This issue of the Friday Five discusses the Fifth Circuit’s strict approach to review deadlines, a court chiding an administrator for relying on evidence not in the record, a court’s refusal to permit discovery into claims statistics, rescission of a life insurance policy due to misrepresentations in the application, and holding an administrator strictly to administrative appeal timelines.
- Fifth Circuit Strips Administrator of Discretionary Review Standard for Untimely Decision
The Fifth Circuit held that an administrator that fails to issue a timely decision during an administrative appeal of a disability benefits claim is not entitled to the deferential standard of review under ERISA, at least within the circumstances of the Cogdell case. During the administrative appeal, the administrator told the claimant that the review would exceed the usual 45-day deadline, but failed to state the additional time necessary or otherwise explain the special circumstances to support an extension of time. The administrator eventually issued its denial 72-days after the appeal was filed. The appellate court determined that, as a “consequence” of the untimely decision and failure to support an extension of time, the administrator’s decision should be evaluated under the de novo standard. The Fifth Circuit affirmed the trial court’s grant of summary judgment to the claimant.
Cogdell v. Reliance Standard Life Ins. Co., No. 25-1083, 2026 WL 588427 (Mar. 3, 2026 5th Cir.) - Court Finds Abuse of Discretion for Reviewer’s Conclusions Not Supported by Record
The district court, in granting summary judgment for the claimant in an ERISA long-term disability benefits dispute, criticized the administrator on multiple fronts. For example, the court held that the administrator should not have required objective evidence for a subjective chronic pain complaint, failed to engage an independent medical examination, neglected to perform a vocational review, and otherwise took multiple missteps in the review process. The court took particular interest in an independent reviewer hired by the administrator, who concluded that the plaintiff could have performed her regular occupation based on the claimant’s frequent travel out-of-state to care for sick family members. These trips, however, were not supported by the record, which led the court to exhibit “a high level of skepticism” of the administrator’s process. The trial court found that the administrator abused its discretion due to the number of issues during the review process.
Guy v. Reliance Standard Life Ins. Co., No. 24-293, 2026 WL 539534 (Feb. 20, 2026 D. Ariz.) - Discovery Into Claim Reviewer Statistics Deemed Off Limits
The plaintiff moved to compel discovery related to the number of claims terminated or denied by a physician reviewing the plaintiff’s claim on behalf of the administrator. The federal magistrate judge denied the motion and the plaintiff appealed. The district judge agreed with the denial of discovery, holding that the plaintiff failed to establish bias to create a threshold need for discovery, while such discovery would not show any procedural defect in the review process. The court agreed with prior Seventh Circuit precedent, which reasoned that the court was only concerned with the plaintiff’s specific case, not general statistics unrelated to the particular denial before the court, even if the same medical reviewer was involved in all of the cases.
Schulmeier v. Lincoln Nat’l Life Ins. Co., No. 24-284, 2026 WL 668269 (Mar. 9, 2026 N.D. Ind.) - Court Allows Administrator to Rescind Policy Based on Misrepresentations in Application
In an ERISA life insurance dispute, the claimant marked “no” to policy application questions regarding prior illicit drug or alcohol use. After the plaintiff’s death, it became clear that the application response was false as the plaintiff had a well-documented history of drug abuse throughout his medical records. In fact, the claimant’s death was caused by a drug overdose. The administrator rescinded the coverage based on this misrepresentation and the district court granted summary judgment to the insurer. The court had little trouble finding that the misrepresentation occurred and afforded the insurer grounds to rescind coverage. The court also rejected the claimant’s related arguments, finding that the insurer was not required to establish intent to deceive by the insured, while the insurer was further not required to reimburse the claimant for his insurance premiums as a condition precedent to rescission.
Florentino v. Hartford Life & Accid. Ins. Co., No. 24-643, 2026 WL 751918 (W.D. Ky. Mar. 17, 2026) - Administrator Violated Claims Regulations by Waiting for Medical Records
In an ERISA long-term disability benefits dispute, the administrator moved for summary judgment on the plaintiff’s failure to exhaust administrative remedies, reasoning that the claimant filed litigation before the administrator had a chance to rule on administrative appeal. The administrator argued that the time period to determine the appeal was tolled because it was awaiting medical records from the plaintiff. The district court held, however, that tolling only applies when the administrator is waiting for records directly from the plaintiff. In this case, the records were due from the plaintiff’s medical providers, not the plaintiff directly. The court further determined that the administrator failed to invoke any extension of the review time period because, even if it was waiting for information from one of the plaintiff’s providers, it should have continued to move the review process forward. The court denied the administrator’s motion for summary judgment and scheduled the matter for a bench trial.
Bianchini v. Hartford Life & Accid. Ins. Co., No. 25-6535, 2026 WL 810303 (SDNY Mar. 24, 2026)
