgment and moved to stay resolution of the fee motion until the appeal was decided. The court denied the motion, in favor of prompt resolution after the merits decision, rather than stay the fee motion until resolution of appeal, because the services subject to the motion were still fresh in mind. The Court emphasized that Rule 54 permits courts to rule on fees despite a pending appeal and found that Defendant failed to show exceptional circumstances warranting a stay. Further, the court permitted Defendant the opportunity to respond to the merits of the motion, despite Plaintiff’s argument that Defendant waived its right to do so by requesting a stay in lieu of filing a response to the motion. Mundrati v. Unum Life Ins. Co. of Am., No. 2:23‑cv‑01860, 2025 WL 1519220 (W.D. Pa. May 28, 2025).
- Will a court grant a motion to transfer venue in an ERISA case where the transferee district is more convenient for the parties and witnesses? Yes, under 28 U.S.C. § 1404(a), courts may transfer venue when the plaintiff resides in the transferee district and key witnesses and medical records are located there. Jennifer Layfield (“Plaintiff”), filed an ERISA suit in the Northern District of California after her claim for long-term disability benefits, based on long-COVID symptoms, was denied by Unum Life Insurance Company of America (“Defendant”). Although she performed remote work for a San Francisco office, Plaintiff resided in Pacific Palisades and received all of her medical care in Los Angeles, both cities located in the Central District of California. When Defendant moved to transfer the case to the Central District, Plaintiff opposed, citing the location of her employer’s headquarters and colleagues. The court explained that venue was proper in both districts because ERISA provides that civil actions may be brought in the district where the plan is administered, where the breach took place, or where the defendant resides or may be found. While the court considers multiple factors in determining whether to transfer a case, the most significant are the local interest in the matter, the deference owed to the Plaintiff’s choice of forum, and the convenience of the parties. The Court found that the Central District was more convenient, and had a stronger local interest, given Plaintiff’s residence, the location of third-party witnesses, and the differing ability to enforce third-party discovery. The court found these factors outweighed Plaintiff’s choice of forum and granted the motion to transfer. Layfield v. Unum Life Ins. Co. of Am., No. 24‑cv‑03616, 2025 WL 1359219 (N.D. Cal. May 9, 2025).
- Whether a plaintiff will be entitled to partial long-term disability benefits where the insurer applied the wrong definition of disability during the benefit period. Yes, because ERISA administrators must apply the plan’s correct policy provision to justify its decision, and applying the “any occupation” standard when it should have applied the “own occupation” standard is an error that leads to an award of benefits. Under an “own occupation” standard, Vincent Bray (“Plaintiff”) would have to show that he was prevented from performing material and substantial duties of his regular occupation, while the “any occupation” standard requires Plaintiff to show that he is disabled from any occupation that his past training, education, or experience would allow him to perform or which he could be trained. Plaintiff was a box stacker at a poultry processing facility and began receiving benefits from Symetra following on-the-job shoulder injuries and surgeries that severely limited his physical function. After over four years of payment, Symetra terminated his benefits. Initially citing failure to provide records, Symetra later terminated benefits because Plaintiff could perform a gainful occupation. However, the court found that Symetra improperly applied the “any occupation” standard during an eight-month period when the plan still required use of the “own occupation” standard. The court explained that the law favors finding an abuse of discretion when an ERISA plan administrator reaches an adverse benefit determination based on an inapplicable plan document or term. The court awarded Plaintiff long-term disability benefits for the eight-month period affected by this error, but found he failed to submit adequate medical support for continued disability beyond that timeframe. Bray v. Symetra Life Ins. Co., No. 24‑cv‑119 (ECT/JFD), 2025 WL 1504311 (D. Minn. May 27, 2025).
- Whether a court will deny long-term disability benefits under ERISA where the plaintiff fails to prove an inability to perform the material duties of his regular occupation. Yes, because ERISA claimants bear the burden of demonstrating functional limitations that prevent them from working in their occupation, not just the presence of symptoms. Siam Mendoza (“Plaintiff”), a senior underwriter for American International Group (“AIG”), claimed long-term disability (“LTD”) benefits after experiencing long-COVID symptoms including brain fog, fatigue, and cognitive issues. Although he was approved for short-term disability, his LTD claim was denied. Plaintiff filed suit under ERISA. The court reviewed medical records, neuropsychological testing, and treating provider notes, and concluded that Plaintiff’s impairments did not preclude him from performing the material and substantial duties of his occupation. His cognitive testing results were mostly normal, and his providers attributed his concentration issues to sleep disturbances, depression, and anxiety. These conditions were not shown to rise to the level of total disability. The court explained that Plaintiff did not meet his burden of showing by a preponderance of the evidence that his sickness limited him from performing the material and substantial duties of his occupation throughout the elimination period. Therefore, the court denied his claim. Mendoza v. First Unum Life Ins. Co., No. 3:24‑cv‑00834‑H‑VET, 2025 WL 1393871 (S.D. Cal. May 5, 2025).
- Whether a plaintiff will be entitled to retroactive long-term disability benefits where the administrative record supports continuous disability from an earlier date. Yes, because, under ERISA, a claimant is entitled to retroactive benefits when the evidence shows that their disability began before the date used by the plan administrator. Hettihewage Dharmasena (“Plaintiff”) worked for Schneider Electric as an electrical engineer and was diagnosed with Facioscapulohumeral Muscular Dystrophy (“FHSD”), a degenerative neuromuscular disease, as well as chronic kidney disease post-transplant. He filed a claim for long-term disability (“LTD”) benefits under the employee benefit plan, which defined disability as the inability to earn more than 80% of pre-disability earnings in one’s own occupation. Metropolitan Life Insurance Company (“Defendant”) denied LTD benefits, arguing that his symptoms did not render him disabled and that the Plaintiff claimed his disability started on February 7, 2022, but he was laid off from his job on February 4, 2022, therefore making him ineligible for benefits. Plaintiff filed suit under ERISA and moved for judgment under Rule 52, which allows a judge to resolve a case based on the administrative record and make findings of fact and law. The court concluded that Defendant disregarded the functional impact of FHSD, failed to address treating physician opinions, and gave undue weight to non-examining reviewers. The Court explained that because Plaintiff’s last day of work and date of disability are two distinct analyses, and the Defendant’s claim denial equates the two, it found that Plaintiff’s retroactive claim for benefits is permitted as long as the record supports that Plaintiff was disabled on or before February 4, 2022. The court found that there was adequate evidence in the record to support Plaintiff’s claim that he was disabled and entered judgment in his favor. Dharmasena v. Metro. Life Ins. Co., No. EDCV 23‑01510, 2025 WL 1563970 (C.D. Cal. May 29, 2025).
Summer Associate, Marilyn Torres, contributed to the writing of this blog post.
