Untimely ERISA Disability Appeal Decisions Forfeit Deferential Review: De Novo Review Applies Absent a Valid Exercise of Discretion

Case: Heather Cogdell v. Reliance Standard Life Insurance Company (4th Cir. Mar. 3, 2026) (published)
Subject: ERISA disability claims procedures; appeal-decision deadlines; “special circumstances” extensions; standard of judicial review

1. Introduction

This Fourth Circuit decision addresses a recurring but high-stakes procedural question in ERISA disability litigation: when an ERISA plan administrator misses the regulatory deadline to decide an internal appeal, is the administrator still entitled to deferential (abuse-of-discretion) review in court?

The plaintiff, Heather Cogdell, a MITRE employee suffering long-COVID symptoms, sought long-term disability (“LTD”) benefits under MITRE’s ERISA-governed plan administered by Reliance Standard Life Insurance Company (“Reliance”). Reliance denied her claim and, after Cogdell filed a timely internal appeal, Reliance issued its appeal decision late. Cogdell sued once the deadline passed. The district court applied de novo review, found Cogdell “Totally Disabled” under the plan’s “regular occupation” standard, and awarded benefits. Reliance appealed, primarily contesting the standard of review.

The Fourth Circuit affirmed and, in doing so, clarified (i) what qualifies as “special circumstances” permitting an extension of the appeal deadline and (ii) the standard-of-review consequences of an untimely appeal decision under the post-2018 disability-claims regulations.

2. Summary of the Opinion

3. Analysis

3.1. Precedents Cited (and How They Shaped the Decision)

• Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989).
  The opinion treats Firestone as the organizing framework: de novo review is the default unless the plan grants discretion and the administrator actually exercises that discretion within the boundaries of the plan and applicable law. The court draws directly from Firestone’s trust-law grounding (including Nichols v. Eaton) to emphasize that judicial deference presupposes a valid fiduciary act.
• Nichols v. Eaton, 91 U.S. 716 (1875), and Restatement trust principles cited via Firestone.
  These authorities supply the trust-law premise: courts do not “control” a trustee’s discretion when trustees are “capable of acting”—but if the trustee does not validly act, there is nothing to defer to. The Fourth Circuit uses this to explain why missing the regulatory deadline is not a mere technicality: it negates the necessary predicate for deferential review.
• Metro. Life Ins. Co. v. Glenn, 554 U.S. 105 (2008).
  Cited for the proposition that Congress left review standards to courts; the decision then re-centers the inquiry on Firestone’s trust-law architecture (and the need for an actual exercise of discretion).
• Black & Decker Disability Plan v. Nord, 538 U.S. 822 (2003).
  Used to situate ERISA as regulating “the manner in which plans process benefits claims” and to support the Secretary of Labor’s authority to promulgate claims-procedure rules. This bolsters the court’s insistence that timing rules are not optional.
• Ellis v. Metro. Life Ins. Co., 126 F.3d 228 (4th Cir. 1997) and Brogan v. Holland, 105 F.3d 158 (4th Cir. 1997).
  Reliance leaned on Ellis to argue “substantial compliance.” The court limits Ellis to its proper domain: substantial compliance may address some procedural defects regarding the adequacy of explanations, but the court declines to extend it to violating affirmative, conditioning time limits. Put differently, timing deadlines define the administrator’s authority to act; they are not simply “spirit-of-the-regulation” guidance.
• Fessenden v. Reliance Standard Life Ins. Co., 927 F.3d 998 (7th Cir. 2019) (Barrett, J.).
  This is the most influential out-of-circuit authority in the opinion. The Fourth Circuit adopts Fessenden’s reasoning that without a timely decision, the administrator has not produced a valid exercise of discretion, and a late decision cannot retroactively change the standard of review—otherwise claimants face strategic uncertainty about whether to sue when exhaustion is triggered.
• Nichols v. Prudential Ins. Co. of Am., 406 F.3d 98 (2d Cir. 2005); Gilbertson v. Allied Signal, Inc., 328 F.3d 625 (10th Cir. 2003); Gritzer v. CBS, Inc., 275 F.3d 291 (3d Cir. 2002); Trs. of Cent. States, Se. & Sw. Areas Health & Welfare Fund v. State Farm Mut. Auto. Ins. Co., 17 F.3d 1081 (7th Cir. 1994).
  These cases collectively support the “actual exercise of discretion” requirement: deferential review attaches only to real, valid discretionary action. The court uses them to show its result is consistent with a broader trust-law-infused ERISA tradition.
• Jebian v. Hewlett Packard Co. Emp. Benefits Org. Income Prot. Plan, 349 F.3d 1098 (9th Cir. 2003).
  Quoted for the principle that decisions “outside the boundaries of conferred discretion are not exercises of discretion.” The Fourth Circuit distinguishes and rejects the more forgiving “inconsequential deadline violations” approach as incompatible with post-2018 “strict adherence” rules for disability claims.
• McIntyre v. Reliance Standard Life Insurance Co., 73 F.4th 993 (8th Cir. 2023) and Southern Farm Bureau Life Insurance Co. v. Moore, 993 F.2d 98 (5th Cir. 1993).
  The opinion finds these authorities unpersuasive (or inapplicable) because they arose under older regulatory regimes or adopt approaches inconsistent with the “strict adherence” structure now governing disability claims.
• Loper Bright Enterprises v. Raimondo, 603 U.S. 369 (2024), and Kisor v. Wilkie, 588 U.S. 558 (2019).
  Reliance invoked Loper Bright to attack the disability-claims regulation’s “deemed denied … without the exercise of discretion” language as an overreach. The court rejects the move: it applies de novo review because Firestone requires an actual exercise of discretion for deference—not because an agency “dictated” a standard of review. Kisor is noted to clarify that the court is not relying on deference to agency interpretation because “special circumstances” is treated as unambiguous.
• Wilson v. UnitedHealthcare Ins. Co., 27 F.4th 228 (4th Cir. 2022).
  Provides the general rule that ERISA claimants must exhaust plan procedures before suit—setting up why the “deemed exhausted” consequence matters when administrators miss deadlines.
• Quesinberry v. Life Ins. Co. of N. Am., 987 F.2d 1017 (4th Cir. 1993).
  Governs the evidentiary scope on de novo review. The Fourth Circuit affirms the district court’s refusal to consider post-exhaustion independent physician reports, emphasizing that the administrator’s tardiness deprived the claimant of the procedural right to receive and respond to that evidence within the appeal process.
• Tekmen v. Reliance Standard Life Ins. Co., 55 F.4th 951 (4th Cir. 2022), and Tatum v. RJR Pension Inv. Comm., 855 F.3d 553 (4th Cir. 2017).
  Provide the appellate review framework (mixed standard) and reinforce that district courts, on de novo review, are factfinders who may assign weight to treating physicians without applying an impermissible “treating physician rule.”
• Gallagher v. Reliance Standard Life Ins. Co., 305 F.3d 264 (4th Cir. 2002) (quoting Kinstler v. First Reliance Standard Ins. Co., 181 F.3d 243 (2d. Cir. 1999)).
  Controls how “regular occupation” is defined when the plan is silent: a position of the same general character, requiring similar skills, training, and comparable duties. The court uses these cases to uphold the district court’s occupation/duties analysis.
• Gagliano v. Reliance Standard Life Ins. Co., 547 F.3d 230 (4th Cir. 2008).
  Cited to reject Reliance’s attempt to resurrect deference from the initial denial: the appeal process is integral to ERISA’s design, and the initial denial cannot substitute for a proper appeal decision.

3.2. Legal Reasoning

A. “Special circumstances” is construed narrowly as “out of the ordinary”

The court interprets “special circumstances” (29 C.F.R. § 2560.503-1(i)(1)(i)) by ordinary meaning: “special” means unusual or out of the ordinary. Because disability appeals routinely involve (i) submission of additional medical records and (ii) consultation with health professionals—including independent reviewers—those facts, standing alone, cannot justify extending the 45-day appeal decision deadline.

Critically, the court ties “special circumstances” to the regulatory design: disability claimants need “speedy decisionmaking,” and the time periods are “maximum periods, not automatic entitlements.” On this record, the delay was “of [Reliance’s] own making” (the file sat idle due to “late appeal referral”), which is the opposite of an unusual circumstance beyond the administrator’s control.

B. Missing the deadline is not a curable “procedural irregularity”; it negates deference

The opinion draws a sharp distinction between:

• Rules that condition the administrator’s authority to act (e.g., the 45-day deadline), and
• Rules governing the quality of a decision within that authority (where discretion and “substantial compliance” might have room to operate).

The deadline is the boundary of conferred discretion. Under Firestone and trust principles, deference exists only to the administrator’s valid exercise of discretion. Once the 45 days elapsed without a decision, there was “no exercise of discretion” to defer to; the claim was “deemed denied,” and the court properly reviewed entitlement to benefits de novo.

C. “Substantial compliance” does not revive discretion after a deadline breach

Reliance argued that because it eventually issued an appeal decision (25 days late), it substantially complied and should still receive abuse-of-discretion review. The court rejects that as incompatible with time limits that define and limit fiduciary authority. It also highlights the claimant-facing harm identified in Fessenden: allowing late decisions to toggle the standard of review would create uncertainty for claimants about whether to sue upon deemed exhaustion.

D. The Loper Bright attack fails because de novo review is a judicial (trust-law) consequence, not an agency-imposed one

Reliance attempted to reframe the 2018 disability regulation as unlawfully “revoking discretion.” The court responds that it does not need the regulation to reach de novo review: Firestone already requires an actual exercise of discretion for deference. The regulation’s “deemed denied … without the exercise of discretion” language is treated as defining what happened (no discretionary act), not as prescribing how courts must review. Therefore, Loper Bright does not change the outcome.

E. Merits rulings reinforce the procedural holding’s practical effect

After confirming de novo review, the Fourth Circuit affirms the district court’s merits determinations:

• “Regular occupation”: using a MITRE job description and record evidence to identify material duties was permissible under Gallagher, and generic DOT “consultant” descriptions were not necessarily comparable.
• Record limitation: excluding late, post-exhaustion independent physician reports was consistent with Quesinberry, especially where tardiness deprived Cogdell of the regulatory right to receive and respond within the appeal process.
• Weight of medical opinions: crediting treating physicians more than paper reviewers is not an impermissible treating-physician rule under Tekmen; it is ordinary factfinding.

3.3. Impact

• Stricter enforcement of disability-appeal timelines in the Fourth Circuit. Administrators should expect that missing the appeal deadline (without a truly “special” justification) will trigger de novo review, not merely a procedural “factor” within abuse-of-discretion review.
• Narrow construction of “special circumstances.” Administrators cannot treat independent medical review or receipt of additional records as an automatic extension trigger; they must identify what is genuinely unusual and why it requires more time.
• Reduced litigation gamesmanship. The decision disincentivizes late “catch-up” decisions designed to regain deference after a claimant sues.
• Administrative-record consequences. Where the administrator’s untimeliness deprives the claimant of the chance to rebut new medical reviews during the appeal, courts may be more willing to exclude those materials under Quesinberry principles.
• Regulatory litigation post-Loper Bright. While the court rejects Reliance’s specific argument, the opinion signals that even if parties attack disability-claims regulations, courts can reach the same standard-of-review result through Firestone’s trust-law requirement of an actual, timely discretionary act.

4. Complex Concepts Simplified

• ERISA “full and fair review” (29 U.S.C. § 1133): Plans must give clear denial reasons and a meaningful internal appeal process before the claimant goes to court.
• Internal appeal deadline (45 days): For disability appeals, the administrator generally must decide within 45 days, with at most one extension (another 45 days) only if “special circumstances” exist and proper notice is given.
• “Special circumstances”: Not “this appeal has medical records” or “we want an independent review.” Those are normal. “Special” means unusual.
• “Deemed exhausted” / “deemed denied”: If the plan fails to follow required claims procedures (including timing), the claimant may sue because the law treats the internal appeal as effectively denied and the internal process as complete.
• Standard of review—abuse of discretion vs. de novo:
  • Abuse of discretion: the court defers to the administrator’s reasonable judgment if the plan granted discretion and it was validly exercised.
  • De novo: the court decides entitlement to benefits for itself, without deference, typically when there is no valid discretionary decision to review.
• Why timing affects deference: In the court’s view, the deadline is part of the “authority” to decide. If the administrator acts outside that authority, the late decision is not a valid discretionary act.
• “Regular occupation”: If undefined, it means a job of the same general character as the claimant’s prior job, requiring similar skills/training and comparable duties—not necessarily a generic occupational label.

5. Conclusion

Cogdell v. Reliance Standard Life Insurance Company establishes an important Fourth Circuit rule for ERISA disability litigation: when a plan administrator fails to decide a disability internal appeal within the regulatory deadline (and cannot show genuine “special circumstances”), the administrator forfeits deferential review because there is no timely, valid exercise of fiduciary discretion to which a court can defer. The proper judicial posture is de novo review.

The decision strengthens the enforceability of ERISA disability claims-procedure timelines, narrows the extension mechanism to truly unusual situations, and limits administrators’ ability to reclaim deference through late-issued decisions—thereby reinforcing ERISA’s “full and fair review” promise as a procedural safeguard with real remedial consequences.