Background
Jason Grice, a Senior Solutions Consultant at Google, has Charcot-Marie-Tooth syndrome and underwent reconstructive surgery on his right foot and ankle in January 2022. He received short-term disability benefits during his recovery. Although his surgeon initially cleared him to return to full-time work without restrictions in July 2022, the surgeon later extended that date to September and reported limitations affecting Grice’s ability to bend, lift, sit, and walk.
Grice sought long-term disability benefits under Google’s plan, which Metropolitan Life Insurance Company administered. MetLife’s reviewers concluded that, after March 2022, Grice could perform his sedentary job full time, subject to certain restrictions. MetLife denied the claim and upheld that decision on administrative appeal. Grice sued under ERISA, and the district court granted summary judgment to MetLife.
The Court’s Holding
The Fifth Circuit affirmed. It assumed without deciding that MetLife’s denial should be reviewed de novo because Grice was not “Totally Disabled” even under that nondeferential standard. The court therefore did not resolve whether the plan validly delegated discretionary authority to MetLife or whether Texas or California prohibitions on delegation clauses applied.
Under the plan, Grice had to show that he could not perform with reasonable continuity the substantial and material duties of his usual occupation during the elimination period and the following 24 months. The record did not establish that inability. Grice’s Google position was sedentary, involved sitting most of the time, and required only brief periods of standing or walking and occasional exertion of up to 10 pounds. His medical records showed that after July 2022 he could return to that role with accommodations for his recovery.
Key Takeaways
- MetLife’s denial survived de novo review because the medical and vocational evidence showed that Grice could perform his sedentary occupation after the elimination period.
- The court assumed de novo review without deciding whether the plan’s delegation clause was valid or enforceable.
- The panel expressed doubt that an ERISA plan could use a choice-of-law provision to avoid both the insured’s home-state ban and the chosen state’s ban on delegation clauses, but it did not decide that issue.
Why It Matters
The decision illustrates that an ERISA claimant’s medical limitations do not establish total disability when the evidence shows the claimant can perform the material duties of a sedentary occupation with restrictions or accommodations. The plan’s definition of disability and the actual demands of the claimant’s job remain central.
The opinion also flags, without resolving, a significant choice-of-law question concerning ERISA delegation clauses when both the claimant’s state and the contractually selected state prohibit such clauses.