ERISA Factual Disputes Require Bench Trials, Appeals Court Says

Reliance Standard Life Insurance Co. owes disability benefits to a financial analyst with hypersensitivity to light and noise, the Fourth Circuit said Friday in an opinion analyzing a circuit split on how courts resolve benefit disputes under ERISA.

When cases challenging a denial of benefits under the Employee Retirement Income Security Act involve disputed facts, they should be resolved through a judge-only bench trial based on the administrative record, the US Court of Appeals for the Fourth Circuit unanimously ruled.

In so doing, the court specifically rejected the “quasi-summary-judgment procedure” used by the First and Tenth circuits, which involves deciding the case based on the administrative record and without making inferences in favor of the non-moving party.

“Where, as here, the district court is faced with directly at-odds contentions regarding whether the individual’s claimed impairment is genuine, we see no alternative to the district court making findings of fact,” the three-judge panel said. “And where such findings implicate material issues, summary judgment simply is not appropriate.”

The decision is a victory for Anita Tekmen, a financial analyst for Adsum Inc. who began experiencing heightened sensitivity to vibration, light, and noise, along with vertigo and cognitive dysfunction, after suffering a concussion in a 2013 car accident. She sued Reliance for disability benefits in 2018 and prevailed in district court.

The appellate panel affirmed both the lower court’s decision to conduct a bench trial and its decision to award Tekmen benefits. The district court properly credited the opinions of Tekmen’s treating physicians, who diagnosed her with postconcussion syndrome and concluded that she had a legitimate impairment in functioning, the Fourth Circuit said.

Judge James Andrew Wynn wrote the opinion. Judges Pamela A. Harris and Barbara Milano Keenan joined.

Kantor & Kantor LLP and Richard D. Carter of Annapolis, Md., represented Tekmen. Wilson Elser Moskowitz Edelman & Dicker LLP represented Reliance.

The case is Tekmen v. Reliance Standard Life Ins. Co., 4th Cir., No. 20-1510, 12/16/22.