Eleventh Circuit Holds Aetna Did Not Act Arbitrarily and Capriciously in Terminating Disability Benefits After Claimant Failed to Provide Proof of Income Over Seven Requests

In Pankey v. Aetna Life Insurance Company, No. 25-11338, 2026 WL 2606845 (11th Cir. Sept. 3, 2026), a per curiam opinion, the Eleventh Circuit affirmed the district court’s grant of summary judgment to Aetna Life Insurance Company, upholding the termination of Plaintiff’s long-term disability benefits under an ERISA-governed plan. Plaintiff worked as a Senior Vice President and Senior Project Manager for CPH Engineers, Inc. before severe sensorineural hearing loss caused him to stop working in 2011. Aetna approved benefits for the initial 24-month “own occupation” period and then for the open-ended “any reasonable occupation” period, and Plaintiff also received Social Security disability benefits beginning in 2012. The Plan’s Test of Disability contained both a physical and a financial component, the latter tied to whether a claimant could perform gainful activity producing more than 60% of adjusted predisability earnings.

Beginning in July 2021, Aetna requested that Plaintiff provide continuing proof of disability, including a completed Attending Physician’s Statement, a Claimant Questionnaire, and tax returns or Schedule K-1 forms. Plaintiff did not respond to that request or to three subsequent requests, and Aetna terminated his benefits in July 2022, citing insufficient proof of loss. Aetna afforded Plaintiff further opportunities to submit the materials both before and after termination, including twice during the administrative appeal, but Plaintiff did not provide updated tax returns, Schedule K-1 forms, or a current Claimant Questionnaire. Aetna upheld the termination on appeal in March 2023, and Plaintiff sued under 29 U.S.C. § 1132(a)(1)(B). The magistrate judge recommended granting Plaintiff summary judgment, but the district court sustained Aetna’s objections, rejected the recommendation, and granted summary judgment to Aetna.

Reviewing de novo, the Eleventh Circuit applied the six-step framework from Blankenship v. Metropolitan Life Insurance Company and, consistent with Goldfarb v. Reliance Standard Life Insurance Co., skipped step one because Aetna was vested with discretion through the Plan’s discretionary clause. The court did not reach the conflict-of-interest inquiry because Plaintiff did not argue on appeal that Aetna operated under a conflict, deeming that argument abandoned. The court’s analysis therefore centered on step three and the reasonableness of Aetna’s termination decision. The court held that because Aetna had discretionary authority to determine whether a claimant satisfied the Test of Disability, it followed logically and textually that Aetna could also weigh the sufficiency of the proof a claimant submitted. The Plan conditioned benefits on submission of necessary proof and permitted Aetna to modify benefits if a claimant did not provide required proof.

The court found Aetna’s requests for updated financial information reasonable, noting that Plaintiff needed to prove continuing disability and that Aetna was entitled to scrutinize whether his income or his relationship with an entity called Brown Little Development had changed. The court rejected Plaintiff’s argument that Aetna administered the Plan inconsistently, observing that Plaintiff’s own refusal to furnish an updated Schedule K-1 form and Claimant Questionnaire departed from the parties’ prior course of conduct, and that the record showed Plaintiff had regularly refused to cooperate with Aetna’s reasonable requests. Because the documents were needed to evaluate whether Plaintiff satisfied the Test of Disability and Plaintiff had refused to provide them across seven requests, the court concluded that the termination was not arbitrary and capricious and affirmed.