Fifth Circuit Affirms Summary Judgment for MetLife on De Novo Review, Holding LTD Claimant Was Not Totally Disabled and Declining to Resolve Choice-of-Law Dispute Over Dueling State Bans on Delegation Clauses

In Grice v. Metropolitan Life Insurance Company, No. 25-50566, 2026 WL 2519457 (5th Cir. Aug. 26, 2026), a per curiam opinion, the Fifth Circuit affirmed the district court’s grant of summary judgment to Metropolitan Life Insurance Company in this ERISA action challenging the denial of long-term disability benefits. Plaintiff, a Senior Solutions Consultant at Google, has Charcot-Marie-Tooth syndrome, a nerve disorder that caused his right foot and ankle to deform. Plaintiff underwent reconstructive surgery on January 20, 2022. At a February follow-up, his treating physician, Dr. Ebert, noted that Plaintiff reported no pain, that the incision was healing well, and that he had full range of motion in his foot. In March, Dr. Ebert estimated that Plaintiff would be incapacitated until July 20, 2022. Over the following months, Plaintiff’s physical therapist noted that he was able to walk, climb a full set of stairs, and demonstrated continued improvement in mobility, and Plaintiff reported at one point that he was planning a trip involving hiking. Plaintiff received short-term disability benefits through his Google plan during this period. Although Dr. Ebert initially confirmed that Plaintiff could return to full-time work without restrictions on July 20, Plaintiff did not return, and Dr. Ebert later submitted a form extending the return-to-work date to September 23 while still listing that date as unrestricted.

Plaintiff filed a claim for long-term disability benefits from MetLife. To qualify, he had to show that he was Totally Disabled, meaning unable to perform with reasonable continuity the substantial and material acts necessary to pursue his usual occupation in the usual and customary way during a 180-day Elimination Period and the following 24 months, and thereafter unable to engage with reasonable continuity in any occupation he could reasonably be expected to perform. A MetLife Nurse Consultant concluded that Dr. Ebert’s records supported only a temporary off-work period. An independent physician, Dr. Andrew Chen, reviewed the records and determined that Plaintiff could sustain his sedentary role after March 1, 2022, and a Vocational Rehabilitation Consultant agreed. MetLife denied the claim on November 30, 2022. On appeal, Plaintiff submitted additional records from his pain management specialist, his physical therapist, and Dr. Ebert. MetLife referred the appeal to a second independent physician, Dr. Arash Yaghoobian, who concurred that Plaintiff was not totally disabled after March 2022, finding he could sit without restriction, stand up to two hours a day, and walk one hour a day, with limitations on crouching, crawling, climbing, and operating machinery that did not affect his sedentary desk job. MetLife upheld the denial on July 5, 2023.

The appeal presented two questions: whether the plan contained a valid delegation clause and whether Plaintiff was entitled to benefits. On the standard of review, Plaintiff advanced four arguments against abuse-of-discretion review, and the court found that only one merited discussion. Texas law bars delegation clauses, but the policy’s choice-of-law provision selected California law, and MetLife argued that California’s ban applies only to insurance coverage for California residents, which Plaintiff was not. The court observed that this reading placed Plaintiff in a peculiar position, in which neither his home state nor the state selected by his policy protected him, such that the policy in essence chose to be governed by no state law at all. The court expressed doubt that an ERISA plan can tell its insured that no state law applies to him, and noted its reluctance to agree with MetLife given that ERISA’s Savings Clause preserves state insurance law. The court nonetheless declined to resolve these choice-of-law questions, reasoning that it need not decide the standard of review because Plaintiff was not totally disabled even under de novo review.

Applying de novo review, the court explained that it would not defer to the administrator’s determinations and that the text of the plan governs. Google reported that Plaintiff’s role was classified as sedentary, involving sitting most of the time with walking or standing for brief periods and occasional exertion of up to ten pounds of force. Reviewing the record, the court held that Plaintiff failed to show he was unable to perform that role with reasonable continuity after July 2022, as his medical records indicated he could return to work, albeit with restrictions to accommodate his recovery. The court affirmed.