Affirmance Without Resolving Discretionary-Clause Choice-of-Law: ERISA LTD Denial Upheld Under Assumed De Novo Review

1. Introduction

In Grice v. Metropolitan Life Insurance Company (5th Cir. Aug. 26, 2026) (per curiam) (unpublished), Jason Grice, a Google employee who underwent reconstructive surgery related to Charcot-Marie-Tooth syndrome, sought long-term disability (“LTD”) benefits under an ERISA-governed plan administered by Metropolitan Life Insurance Company (“MetLife”). MetLife denied LTD benefits after medical and vocational reviews concluded Grice could perform his sedentary “Usual Occupation.” Grice sued under ERISA, 29 U.S.C. § 1132(a)(1)(B). The district court granted summary judgment to MetLife, and the Fifth Circuit affirmed.

The appeal teed up two recurring ERISA issues: (1) the standard of review (abuse of discretion vs. de novo) in light of disputed “delegation” (discretionary) clause enforceability and state-law bans; and (2) whether the record established “Total Disability” under the plan’s text.

2. Summary of the Opinion

The Fifth Circuit affirmed the denial of LTD benefits. Rather than decide the “thorny” question whether the plan validly conferred discretionary authority (and how Texas, California, ERISA preemption, and ERISA’s Savings Clause interact), the court assumed de novo review applied. Even under that non-deferential standard, Grice failed to prove he was “Totally Disabled” from performing the “Substantial and Material Acts” of his sedentary Google job with “reasonable continuity” during the relevant period.

3. Analysis

A. Precedents Cited

  • Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989): The foundational rule that a plan administrator’s benefit determinations are reviewed for abuse of discretion only when the plan grants “discretionary authority” to determine eligibility or construe plan terms. The opinion uses Firestone as the starting point for the standard-of-review framework.
  • Ariana M. v. Humana Health Plan of Tex., Inc., 884 F.3d 246, 247 (5th Cir. 2018): Cited for two propositions: (1) discretion is conferred via “delegation clauses,” and (2) under de novo review the court does not defer to an administrator’s determinations—whether factual or interpretive (later citing 884 F.4th at 256–57 as quoted in the opinion). This anchors the court’s articulation of what de novo review entails.
  • Rittinger v. Healthy All. Life Ins. Co., 914 F.3d 952, 955 (5th Cir. 2019): Cited for the Fifth Circuit’s acceptance of choice-of-law provisions in ERISA plans—relevant to MetLife’s argument that California law governs and therefore Texas’s ban on delegation clauses does not apply. The citation frames the court’s acknowledgement that choice-of-law clauses are generally enforceable in this circuit, but not necessarily limitless.
  • United States v. Sepulveda, 64 F.4th 700, 713 (5th Cir. 2023): Borrowed from a different context (restitution review) for a practical appellate principle: when a decision “survives de novo review,” an appellate court need not decide whether a “less stringent” standard might apply. The court uses Sepulveda as the bridge to sidestep the delegation-clause dispute in an ERISA case.
  • Byerly v. Standard Ins. Co., 843 F. App'x 572, 575 (5th Cir. 2021) (per curiam) and Lebron v. Nat'l Union Fire Ins. Co., 849 F. App'x 484, 486 (5th Cir. 2021) (per curiam): Unpublished Fifth Circuit ERISA decisions applying the same “assume de novo” approach. The court cites them to show it has used this shortcut in ERISA benefits disputes before (even if not in published precedent).
  • Dwyer v. United Healthcare Ins. Co., 115 F.4th 640, 647 (5th Cir. 2024): Cited for two de novo-review guideposts: (1) the plan must explain the denial and base it on “concrete evidence,” and (2) “the text of the plan is the alpha and the omega.” The court relies on Dwyer to emphasize textualism in ERISA plan interpretation and evidence-based adjudication.

B. Legal Reasoning

  1. Standard-of-review dispute framed, but not decided. The court recites the Firestone rule and notes Grice’s multiple challenges to discretionary review, focusing on the state-law bans on delegation clauses (Texas and California). It highlights the unusual posture: Texas law bans delegation clauses (Tex. Ins. Code § 1701.062(a)), and California law also bans them (Cal. Ins. Code § 10110.6(a)), but MetLife argued neither protects Grice due to the plan’s choice-of-law clause and California’s resident limitation.
  2. Signaled skepticism about “no state law applies” plan design. While declining to decide, the panel indicates it would be “loathe” to accept an outcome where the plan “chose to be governed by no state law at all,” pointing to ERISA’s Savings Clause (29 U.S.C. § 1144(b)(2)(A)) as preserving state insurance regulation. (Notably, the opinion contains an apparent typographical slip citing “19 U.S.C. § 1144(b)(2)(A)” when referencing the Savings Clause.)
  3. Disposition via assumed de novo review. Applying the Sepulveda logic (and citing Byerly and Lebron), the court assumes the claimant-friendly standard—de novo—and proceeds to the merits.
  4. Merits resolved by plan text plus occupational demands. Using Dwyer, the court starts with the plan definition of “Totally Disabled” and the 180-day “Elimination Period.” The dispositive factual premise is occupational: Google classified Grice’s job as “sedentary level work,” mostly sitting, with only brief standing/walking. The medical review evidence (multiple independent reviewers) supported that Grice could perform sedentary work after the early post-surgery period, and the restrictions identified (e.g., no ladders, unprotected heights, heavy machinery) were not material to a sedentary desk role. Thus, Grice did not show inability to perform the “Substantial and Material Acts” of his “Usual Occupation” with “reasonable continuity.”

C. Impact

  • Procedural impact (standard of review): Even though unpublished, the decision reinforces a pragmatic appellate pathway in ERISA cases: where the denial is correct under de novo review, the court may affirm without resolving contentious delegation-clause/choice-of-law/preemption issues. Practically, this can reduce the likelihood of published guidance on discretionary-clause enforceability when the merits are weak.
  • Substantive impact (proof of disability for sedentary roles): The opinion underscores how difficult it can be to prove “Total Disability” under an “own occupation” definition when the job is sedentary. Restrictions that matter for physical or hazardous work may be legally irrelevant if they do not affect the job’s “Substantial and Material Acts.”
  • Choice-of-law and Savings Clause signal: The court’s dicta suggests discomfort with plan drafting that, through choice-of-law mechanics, arguably evades state insurance bans on discretionary clauses. Future litigants may invoke this language to argue that an ERISA plan cannot nullify the Savings Clause by selecting a jurisdictional gap where no state insurance law applies. However, because the court expressly avoided the issue, the signal is persuasive rather than controlling.

4. Complex Concepts Simplified

Delegation clause (discretionary clause)
A plan term stating the insurer/administrator has discretion to interpret the plan and decide eligibility. If valid, courts typically review denials deferentially (abuse of discretion) rather than independently.
De novo vs. abuse-of-discretion review
De novo means the court decides for itself whether the claimant met the plan’s requirements, without deference. Abuse of discretion means the court upholds the administrator if the decision is reasonable, even if the court might have decided differently.
ERISA preemption and the Savings Clause
ERISA broadly preempts state laws that “relate to” employee benefit plans, but the Savings Clause (29 U.S.C. § 1144(b)(2)(A)) preserves state laws that regulate insurance. State bans on discretionary clauses are often litigated under this framework.
Elimination Period
A waiting period (here, 180 days) during which disability must persist before LTD benefits become payable.
“Totally Disabled” / “Usual Occupation”
Plan-defined terms. Here, “Totally Disabled” required inability to perform the “Substantial and Material Acts” of the claimant’s “Usual Occupation” with “reasonable continuity” and in the “usual and customary way.”

5. Conclusion

Grice v. Metropolitan Life Insurance Company affirms an ERISA LTD denial by applying (and satisfying) de novo review, thereby avoiding a difficult and unresolved question about choice-of-law clauses, state-law bans on discretionary clauses, and the reach of ERISA’s Savings Clause. On the merits, the plan’s text and the sedentary nature of Grice’s job were pivotal: medical restrictions that did not materially interfere with desk work were insufficient to establish “Total Disability” under the policy definition.