ERISA “Active Employment” Lapse May Be Reasonably Found from Contemporaneous Payroll/Productivity Records, Triggering a Preexisting-Condition Exclusion Under Arbitrary-and-Capricious Review

1. Introduction

In Alyosha Tunkle v. Reliastar Life Insurance Company (11th Cir. Jan. 20, 2026) (unpublished), the Eleventh Circuit affirmed summary judgment for ReliaStar Life Insurance Company, the administrator and insurer of a group long-term disability plan governed by ERISA.

The plaintiff-appellant, Dr. Alyosha S. Tunkle, a general surgeon employed by 21st Century Oncology, Inc., developed a disabling tremor. He sought long-term disability benefits under his employer’s group policy. ReliaStar denied the claim on the ground that his disability was caused by a “preexisting condition” because, in ReliaStar’s view, Dr. Tunkle’s coverage had lapsed when he fell below the policy’s “active employment” requirement (30 hours/week), and his subsequent medical consultation about the tremor occurred within the policy’s preexisting-condition lookback window before coverage restarted.

The key legal issue on appeal was not whether Dr. Tunkle in fact worked 30+ hours/week, but whether—under the plan’s grant of discretionary authority and the resulting arbitrary-and-capricious standard—the administrative record gave ReliaStar a reasonable basis to conclude that he worked fewer than 30 hours/week between March 15 and May 23, 2020, causing an automatic lapse of coverage and triggering the preexisting-condition exclusion.

2. Summary of the Opinion

The Eleventh Circuit held that ReliaStar’s denial was not arbitrary and capricious because the administrative record reasonably supported ReliaStar’s determination that Dr. Tunkle worked fewer than 30 hours/week from March 15 to May 23, 2020. The court emphasized:

The only contemporaneous records of hours—payroll documents and the productivity report—reflected fewer than 30 hours/week.
The employer confirmed to ReliaStar that those records were the only records of hours and that the practice recorded hours.
Although Dr. Tunkle and a coworker asserted he performed substantial “undocumented work,” the arbitrary-and-capricious inquiry turns on whether the record reasonably supported the administrator’s decision, even if contrary conclusions were also possible.

Because the record reasonably supported a lapse of coverage, ReliaStar reasonably applied the policy’s preexisting-condition exclusion: Dr. Tunkle consulted Dr. Michael Havig about the tremor within three months before coverage restarted on May 24, 2020, and the disability began within one year of that effective date. The court also noted that Dr. Tunkle conceded there was no conflict of interest, which ended that portion of the analysis.

3. Analysis

A. Precedents Cited

The opinion is best read as a faithful application—and practical reinforcement—of the Eleventh Circuit’s ERISA review framework, particularly on (i) standard of review, (ii) the primacy of the administrative record, and (iii) summary judgment procedure in arbitrary-and-capricious cases.

1) Goldfarb v. Reliance Standard Life Ins. Co., 106 F.4th 1100 (11th Cir. 2024)

Goldfarb supplies multiple controlling propositions used throughout the opinion:

De novo review of summary judgment and de novo review of the district court’s affirmance of the administrator’s decision, applying the same ERISA standards.
When a plan grants discretion, courts apply arbitrary-and-capricious review to the administrator’s benefits determination.
Critically, the arbitrariness inquiry focuses on what the administrative record reasonably supported at the time of decision, not on “what was factually true” in some broader evidentiary sense.
Even if the record could support contrary conclusions or is arguably incomplete, the decision stands if the record reasonably supports it.

The panel uses Goldfarb to frame the entire dispute: Dr. Tunkle’s alternative narrative (salary reduction for overhead, undocumented work) might support approval, but that does not defeat a denial supported by contemporaneous records and employer confirmation.

2) Blankenship v. Metro. Life Ins. Co., 644 F.3d 1350 (11th Cir. 2011)

Blankenship is cited for the Eleventh Circuit’s established approach to reviewing discretionary ERISA benefit determinations and for the role of conflicts of interest in the analysis. The court relies on Blankenship to:

Confirm that discretionary authority triggers arbitrary-and-capricious review.
Reinforce that courts examine whether there is a reasonable basis in the record for the administrator’s decision.
Identify the conflict-of-interest step—then terminate that inquiry because Dr. Tunkle conceded no conflict.

3) Capone v. Aetna Life Ins. Co., 592 F.3d 1189 (11th Cir. 2010)

Capone appears as part of the chain of authority supporting the review framework used in Blankenship. In practical terms, the citation situates the case within the circuit’s settled methodology for assessing benefits denials where the plan grants discretion.

4) Glazer v. Reliance Standard Life Ins. Co., 524 F.3d 1241 (11th Cir. 2008)

Glazer is used for a procedural point with significant consequences: under arbitrary-and-capricious review, factual disputes within an uncontested administrative record do not preclude summary judgment. The panel analogizes Glazer’s logic (factual dispute about disability did not bar summary judgment) to Dr. Tunkle’s dispute over whether he truly worked 30 hours/week. Because the contents of the administrative record were not disputed, the question became purely whether the administrator had a reasonable basis on that record.

5) Jett v. Blue Cross & Blue Shield of Ala., 890 F.2d 1137 (11th Cir. 1989)

Jett is invoked for foundational principles about ERISA record review and reasonableness: the court asks what conclusions the record reasonably supported, not whether a court would reach the same conclusion or whether the record could support a different one.

6) Hill v. Emp. Benefits Admin. Comm. of Mueller Grp. LLC, 971 F.3d 1321 (11th Cir. 2020)

Hill is cited for the proposition that where there is no claim the administrator labored under a conflict of interest, the analysis ends. Here, because Dr. Tunkle “does not dispute” that ReliaStar had no conflict, the court explicitly stops at that point—signaling that litigants must preserve and develop conflict arguments if they want them considered.

B. Legal Reasoning

1) The dispositive lens: reasonableness on the administrative record

The opinion repeatedly re-centers the dispute on record-based reasonableness. Dr. Tunkle’s core attack was factual—he claimed he actually worked 35–40 hours/week (plus extensive call and administrative duties) and that the productivity report was incomplete. The court, however, treated the governing question as narrower: did ReliaStar have a reasonable basis, on the record before it, to find he dipped below 30 hours/week and therefore lost coverage?

2) Why the record reasonably supported ReliaStar’s “under 30 hours” determination

The panel identified two main pillars in the record:

Contemporaneous payroll and productivity documentation. Payroll records reflected an average of four and three-quarters hours/week during the relevant period. The productivity report reflected an average of about six and a half hours/week in surgery or consulting with patients. Neither contemporaneous source reflected 30+ hours/week.
Employer confirmations that strengthened the inference. 21st Century Oncology told ReliaStar that Dr. Tunkle was not on leave, directed ReliaStar to the productivity report as the hours record, verified that hours were recorded, and stated it did not have “any information to support Dr. Tunkle working full time” between mid-March and late-May.

This combination mattered. Even if a physician’s professional role commonly includes non-billable work, the plan administrator is not required—under arbitrary-and-capricious review—to credit retrospective testimonial estimates over contemporaneous business records, especially when the employer represents those records capture hours.

3) Treatment of countervailing evidence

Dr. Tunkle offered three categories of counter-evidence: (i) his explanation that salary was reduced to preserve staff/overhead and did not correlate to hours; (ii) assertions by him and Dr. Justin Warner that substantial work was “undocumented”; and (iii) the CPA’s conclusion that it was “not clear” whether the productivity report captured all hours.

The court’s response was doctrinal: such evidence may show that approval was possible, but it does not make denial unreasonable if contemporaneous records and employer statements reasonably support denial. This is the opinion’s practical rule: under discretionary review, a claimant must do more than present an alternative plausible story; the claimant must show the administrator’s reliance on the record was unreasonable.

4) The “total time” argument and interpretive reasonableness

At oral argument, Dr. Tunkle pointed to the productivity report’s “total time” of 12 hours/day. The panel held ReliaStar had a reasonable basis to conclude “total time” did not mean “hours worked,” because:

Dr. Tunkle himself claimed 35–40 hours/week—far below the 60 hours/week implied by “12 hours/day.”
After sending the report containing “total time,” the employer still told ReliaStar it had no information supporting full-time work.
The report used “total time” as a denominator to compute a productivity percentage—consistent with a benchmark, not a log of actual hours.

The court thus treated the dispute as an ordinary question of rational interpretation of administrative materials—resolved by internal consistency and corroboration from the employer’s communications.

5) From hours determination to preexisting-condition exclusion

Once the under-30-hours finding was deemed reasonable, the rest followed in a straightforward policy sequence:

Under the policy, dropping below 30 hours/week ended coverage automatically unless on vacation or covered leave; the record reflected no leave.
Coverage could reasonably be treated as restarting when payroll returned to 40 hours/week on May 24, 2020.
The policy excluded disabilities beginning within one year of the effective date if caused by a “preexisting condition,” defined to include a condition for which the employee received consultation within the three months before the effective date.
Dr. Tunkle consulted Dr. Michael Havig about the tremor on May 14, 2020—within three months before May 24, 2020—supplying a reasonable basis to treat the tremor as preexisting.

C. Impact

Although unpublished, the decision has clear practical significance for ERISA disability disputes in the Eleventh Circuit:

Contemporaneous employment records can be decisive. Where eligibility turns on “active employment” hours, payroll summaries and internal productivity reports—especially when the employer confirms they are the operative records—may provide a sufficient “reasonable basis” even if professionals claim substantial unrecorded work.
Retrospective testimony faces an uphill battle under discretionary review. Letters from the claimant and colleagues may not overcome contemporaneous records unless they show the administrator’s inference was unreasonable, not merely disputable.
Metric disputes are resolved by internal consistency and administrator latitude. The “total time” discussion signals that ambiguous report fields will be interpreted in context; a claimant should not assume labels will be taken at face value if other record evidence contradicts that meaning.
Summary judgment remains a common endpoint. By reiterating that factual disputes within an uncontested administrative record do not bar summary judgment under arbitrary-and-capricious review, the case underscores the procedural reality that many ERISA benefits cases will be resolved as questions of law on the record.
Conflict-of-interest arguments must be preserved. The court’s reliance on the claimant’s concession illustrates that abandoning conflict arguments forecloses a potentially important lens of scrutiny.

4. Complex Concepts Simplified

ERISA (Employee Retirement Income Security Act): A federal law governing many employer-provided benefit plans (including disability plans). It sets rules for claims procedures and lawsuits.
29 U.S.C. § 1132(a)(1)(B): The ERISA provision allowing a participant to sue to recover benefits due under the plan’s terms.
Administrative record: The collection of documents and information the plan administrator had when deciding the claim (e.g., payroll records, medical notes, employer emails). Under ERISA, courts often limit review to this record.
Discretionary authority & arbitrary and capricious review: If the plan grants the administrator discretion to determine eligibility, courts do not decide eligibility from scratch. They ask whether the denial had a reasonable basis in the record. A decision can be upheld even if another decision was also reasonable.
Active employment requirement (30 hours/week): A plan eligibility rule: coverage applies only if the employee is actively working at least the stated hours. Falling below can end coverage automatically.
Preexisting condition exclusion: A limitation denying coverage for disabilities tied to conditions treated or consulted about during a defined lookback period before coverage becomes effective (here, consultation within three months before the effective date, where disability began within one year).
Summary judgment in ERISA cases: A procedural mechanism to resolve a case without trial when the material question is whether the administrator’s decision was reasonable on the record— even if parties dispute underlying “real-world” facts.

5. Conclusion

Tunkle v. Reliastar reinforces a practical ERISA rule in the Eleventh Circuit’s discretionary-review cases: when the plan administrator’s decision is judged for reasonableness on the administrative record, contemporaneous payroll/productivity records—bolstered by employer confirmation—can provide an adequate basis to find an “active employment” lapse, which in turn may reset an effective date and trigger a preexisting-condition exclusion.

The opinion’s broader significance lies less in novel doctrine than in sharpened application: claimants challenging an hours-based eligibility determination must confront the administrator’s record-based inferences directly and demonstrate unreasonableness, not merely offer plausible alternative explanations.