ERISA Plan Forfeits Deferential Review by Failing to Explain Conflicting Vocational Opinions

In Schuyler v. Sun Life Assurance Company of Canada, 2026 WL 2823712 (S.D.N.Y. Sept. 18, 2026), United States District Judge Ronnie Abrams denied cross-motions for summary judgment in an ERISA long-term disability dispute and remanded the claim to Sun Life for a renewed determination, holding that Sun Life forfeited deferential review by failing to explain why it disregarded the conclusions of its own vocational expert.

What led Plaintiff to file her ERISA disability claim?

Plaintiff worked as a Territory Sales Representative for Benco Dental, a role that required substantial travel by car and plane. In September 2015, she fell down a flight of stairs and struck her head, and physicians diagnosed her with a traumatic brain injury along with bleeding in three parts of her brain and a skull fracture. She continued working until May 2019, then submitted a claim for long-term disability benefits under her employer’s ERISA-governed plan, with an onset date of May 23, 2019. Sun Life denied the claim and later denied her administrative appeal, concluding that she had not shown she was totally disabled from performing her regular occupation throughout the plan’s ninety-day elimination period.

Why did the court find Sun Life committed a procedural violation under ERISA?

The court examined the reports of Sun Life’s two vocational experts. During the initial review, the first expert concluded that Plaintiff’s occupation required walking or standing to a significant degree, roughly six hours in an eight-hour day, consistent with the regulatory definition of light work. On appeal, the second expert described the same occupation as requiring only occasional standing and walking, up to two-and-one-half hours per day, a description that tracked the lesser standard for sedentary work. Sun Life relied on the second expert’s less demanding classification in denying the appeal but never explained why it departed from the first expert’s more physically demanding assessment. The court held that this omission violated the Department of Labor claims-procedure regulation at 29 C.F.R. § 2560.503-1(j)(6)(i)(B), which requires a plan administrator to explain its basis for disagreeing with or not following the views of its own experts, regardless of whether it relied on those views.

Why did the court apply de novo review rather than the arbitrary and capricious standard?

Although the plan granted Sun Life discretionary authority, the court explained that under Halo v. Yale Health Plan, a plan’s failure to comply with the Department of Labor claims-procedure regulation results in de novo review unless the plan shows the failure was inadvertent and harmless. The court found the violation was not harmless. Accepting the standing and walking limitations found by Sun Life’s own medical consultant, Plaintiff could not have met the more demanding light-work requirements described by the first expert, so she could have qualified for benefits under that benchmark. The second expert’s reclassification cut those demands by more than half and may have determined the outcome. Because Sun Life altered the dispositive vocational premise for the first time in its appeal denial, without notice or explanation, Plaintiff had no opportunity to respond, and Sun Life could not show the deviation was inadvertent and harmless. Sun Life therefore forfeited deferential review.

Why did the court deny summary judgment and remand the ERISA claim to Sun Life?

Applying de novo review, the court found material factual disputes about the extent of Plaintiff’s injuries, her limitations, and her ability to work and earn income, including disputes turning on her credibility. The court noted that resolving those disputes on the papers would require it to weigh evidence and assess credibility, which is not the function of summary judgment. Rather than conduct a trial on the papers, the court remanded to Sun Life so the plan administrator could consider the full record, including new evidence not previously before it, such as Plaintiff’s favorable Social Security Disability determination and the expert reports underlying that award. The court also observed that Plaintiff herself sought remand for an initial determination under the plan’s any-occupation standard, a question Sun Life never reached. Because the claim was remanded for a full and fair review, the court held that any award of fees, costs, and interest would be premature.