ERISA “Any Occupation” Denials: Eleventh Circuit Clarifies that Unsupported FCEs May Be Discounted, SSA Awards Are Non‑Dispositive, and Rule 52 Bench Decisions on Agreed Administrative Records Are Proper

Introduction

This commentary analyzes the Eleventh Circuit’s unpublished, per curiam decision in Alana Walker v. Life Insurance Company of North America, No. 24‑13066 (11th Cir. Aug. 13, 2025), affirming a district court judgment on the administrative record in an ERISA long‑term disability (LTD) dispute. The case centers on whether Life Insurance Company of North America (LINA) properly terminated LTD benefits after the plan’s initial 24‑month “own occupation” period, at the transition to the more demanding “any occupation” standard that also required the insured to be unable to earn at least 60% of indexed pre‑disability earnings.

On appeal, the claimant raised four core arguments:

She had presented objective evidence of disability (imaging and a Functional Capacity Evaluation, FCE) that the district court wrongfully discounted.
LINA’s consulting physicians’ opinions were insufficient to overcome her objective evidence.
No “any occupation” existed in the national economy that she could perform and that met the plan’s 60% earnings threshold.
The Social Security Disability Insurance (SSDI) award was persuasive proof of disability.

The Eleventh Circuit rejected each argument, underscoring important recurring ERISA themes: how Rule 52 bench decisions operate on agreed administrative records; the weight courts may assign to FCEs when inconsistent with comprehensive physician reviews and objective imaging; how plan terms drive the “any occupation” and wage‑threshold analysis; and why SSDI awards, though relevant, are not dispositive in ERISA cases.

Summary of the Opinion

The Eleventh Circuit affirmed the district court’s judgment for LINA, concluding there was no clear error in the court’s factual findings and no legal error in its application of ERISA principles:

Procedural posture: The parties proceeded (without preserved objection) under Federal Rule of Civil Procedure 52 on an agreed administrative record. On appeal, legal issues were reviewed de novo and factual findings for clear error.
Medical evidence: The district court did not clearly err by crediting LINA’s three physicians (two paper reviewers and an IME) over a claimant‑procured FCE and a brief treating note, particularly where the physicians reasonably explained that the FCE’s conclusions were not corroborated by the objective imaging or their broader record review.
Vocational/economic prong: The court upheld LINA’s identification of “Manager, Financial Institution” as an occupation the claimant was qualified to perform and that could meet the plan’s 60% earnings threshold, noting the policy’s focus on how occupations are performed in the national economy rather than at a specific employer. It also rejected a reaching‑restriction challenge, reasoning that frequent overhead reaching could be performed with the claimant’s non‑dominant arm.
SSDI award: Approval by the Social Security Administration (SSA) was not dispositive; LINA’s record included later physician reviews not before SSA.
Two‑phase policies: An earlier 24‑month award did not preclude a later denial under the different, stricter “any occupation” standard supported by an expanded record.

Analysis

Precedents Cited and Their Role

Sapuppo v. Allstate Floridian Ins. Co., 739 F.3d 678 (11th Cir. 2014): Applied to hold that Walker waived a procedural challenge (insisting on summary judgment standards) by not raising it in her initial appellate brief and not preserving the issue below. The court also found acquiescence, given her reliance on a Rule 52 case in the district court.
Acree v. Hartford Life & Accident Ins. Co., 917 F. Supp. 2d 1296 (M.D. Ga. 2013): Cited for the proposition that when both sides seek a decision on an agreed administrative record, judicial economy favors Rule 52 findings of fact and conclusions of law rather than summary judgment.
Harris v. Lincoln Nat’l Life Ins. Co., 42 F.4th 1292 (11th Cir. 2022): Clarified the ERISA review framework: unless a plan grants the administrator discretionary authority, courts review benefits determinations de novo.
Doyle v. Liberty Life Assurance Co. of Boston, 542 F.3d 1352 (11th Cir. 2008): Cited twice—first, for the de novo standard when no discretion is conferred; second, to confirm that a prior 24‑month award under an “own occupation” phase does not bind the later “any occupation” analysis with different criteria and an expanded record.
Silva v. Pro Transport, Inc., 898 F.3d 1335 (11th Cir. 2018) (per curiam); Solomon v. Liberty County Commissioners, 221 F.3d 1218 (11th Cir. 2000); Anderson v. City of Bessemer City, 470 U.S. 564 (1985): These cases set the “clear error” appellate review standard after a Rule 52 bench decision. Where two permissible views of the evidence exist, the factfinder’s choice cannot be clearly erroneous.
Whatley v. CNA Ins. Cos., 189 F.3d 1310 (11th Cir. 1999): Reaffirmed that SSA disability determinations are not dispositive in ERISA cases.
Levinson v. Reliance Standard Ins. Co., 245 F.3d 1321 (11th Cir. 2001): Distinguished; unlike Walker’s policy, Levinson involved different plan terms and did not foreclose re‑evaluation at the “any occupation” stage under different criteria.

Legal Reasoning

1) Procedural Framework and Standards of Review

The plan did not grant LINA discretionary authority to interpret the plan or determine eligibility. Under Harris, that means de novo review in the district court. The parties presented the case on an agreed administrative record, and the district court entered findings under Rule 52. On appeal, the Eleventh Circuit reviewed legal issues de novo and factual findings for clear error (Silva; Solomon; Anderson). The claimant’s attempt to recast the case as a summary judgment dispute was waived (Sapuppo), and the record showed acquiescence in a Rule 52 procedure (including reliance on Acree).

2) Medical Evidence and the Weight of an FCE

The claimant’s evidence comprised imaging (spinal stenosis, disc protrusions, knee arthritis, shoulder pathology) and an FCE categorizing her as “Below Sedentary,” with asserted sitting intolerance necessitating extended reclined breaks. Her PCP signed off on the FCE, but had seen her twice and offered only brief functional notes.

LINA’s case rested on multiple physician reviews: an IME by a board‑certified orthopedist (Dr. Murray) finding capability for sedentary work with activity restrictions; and two independent reviewers (Drs. Getz and Belcourt) who closely analyzed the imaging and broader records and concluded there was no clinical support for total impairment and no restriction on sitting. Both reviewers addressed the FCE and explained why its conclusions did not comport with objective findings. Dr. Getz also consulted the PCP, who acknowledged limitations primarily with prolonged standing/walking due to knee osteoarthritis.

The Eleventh Circuit held the district court did not clearly err in finding the consulting physicians more persuasive than the FCE and the sparse treating notes. The court emphasized:

Consulting physicians’ conclusions were grounded in comprehensive record reviews and objective imaging.
They specifically addressed and refuted the FCE’s more restrictive conclusions.
Multiple physicians agreed that sitting was not materially restricted, aligning with sedentary capacity.

Practically, the opinion reinforces that an FCE carries persuasive force only when it coheres with the broader medical record and objective findings and is explained in a way that addresses inconsistency with imaging or clinical observations. Where a well‑reasoned suite of physician reviews (including an IME) contradicts an FCE, a district court may—without clear error—credit the physicians over the FCE.

3) Any‑Occupation and Earnings Threshold: Vocational Findings

After 24 months, Walker had to show she was unable to perform the “material duties of any occupation for which [she] is, or may reasonably become, qualified” and “unable to earn 60% or more of [her] Indexed Earnings.” The vocational evidence focused on the DOT‑described “Manager, Financial Institution” position as an example within her transferable skill set that could meet the plan’s wage threshold.

Key aspects of the court’s reasoning:

General labor market definition controls: The plan defined “regular occupation” by how it is performed in the national economy, not the claimant’s prior employer‑specific tasks. This framing also penetrated the transferable skills analysis. The district court compared the essential duties of Walker’s role at D.R. Horton with the DOT description and found substantial overlap in management and supervisory functions.
Physical demands: While some physician‑imposed restrictions existed (notably overhead reaching with the right, dominant arm), the court accepted that frequent overhead reaching could be performed with the unrestricted, non‑dominant left arm. That factual resolution, grounded in the medical limitations and job demands, was not clearly erroneous.
Earnings threshold: The court held Walker failed to show there were no jobs in the national economy that met the 60% indexed‑earnings requirement and were within her capabilities. The insurer’s vocational analysis, aligned with plan terms and DOT methodology, was credited over the claimant’s vocational critique.

The opinion thus supports a vocational approach that:

Emphasizes national‑economy job definitions (DOT/O*NET) over idiosyncratic employer tasks.
Permits an insurer to overcome vocational critiques where the record supports a reasonable job match and wage attainment under plan terms.
Allows nuanced physical‑demand matching (such as overhead reaching satisfied by the non‑dominant limb) when consistent with medical restrictions.

4) SSDI Award: Relevance but Not Dispositive

Consistent with Whatley, the panel reaffirmed that SSDI approval is not dispositive in ERISA litigation. Two rationales carried the day:

The ERISA plan’s definition of disability and proof requirements differ from SSA standards.
The ERISA record included later physician reviews (and an IME) that SSA did not consider.

Although LINA had assisted Walker in obtaining SSDI during the initial 24‑month period, the panel found no error in the district court’s refusal to defer to the SSA award at the any‑occupation phase.

5) Two‑Phase Policy Design: Initial Award Does Not Control Later Denial

The court rejected the argument that an unchanged medical condition should preclude a later LTD denial. Because the policy imposed a distinct, more stringent any‑occupation standard after 24 months and the later record was more developed, a prior award did not bind the later determination (Doyle; distinguishing Levinson).

Impact and Practical Implications

For Claimants

FCEs must be integrated with objective evidence: An FCE that asserts sitting intolerance or below‑sedentary capacity should be tethered to imaging, longitudinal clinical findings, and treating opinions that explain the mechanism for the functional loss. Vague or isolated treating notes will be outmatched by comprehensive consulting reviews.
Document sitting restrictions robustly: If inability to sit is central, ensure treating specialists explicitly link objective pathology to sitting intolerance and address pacing, positional changes, and the need for unscheduled breaks in vocationally meaningful terms.
Prepare a wage‑focused vocational record: When a plan includes a high earnings threshold (here, 60% of indexed earnings on a base salary around $286,000), bring granular wage data (BLS/OES, O*NET, industry surveys) to show the asserted occupation cannot realistically meet the threshold given the claimant’s locale, experience, and restrictions.
Be specific about bilateral vs unilateral demands: If frequent overhead reaching is vocationally bilateral in practice, submit ergonomic and occupational‑medicine evidence showing why non‑dominant‑arm compensation is not vocationally adequate.
SSA evidence helps but won’t carry the day: Provide the full SSA record and explain how it aligns with the plan’s definition; anticipate and rebut any later medical reviews not before SSA.
Preserve procedural objections: If you prefer summary judgment standards, say so early and often; do not acquiesce in Rule 52 treatment on an agreed record unless strategically intended.

For Plan Administrators and Insurers

Explain FCE critiques clearly: When discounting an adverse FCE, anchor the critique in objective imaging, longitudinal records, and functional observations; show the FCE’s inconsistencies with the broader record.
Use multiple, qualified reviewers plus IME where appropriate: A layered medical evaluation—especially when consistent across specialists and the IME—enhances persuasiveness.
Document treating‑physician outreach: Contacting treaters to clarify functional limits can be a decisive credibility marker.
Vocational rigor and wage substantiation: Tie occupational matches to DOT/O*NET descriptions and provide transparent rationale on wage levels meeting plan thresholds. Address key physical‑demand elements (like reaching) with specificity.
SSDI coordination: If you previously supported an SSDI claim, be prepared to explain differences in standards, timing, and additional evidence considered in the ERISA process at the any‑occupation phase.

Complex Concepts Simplified

Own Occupation vs Any Occupation: Many LTD plans pay for up to 24 months if you cannot perform the material duties of your own job (as defined in the national economy), then continue only if you cannot perform any job for which you are qualified by education, training, or experience, often coupled with a wage threshold (here, 60% of indexed earnings).
Indexed Earnings and Wage Threshold: Indexed earnings are your salary at disability start, increased annually per plan terms. To qualify for benefits at the any‑occupation stage, you must be unable to earn at least the specified percentage (60% here) of those indexed earnings in suitable work.
Functional Capacity Evaluation (FCE): A series of standardized tests of physical functioning. Useful, but not definitive; courts examine whether an FCE aligns with imaging, clinical records, and physician assessments.
Independent Medical Examination (IME) vs Paper Review: An IME involves a live exam; paper reviewers analyze records. Multiple consistent reviews (and an IME) often outweigh a single FCE or brief treating note, especially if well‑explained.
Rule 52 Bench Decision on Administrative Record: Instead of summary judgment, courts may, with party acquiescence, decide ERISA cases via findings of fact and conclusions of law based on the existing claim file. On appeal, facts are reviewed for clear error, not anew.
Clear Error Review: A deferential standard. If the district court’s view is permissible—even if another view is also possible—the appellate court will not reverse.
SSA Awards in ERISA Cases: Relevant but non‑binding; the plan’s definition and record often differ from SSA’s, and ERISA litigation may include later, more complete evidence.
Transferable Skills Analysis (TSA): A vocational tool identifying other jobs in the national economy that a claimant can perform, considering restrictions and background, often cross‑referenced to DOT/O*NET descriptions and wage data.

Conclusion

Although unpublished, Walker reinforces several durable ERISA principles within the Eleventh Circuit. First, when parties try an ERISA case to the court on an agreed administrative record under Rule 52, appellate review of the district court’s factual findings is deferential. Second, FCEs—while valuable—can be discounted where multiple, well‑reasoned physician reviews and objective imaging provide a contrary picture, especially on key functions like sitting tolerance that determine sedentary capacity. Third, at the any‑occupation stage, plan terms govern: occupations are evaluated as performed in the national economy; transferable managerial skills can justify matches such as “Manager, Financial Institution”; and the claimant bears the burden to show that no qualifying jobs meeting the plan’s wage threshold are performable. Fourth, SSDI awards do not control ERISA outcomes, particularly where the later ERISA record is more developed.

For practitioners, Walker is a concrete reminder that ERISA LTD litigation is won or lost on the coherence of the medical and vocational record with the plan’s specific definitions—especially the strength of the explanation connecting objective findings to functional limits and the quality of the wage‑grounded vocational analysis at the any‑occupation phase. The opinion offers a practical roadmap for both sides: meticulous medical synthesis and rigorous vocational proof will usually carry more weight than isolated test results or generalized objections.