Heather Cogdell v. Reliance Standard Life Insurance - ERISA Disability Benefits

PUBLISHED UNITED STATES COURT OF AP PEALS FOR THE FOURTH CIRCUIT No. 24 - 1940 HEATHER CO GDELL, Plaintiff – App ellee, v. RELIANCE STANDARD L IFE INSURANC E COMPANY, Defendant – App ellant. No. 2 5- 1083 HEATHER CO GDELL, Plaintiff – App ellee, v. RELIANCE STANDARD L IFE INSURANC E COMPANY, Defendant – App ellant. Appeal s from the United States District Cou rt for the Eastern District of Virginia, at Alexandria. Anthony John Tre nga, Senior District Judge. (1:23 - cv - 01343 - AJT - JFA) Argued: December 9, 2025 Decided: March 3, 2026 Before AGEE and QUATTLEBAUM, Circuit Judges, and FLOYD, Sen ior Circuit Judge.

2 Affirmed by publish ed opinio n. Judge Agee wrote the opinion, in which Judge Quattlebaum and Judge Floyd joined. ARGUED: Jos hua Bachrach, WILSON, ELSER, MOSKOWITZ, ED ELMAN & DICKER LLP, Philadelphia, Pennsylvania, for Appellant. Benjamin W. Glass, III, BENJAMIN W. GLASS, III & AS SOCIATES, Fairfax, Virginia, for App ellee. ON BRIEF: Pe ter M. Moore, WI LSON, ELS ER, MOSK OWITZ, EDE LMAN & DI CKER LLP, McLean, Virginia, for App ellant. Damon R. Miller, BENJAMIN W. GLASS, III & ASSOCIATES, Fairfax, Virginia, for App ellee.

3 AGEE, Circuit Judg e: When the administrator of an employee benefits plan governed by the Employee Retirement Income Security Act (“ER ISA ”), 29 U.S. C. § 1001, et seq., d enies a claim for benefits, it must employ reasonable pro cedures that provide the claimant with a full and fair review of that denial. F or a disability benefit s claim, a plan ad ministrator ordinarily has 45 da ys to dec ide an internal appeal of the initial denial. But if the p lan administrator notifies the claimant that special ci rcumstances exist and tells the claimant when a decision is expected, it can take up to another 45 days. If the ad ministrator upholds the denial of b enefits, ERISA allows the claimant to seek judicial review in federal court. In undertaking that review, if the plan vests its administrator with discretion to mak e eligibility determinations, and the administrator effectively exercises that discretion, a district co urt must afford deference to the administrator’s decision in most instances. However, if th e administrator fails to exercise its fiduciary discretion, then a district court may review de novo w hether the claimant is entitled to benefits. Here, we must decide whether a plan administrator that issues an untimely decision for an internal appeal of a disability benefits claim is en titled to deferential review. We hold that, at least und er the facts of this case, th e answer is “no” given t he absence o f a valid exercise of discretion.

4 I. Heather Cogdell worked at MITRE Corporatio n (“MITRE”) beginni ng in 201 4, most recently as a Principal Business Process Engineer. In July 2021, Cogdell contracted COVID - 19 and experience d symptoms of long - COVID, including intense fatigu e and sporadic headaches, for some time after the in itial illness subsided. Conse quently, Cogdell took Family and Medical Leave Act leave for the next year, during w hich she worked part - time. Just as she turn ed a corner and start ed to progress, Cogdell suffered fro m a second COVID - 19 infection in July 2022. Th is second bout derailed her recovery and left her unable to w ork in her job at MITRE. Cogdell filed a claim in November 2022 for long - term disability (“LTD”) und er MITRE ’s plan (the “Plan”), which was a dministered by Reliance. Because the P lan required Cogdell to exhaust all other benefits before receiving LTD, she selected the day after her short - term disability benefits ended as the “date of loss.” J.A. 224. For Cogdell to be entitled to L TD benefits un der the Plan, sh e must be “ Totally Disabled, ” meaning that, “as a result of [a sickness] . . . d uring the Elimination Period [1] and for th e first 24 months for which a Monthly Benefit is payable, [she ] cannot perform the material d uties of [her] regular occupation. ” 2 J.A. 59. 1 The “E limination Period” is “a period of consecutive days of Total Disability . . . for which no benefit is payab le, ” whi ch “begin s on the first day of Total Disability” an d continues for “180 consecutive day s of Total Disability.” J.A. 56, 58. 2 In a roundabout definition, the Plan provides that a “Partially Disabled” claimant is “Totally Disabled.” J.A. 59. “Partially Disabled” means that “as a result of an Injury or Sickness an Insured is capable of performing the material du ties of his/her regular occupation on a part - time basis or some of the material du ties on a f u ll - time basis.” Id.

5 In a letter dated January 12, 2023, Reliance denied Cogdell’s LTD benefits claim, concluding that she was not “Totally Disabled.” J.A. 18 8 – 91. Cogdell submitted additional medical records to Reliance, and, in an other letter dated February 17, 20 23, Reliance told her that it stood by its decision to deny benefits. J.A. 197 – 200. Cogdell timely filed an internal appeal on August 1 5, 2023, triggering the b eginning of Reliance’s 45 - day decision period. Along w ith a 21 - page letter i n support of her claim, Cogdell submitted various documen ts for Reliance to consider. R ecords show that by August 23, a nurse e mploye d by Relianc e had already: (a) rev iewed and summarized all the newly submitted documents; (b) “[c]on sulted other clinician with regards to this claim”; (c) received that clinician’s concurrence in her assessment of tho se documents; and (d) “suggest[ed]” the appeal be sent for a “pre - ap peal” behavioral health “specialist to determine if [Cogdell] would hav e a lack of function [.] ” J.A. 108 – 09. But Reliance did nothing mo re with Cogdell’s appeal until 27 days later (S eptember 19), w hen it was “referred” to the internal appeals department. J.A. 116. In a September 25 letter to Cogdell, Reliance stated that it “determin ed [it] will require an independent physician review” and that the letter was “to serve as notice of [its] intention to take beyond [45 ] days to make a final decision.” J.A. 204 – 05. The S eptember 25 letter did not include the date Reliance expected to issue its decision, nor did it identify a “special circumstance” to justify an extension. On October 3, after the initial 45 - day decision period lap sed, Cogdell sued Reliance in the Eastern District of Virginia for wrong ful denial of benefits under 29 U. S.C.

6 § 1132 (a)(1)(B). On October 26 — 72 days after Cogdell filed her appeal — Reliance upheld its decision deny ing Cogdell’s claim fo r LTD benefits. T he parties cross - moved for judgment on the administrative record and the district court found for Cogdell. Cogdell v. Reliance St andar d Life Ins. Co., 748 F. Supp. 3d 3 91 (E.D. Va. 2024). A t the outset, the district c ourt rejected Reliance’s argument that it was entitled to deferential review. See id. at 395 – 99. In doing so, it found that Reliance departed from the applicable claims procedures regulations because it did not time ly decide Cogdell’s internal appeal. S ee id. at 399. That failure, the district court concluded, meant that de novo review of Cogdell’s claim for benefits was appropriate. Id. The court went on to make findings of fact and conclusions of la w under Federal Rule of Civil Proced ure 52, and, o n the merits, concluded that Cogdell was entitled to LTD benefits under the P lan. See id. at 399 – 404. After R eliance timely noticed an appeal of that decision, the district court awarded Cogdell $210,769. 49 in past - due benefi ts, $22, 544.95 i n prejudgment interest, and post - judgment interest. J.A. 43. R eliance then timely noticed a n appeal of that award, and both appeals were conso lidated for briefing and consideration. 3 We have jurisdiction under 28 U.S.C. § 1291. 3 Despite appealing both orders, Reliance challenges only the merits of th e district court’s first decision, not its later calculatio n of the benefits owed.

7 II. W e review the district court’s “legal co nclusions and application of the law to the facts” de novo, Tatum v. RJ R Pensi on Inv. C omm., 855 F.3d 553, 560 (4th Cir. 2017), and its factual findings for clear error, Tekmen v. Reliance St andar d Life Ins. Co., 55 F.4th 951, 964 (4th Ci r. 2022). III. The standard of review takes center stage in this appeal. By statute, a participant in, or beneficiary of, an ER ISA - governed plan may sue in federal court “to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, o r to clarify his rights to future benefits und er the terms of the plan.” 29 U.S.C. § 1132(a)(1)(B). Although ERISA is “a comprehensive and reticulated statute[,]” it does not provide the standard of review courts are to u se when deciding an act ion chal lenging benefit eligibility determinations. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 108 – 09 (1989) (quo ting Nachman Corp. v. Pension Benefit Guar. Co rp., 446 U.S. 359, 361 (198 0)). To fill that gap, the S upreme Court has resolved that “a denial of benefits challenged under § 1132 (a)(1)(B) is to be reviewed. . . de novo [] unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms o f the plan. ” Id. at 115. So as long as the administrator exercises its fiduciary authority within the parameters established by the plan, ERISA, and its regulations, a court will review its ben efits determination for abuse of discretion.

8 Here we must de cide two issues to apply the standard of review. T he first is whether Reliance timely d ecided Cogdell’s in ternal appeal as required by the applicable ERISA regulations and the Plan. As we exp lain below, we agree with the district court that Reliance failed to do so, meaning that Cogdell’s claim was deemed denied a nd tha t sh e exhausted her administrative remedies as required to fil e her suit in federal court. T he second issue is whether Reliance’s failure to timely issue a deci sion affects the district court’s standard of review when reviewing Cogdell’s deemed - denied claim. The district court concluded that R eliance’s failure resulted in de novo review. We agree. Although the P lan vests Reliance w ith discretion to make benefits eligibility determinations, Reliance’s failure to timely decide Cogdell’s internal ap peal amounted to a forfeiture of fiduciary action, and no deference is due in that circumstan ce. Because the district court p roperly reviewed Cogdell’s claim de novo, and be c ause Reliance does no t show any legal error or clearly erroneous factfinding arising from that review, we see no error in the court’s d isability benefits de termination and accordingly will affirm the district court’s judgment. A. We begin with an overview of ERISA and its implemen ting regulations. Congress enacted ERISA “to promote the interests of employees and their b eneficiaries in employee benefit plans, and to protect contractually d efined benefits.” Firestone, 489 U.S. at 1 13 (cleaned up). ERISA advances these aims by “regulating the manner in wh ich plans process benefits claims.” Black & Decker Disability Plan v. Nord, 538 U.S. 822, 830 (2003). For example, ERISA requires an administrator of an em ployee benefit plan to “ provi de

9 adequate notice in writing to any participant o r beneficiary whose claim for benefits . . . has been denied, ” and to “ afford a reasonable opportunity to any participant whose claim for benefits has been denied for a full and fair rev iew . . . of the decision d enying the claim. ” 29 U.S.C. § 1133 (1) – (2). “ERISA empowers the Secretary of L abor to ‘prescribe such regulation s as he finds necessary or appropriate to carry out’ the statutory provisions securing employee benefit rights.” Black & Decker, 538 U.S. at 831 (qu oting 29 U.S.C. § 1 135). Charged w ith the duty to implement ERISA’s directives, the Secretary o f Labor has promulgated (and periodically amended) claims procedure regulations. S ee 29 C.F.R. § 2560.503 - 1. Broadly s peaking, t he se regulations requ ire an employee benefit plan to “establish and maintain reasonable procedures governing the . . . appeal of adv erse benefit determinations[.]” 4 Id. § 2560.503 - 1(b). To be reasonable, the claims procedures for ERISA - governed plans must comply with certain requirements relating to, for example: the timing, manner, and content of an in itial notification of a benefit determination; t he process for a claimant to adm inistratively appeal an adverse benefits determinatio n; and the timing for a plan admin istrator to notify a claimant of its decision on appeal. Id. § 2560.503 - 1(b)(1), (f) – (i). T hese procedural requirements for a full an d fair review “serve two complementary purposes.” Ellis v. Metr o. L ife Ins. Co., 126 F.3d 22 8, 23 6 (4th Cir. 4 Relevant here, “adverse ben efit determination” means “[a] denial, red uction, or termination of, or a failu re to provide or make paymen t (in whole or in part) for, a benefit, including any such denial, reduction, termination, or failure to provide or make payment that is based on a determination of a participant ’ s or beneficiary ’ s eligibility to particip ate in a plan [.]” 29 C. F.R. § 2560. 503 - 1(m)(4)(i).

10 1997). On the one hand, “[t]hey are designed to permit a plan ’s administrator to resolve disputes in an efficient, streamlined, non - adversarial manner.” Id. And o n the ot her, the y protect claimants from “arbitrary or unprincipled decision - making. ” Id. In the late 1990s, the Secretary recognized that “speedy decisionmaking is a crucial protection for claimants who need . . . the replacement income that disability benefits provide[,]” ERISA; Rules and Regulations for Administration and Enforcement; Claims Procedure, 65 Fed. Re g. 70, 246, 70, 247 (Nov. 21, 2000), and therefore specified certain requirements for disability benefits plans. As for timing, a claimant for disab ility benefits has 180 days to internally ap peal an adverse benefits deter mination to the plan administrator (sometimes referred to as an “intern al appeal”). 29 C.F.R. § 2560.503 - 1(h)(3)(i), (4). Once a claimant files an internal appeal, the administrator must ordinarily issue a decision within 45 d ays. 5 Id. § 2560.50 3 - 1(i)(1)(i), (3)(i). That 45 - day period can be extende d up to a nother 45 days (for a total of 90 d ays to decide the appeal) if the plan administrator: (a) “determines that special circum stances. . . requ ire an extension of time for processing the claim”; and (b) provides the claimant, w ithin the initial 45 - day period, with written notice that indicates (i) “ the special circumstances requiring an extension of time” and (ii) “the date by w hich the plan expects to render” a decision. Id. § 2650.503 - 1(i)(1)(i). 5 T he clock begi ns when a cla imant files an internal ap peal regardless of “whether all the information necessary to make a ben efit determination on review accompanies the filing.” 29 C.F.R. § 2560.503 - 1(i)(4). But if a claimant fails to submit the necessary information, the p eriod for the administrator to issue its d ecision is tolled from the time it notifies the claimant o f the need for additional information until the claimant responds to that request. Id.

11 C oupled with a plan administrator’s duty to provide reasonab le claim resolution procedures — such as timely deciding an internal appeal — is the claimant’s obligation to follow and exhaust other app licable procedures before bringing an action for wrongful denial of benefits under 29 U.S.C. § 1132. Wilson v. Un itedHealthcare Ins. Co., 27 F.4th 228, 241 (4th Cir. 2022). But what is a claimant supposed to do if the plan administrator’s deadline passes and it has yet to issue a decision? For abo ut the first 25 years that E RISA was in effect, the an swer was unsettled. In the late 1990s, after concluding that “claimants should not be required to continue to pursue claims through an administrative process that fails to meet the minimum standards of the regulation[,]” ERISA; Rules and Regulations for Ad ministration and Enforcement; Claims Procedures, 63 Fed. Reg. 48,390, 48,397 (S ept. 9, 1998), th e Secretary amended the regulatory mandates and “rad ically overhauled” the claims regulation, Fesse nden v. Reliance St andar d Life Ins. Co., 927 F.3d 998, 1002 (7th Cir. 2019) (Barrett, J.). Relevant here, a new subsection (l) addressed a plan administrator’s “[f]ailure to establish and follow reasonable claims procedures[,]” 29 C.F.R. § 2560.503 - 1(l) (2002), providing: [I] n the case of the failure o f a plan to establish or follow claims pro cedures consistent with the requirements of this section, a claimant shall be deemed to have exhausted the administrative remed ies available under the plan and shall be entitled to pu rsue any available remedies und er section 502(a) of the Act on the basis that the plan has failed to provide a reasonable claims procedure that would yield a decision on the merits of the claim. Subsection (l) was amended again in 20 16. Because “d isability and lost earnings impose severe hardship on many ind ividuals,” C laims Procedure for Plans Provid ing Disability Benefits, 81 Fed. Reg. 92,316, 92,317 (Dec. 19, 2016), the Secretary bifurcated

12 subsection (l), creating a heightened compliance standard applicable only to “[p]lans providing disability benefits[,]” 29 C.F.R. § 2560.503 - 1(l)(2) (2017), and leaving that subsecti on unchan ged for other ERISA - governe d plans, id. § 2560.503 - 1(l)(1). For disability benefits claims filed on or after April 1, 2018, plan administrators must “strictly adhere” to the claims processing regulations — such as those go verning ti ming. Id. § 2560.503 - 1(l)(2)(i), (p)(3). If a plan does not do so, then, subject to a narro w de minimis exception, “the claimant is deemed to have exhausted the administrative remedies available under the plan, ” and is “entitled to pursue any available remedies under section 502(a) o f [ERISA] on the basis that the plan has failed to provide a reasonable claims procedure that would yield a decision on the merits of the claim. ” Id. § 2560.50 3 - 1(l)(2)(i). I f the claiman t opts to pursue those remedies in court, th en “ the claim . . . is deemed denied on review without the exercise of discretion by an appropriate fiduciary. ” I d. B. With that regulatory framework in mind, we first address whether Reliance timely decided Cogdell’s internal appeal. P reliminarily, Reliance do es not challenge the validity of the timing prov isions in the claims pro cedure regulations implementing the “full an d fair review” requirement in 29 U.S.C. § 1133 (2). Oral Argumen t at 06:00 – 06: 22. Those regulations require a plan administrator to decide an internal appeal “not later than” 45 days after it is received. 29 C.F.R. § 2560. 503 - 1(i)(1)(i), (3)(i). A plan administrator can extend that period up to anot her 45 days only if it determines “special circumstances” necessitate an extension. Id. Even then, the plan administrator must provide “written

13 notice” to the claimant th at “indicate[s] th [ose] special circumstances” and the date that it expects to issue a decision. 6 Id. Cogdell filed her internal appeal on August 15, 2023, meaning that, absent an extension, Reliance had 45 days (or until October 1) to issue a decision. It is undisputed that Reliance did not i ssue a dec ision by that date. But Reliance argues that it invoked the 45 - day extension — postponing its deadline to Novembe r 13 — in a September 25 letter to Cogdell. In its view, th at act made its later October 26 decision timely. In the September 25 letter, Reliance stated th at it intended to take beyond 45 days to decide the appeal but did not provide the date it expected to do so. The sole explanation for th e extension was that Reliance was “await[ing] the co mpletion” of an “in dependent physician review” it h ad requested. J.A. 204 – 05. It did not say that review was a special ci rcumstance, no r did it explain how it could be one. The district court rejected Relian ce’s argu ment that it properly invoked the 45 - day extension, concludi ng that Reliance ha d only the initial 45 days to decide Cogdell’s internal 6 Following the regulation, the language of the Plan also in cludes the 45 - day deadline, subject to a po tential extension up to 45 day s if special circumstances exist: We will advise the Insured o f the results of our review within 45 days after we receive the Insured’s timely requ est for review, unless it is determined that special circumstances require an extension of time for processing the appeal. If it is determined that an extension of time for p rocessing is required, we will give the Insured written notice of the extension prior to the termination of the initial 45 - day period. In no event will such extension exceed a period of 45 days fro m the end of the initial period. The exten sion notice shall indicate the special circumstances requiring an extension of time and the date by which the determinatio n on review is expected to be made. J.A. 66.

14 appeal because no sp ecial circumstances justified an extension. See Cogdell, 748 F. Supp. at 397 – 99. On appeal, Reliance argues that the district court erred because, in its view, so long as a plan administrator determines special circumstances exist, that fi nding in a nd of itself is sufficient. The claims regulations do not define “special circumstances,” giving little guidance as to what it means beyond one example — “the need to hold a hearing, if the plan ’s procedures provide for a hearing.” 7 29 C.F.R. § 2560.503 - 1(i)(1)(i). With out further definitional clarity, we “b egin our interpretation of the regu lation with its text [.] ” Green v. Brennan, 578 U.S. 547, 553 (2016). And b ecause the text is clear, our analysis ends there too. See id. “Special” commonly refers to something “out of the ordinary” or “unusual.” 2 Shorter Oxford English Dictionary 2945 (5th ed. 2002). So, a circumstance is “special” in the context of the claims regu lation if it does not regularly arise in an in ternal appeal from the denial of benefits. Put ano ther way, a circumstance is not “special” if it is com monplace in the appeals process. 8 7 A question arose at oral argum ent regarding the appropriate stand ard of review for a plan administrator’s special circumstances determination. So as long as the administrator exercises its fiduciary authority within the parameters established by the plan, ERISA, and its regulations, a court will review th at determination for abuse of discretion. 8 Although “special circumstances” is plain and unambiguou s, and deference to an agency’s interpretation of its ow n regulation is therefore not implicated, see Kis o r v. Wilkie, 588 U.S. 558 (2019), we observe that our interpretation is consistent with the Secretary’s understa nding of special circumstances, as articulated in the preamble to the claims regulation: (Continued)

15 Applyin g this framework, we hold that there were no special circumstances here. Reliance points only to the n ew records Cogdell submitted with her internal app eal and the need to have those records reviewed by “appropriate medical specialists” to ensure a “full and fair review[.]” Ope ning Br. 30. But that does not explain why this event is no t “ordinary” or is in any way “unusual,” so as to be a “special circumstance.” In fact, ER ISA regulations seem to contemplate both th ese events as routine par t s o f most internal appeals. T he claims regulation s not only envision that a claimant will submit more document s and records when appealing an adverse benefit determination — they require plans to provi de claimants with the oppor tunit y to do so as part of their reasonable claims procedures. See 29 C.F.R. § 2560.50 3 - 1(h)(2)(ii), (4) (providing that a plan ’ s claims procedures must provide a claimant with “a reasonable opportunity for a full and fair review of a[n] . . . adv erse benefit determination ” and the plan must “ [p]rovide [c] laimants the opportunity to submit written com ments, documents, records, and other information In providing a limited extension opportunity for deciding group health and disability claims, it is the Department ’ s intenti on to pr ovide pla ns with t he flexibility necessary to handle all c laims appropriately, whether such claims are easy or difficult, co mplete when filed or needing more information. The Department emphasizes that the time per iods for decisionmaking are generally maximum periods, not automatic entitlemen ts. If a specific claim presents no difficulty whatsoever, it may be unreasonable to d elay in deciding that claim until the end of the maximum period; similarly, an extension may be imposed only for reasons beyond the contro l of the plan. For example, the Department would not view delays caused by cyclical or seasonal fluctuations in claims vo lume to be matters beyond the control of the plan that would justify an extension. ERISA; Rules and Regulations for Administration and Enforcement; Claims Procedure, 65 Fed. Reg. at 70,250 (emphasis added).

16 relating to the claim for benefits ”). And the P lan here does just that. J.A. 66 (statin g that, “[a]s part of the appeal pro cess” Reliance will provide the claimant “with the opportunity to send [it] written comments, documents, record s, and other information related to the . .. claim for benefits in con junction with the . . . timely appeal”). As for the need fo r an independent professional to review new records on appeal, that is commonp lace — and often req uired — in the internal appeal process. Further, f or a disability benefit plan’s claims procedures to b e reasonable, they must p rovide that the plan administrator will consult with a “health care professional” when “deciding an appeal of any adverse benefit determination that is based in whole or in part on a medical judgment [.]” 29 C.F.R § 2 560.503 - 1(h)(3)(iii), (4). Given these regulations, if new r ecords or a physician rev iew is a unique factor fo r a particular reason, the plan administrator must explain why that is so and what makes it a “special circumstance” in its no tice to the claimant. In this case, neither the plan admi ni strator nor the record reveal such in formation. In fact, t he timeline of Reliance’s processing of Cogdell’s internal appeal confirms the y were no t “special circumstances.” T he record instead reveal s that Reliance’s failure to complete its revie w within 45 days was completely of its own making. Cogdell filed her internal appeal on August 15, 2023, and b y August 23, a nurse employed by Reliance had reviewed the newly submitted document s, consulted an other clinician about Cogdell’s claim and received that clinician’s concurrence in her assessment, and recommended the claim be referred for an independent evaluation. In total, it took Reliance eight d ays to review the new documents and records.

17 But Reliance let the file sit idle for another 2 7 days until it was referred to th e appeals department on September 19. An internal Reliance note from the next day refl ects that an extension was necessary “due to late appeal referral.” J.A. 116. On September 20, Reliance finally sent a letter to Cogdell acknowledging it had received her internal appeal and stating that it intended to take more than 45 days to issue a decision, but did not identify a “special circumstance” justifying the delay. J.A. 202 (“Please allow this letter to serv e as notice of our intention to take beyo nd 45 days to make a final decision[.]”). Reliance then sent another letter to Cogdell on September 25 stating that it was pursuing an “inde pendent physician review” and that it “inten[ded] to take beyond [45] days to make a final decision, as [it] await[ed] the completion of the [physician review] and/or receipt o f the []requested information, if any such informatio n is available for review.” 9 J.A. 204 – 05. Also on September 25, Reliance referred Cogdell’s file to two independent medical professionals, receiving the first r eport back only four days later, on Sept embe r 29, and t he second six days after that, on October 5. J.A. 26. Reliance fo rwarded those reports to Cogdell on October 11 for h er to provide her input wit hin 14 days. It then iss ue d its final decision upholding the denial of her claim on October 26. 9 Awaiting receipt of additional documents here is not a special circumsta nce sufficient to justify the 45 - d ay extension. The regulations explicitly contain a tolling provision that provides for an extension of time “due to a claimant's failure to submit information necessary to decide a claim. ” 29 C.F.R. § 2560.503 - 1(i)(4). This provision does not apply because Reliance did no t require Cogdell to submit additional documen ts; it simply said she Cogdell cou ld submit them if she wanted to. Confirming this, on September 20, a Reliance claims an alyst emailed Cogdell’s counsel asking, “Do you in tend to submit any additional information or shall I con tinue with my review.” J.A. 117. Cogdell’s counsel responded: “There is no additional information we wish to submit with the appeal.” Id.

18 Giving Reliance the benefit of the doub t, it took at m ost 3 6 days for it to decid e Cogdell’s internal appeal: (a) 6 days for its nurse to review an d summarize the new document s and recor ds (8/17 – 8/23); (b) 5 days for the appeals department to review th e record and determine an ind ependent review was necessary (9/19 – 9/25); (c) 10 d ays to receive the independent professionals’ repo rts (9/25 – 10/5); (d) 14 days to allow Cogdell to respond to those re ports (10/ 11 – 10/25); and (e) 1 day to review th ose reports and issue a final decision (10/25 – 10/26). T his timelin e, drawn from the record evidence, shows that the new medical records Cogdell submitted with her internal appeal and the need for an “independent physician review” were not why Reliance needed more than 45 days to issue its decision. Reliance could have completed its review of Cogdell’s internal appeal well within the initial 45 days. And, if it could not have, it provi ded no valid reason fo r failing to do so. Reliance has not shown “special circumstances” to justify an extension. U nder the plain language of the govern ing regulations, the submission of new records and need fo r independent physician review are contemplated in most, and av ailable to all, as part of the internal appeals process. By definition, these are not “special circumstances, ” absent somethi ng more. And nothing “more” appears on this record that would tip the balance from the ordinary review of an internal appeal to “special circumstances” permitting

19 Reliance to invoke an extension. This recognition is fatal to Reliance’s argument th at it was entitled to another 45 days to issue a decision. 10 * * * We hold that Reliance failed to inv oke a 45 - day extension because, on these facts, no special circumstances justified an extension as a matter of law. Reliance thus had 45 days, or until October 1, 2023, to issue its decision. It indisputably failed to do so. C. W e now turn to the consequen ces of Reliance’s failure to timely decide Cogdell’s internal appeal. Recall th at an ERISA - governed plan must “establish and maintain reasonable procedures governing the filings of benefit claims, ” and that for a plan ’ s claims procedures to be reasonable, it m ust, among other things, adh ere to the reg ulatory time constraints. 2 9 C.F.R. § 2560.503 - 1(b)(1). S ince the 2018 amendmen ts took effect, a plan administrator must “strictly adhere” to all re gulatory requirements, including the timing provision. Id. § 2560.503 - 1(l)(2)(i). At the outset, we hav e no trouble concluding that Reliance did not strictly adhere to the regulations because, as discussed ab ove, it did not timely decide Cogdell’s internal app eal. 10 The regulations reflect that d etermining “special circumstances” is not the sole requirement for a 45 - day extension, as the administrator “shall” provide written notice to the claimant that “indicate[s] the sp ecial circumstances requiring an extension of time and the date by which the plan expects to ren der the determination on review.” 29 C.F.R. § 2560.503 - 1(i)(1)(i) (emphasis added). Reliance never gave Cogdell “the date by which the plan expect [ed] to render [its] determination[.]” Id. Arguably, th is defect could independently negate Reliance’s argument that it properly invoked an extension. However, the district court did not rely on this point. Since we resolve th is case on the “special circumstances” issue, we leave the date - certain requirement for resolutio n in another case on anothe r day.

20 In light of that failure, the claims processing regulations provide two co nsequences. First, unless a narrow de minim is exception applies, “the claimant is deemed to have exhausted the administrative remedies av ailable under the plan. . . [and] is entitled to pursue any available remedies under [29 U.S. C. § 1132 ].” Id. S econd, if the claimant opts to pursue those remedies, then “the claim or appeal is deemed denied on review without the exercise of discretion by an approp riate fiduciary.” Id. On appeal, Reliance agrees that an un timely decision permits Cogdell to file a lawsuit without exhausting her adm inistrative remedies but argues that it does not affect the applicable standard of review. We certainly agree with Reliance that, because the d e minimis exception does not appl y here, 11 Cogdell’s admin istrative remedies were exhauste d on Oct ober 1, 202 3, and that she timely sough t review of her entitlement to benefits in federal court. However, we disagree with Reliance’s argument as to the standard of review on the merits. For the reasons explained below, we ho ld that there was no exercise of discretion by Reliance as the plan administrator to which deference would be owed. Therefore, the district court was correct to review Cogdell’s claim de novo. 11 The de mini mis exception pr ovides that a claimant does not exhaust administrative remedies due to a plan’s failure to strictly adhere to the claims processing regulation if the regulatory violation was (i) de min imis; (ii) non - prejudicial; (iii) attribu table to good cause or matters beyond the administrator’s control; (iv) in the context of an ongoing good - faith exchange of information between the administrator and the claimant; and (v) not reflective of a pattern or practice of noncompliance. § 2560.503 - 1(l)(2)(ii). Alth ough Reliance argues that its late decision did not p rejudice Cogdell, it never explain s ho w it was de minimis. And even if the violation was de minimis, the fact that Reliance alon e was responsible for its inability to issue a timely decision means that the v iolation cannot be attribu table to good cause or matters beyond its con trol.

21 1. Congress “left to the co urts the development of review stand ards” in the ERISA context. Metro. Life Ins. Co. v. Glenn, 554 U.S. 10 5, 116 (2 008). When discern ing the appropriate stand ard of review, the Supreme Court in F irestone observed that because “ERISA abounds with the language and terminology of tru st law,” “principles of trust law” must guide courts in that task. 4 89 U.S. at 110 – 11. In other words, Firestone “was essentially an application of th e common law of trusts to judicial review o f ERISA claim denials.” Gilbertson v. Allied Signal, In c., 328 F.3d 625, 632 (10th Cir. 2003). T hose trust prin ciples “make a deferential standard o f review appropriate when a trustee exercises discretionary powers. ” Fires tone, 489 U.S. at 111 (citing Restatement (Second) of Trusts § 187 (1959)). “[W] hen trustees are in existence, and cap able of acting, a court of equity will no t interfere to control them in the exercise o f a discretion vested in them by the instrument under which they act. ” Id. (quoting Nichols v. Ea ton, 91 U.S. 716, 724 – 25 (1875) (emphasis added)); see also R estatement (Second) of Trusts § 2 87 (2007) (“ [W] hen a trustee has discretion with respect to the exercise of a power, its exercise [i] s subject to supervision by a court only to prevent abuse of discretion. ”). Firestone applied these trust law prin ciples to make clear that rev iew for abuse of discretion is appropriate only when (1) the plan confers discretionary authority to the administrator to “determine eligibility fo r benefits or to construe the terms o f the plan”; and (2) the administrator actually exercises that discretionary authority. Firestone, 489 U.S. at 115; see also Fessenden, 927 F.3d at 100 1 (“[The abuse of discretion] standard reflects deference to the administrato r’s exercise of discretion.” (emphasis added));

22 Nichols v. Prudentia l Ins. Co. of A m., 406 F.3d 98, 109 (2d Cir. 2005) (“[We] may give deferential review only to actual exercises of discretion. ”); Gilbertson, 328 F.3d at 631 (“[T] o be entitled to deferential review, not only must the admin istrator be given discretion by the plan, but the ad ministrator's decision in a g iven case must be a valid exe rcise of that discretion.”). C onsequently, the failure of a plan administrator to exercise its discretion in accord with the plan, ERISA, and ER ISA’s implementing regulations results in de novo review of a benefits determination, no t review for abuse of discretion. 2. T he parties agree that the P lan vests discretion in Reliance. See J.A. 64 (providing that Reliance, as the “claims review fiduciary,” “has the discretionary au thority to interpret the [Plan and the insurance policy ] and to determine eligibility for benefits”); O pening Br. 24; Resp. Br. 20 – 22. So the first Fireston e requirement for applying a deferential standard of review is satisfied. That leaves the second re quirement: whether Reliance as plan administrator effectively exercised that discretion here. Had Reliance never issued a final decision disposing of Cogdell’s internal appeal, the answer would clearly be “no” and de novo review would apply. See Fessenden, 927 F.3d at 1001 (“[W] hen an adm inistrator fails to render a final decision, there is no valid exercise of discretion to which the court can defer, and it decides de novo whether the insu red is entitled to benefits.”); Gritzer v. CBS, Inc., 275 F.3d 291, 296 (3d Cir. 2002) (“Where a trustee fails to act o r to exercise his or her discretion, de novo review is approp riate because the trustee has forfeited the privilege to apply his or her discretion; it is the trustee’s an alysis, not his or her right to use discretion

23 or a mere arbitrary denial, to which a court should defer.”); Trs. of Cent. States, Se. & Sw. Areas Health & Welfare Fund v. S tate Farm Mut. Auto. Ins. Co., 17 F.3d 1081, 1083 (7th Cir. 1994) (“Deferential review is appropriate only when the trust instrument allows the trustee to interpret the instrument and when the trustee has in fact interpreted th e instrument.” (emphasis added)). And Reliance agrees. Opening Br. 33. Reliance contends that it did issue a final decision upholding its denial of Cogd ell’s claim on October 26 — even though th at was more than three weeks after the 45 - day deadline. Reliance argues that the October 26 decision wa s nonetheless a valid exercise of discretion for two reasons, and that the district court should have afforded it deference. We disagree. a. First, Reliance argues that its late decision makes this case different from those that have held that a plan administrator forfeits discretionary review when it simply fails to decide an internal appeal. T his is in essence a substantial complian ce argument — Reliance ultimately issued a decision, it was just 25 days late. No h arm, no foul? We think not. It’s t rue that, as Reliance points out, we hav e held that “substantial compliance with the spirit of the regulation will suffice, for not all procedural d efects will invalidate a plan administrator ’ s decision.” Ellis, 126 F.3d at 235 (cleaned u p). “S ubstantial compliance exists where the claimant is p rovided with ‘ a statement of reason s that, under the circumstances of the case, permitted a sufficien tly clear understanding of the administrator ’ s position to permit effective rev iew. ’” Id. (quoting Brogan v. Holl and, 105 F.3d 158, 165 (4th Cir. 1997)). But w e have not located, an d Reliance has not cited, a single

24 case where we have applied the substantial compliance doctrine to the failure to ob serve the affirmative requirements of ERISA’s timing regulations or the provisions of the Plan. To the extent Reliance asks us to do so here, w e decline. Firestone provide s that we app ly the trust law principle that “a court of equity will not interfere to co ntrol [trustees] in the exercise of a discretion vested in them by the instrument under which they act.” Fireston e, 489 U.S. at 111 (cleaned up). But the ERISA regulations impose enforceable requirements on ERISA plans, and the Plan places temporal limits on Reliance’s ability as plan administrator to exercise its discretion. Consequently, the failure to follow the Plan’s time restraints n egates the discretion that would otherwise be due. All that ’s to say, both the ERISA regulation and the Plan required Reliance to decide Cogdell’s internal appeal within 45 days. Because “[d]ecisions made outside the boundaries of conferred discretion are not exercises of discretion,” Jebian v. Hewlett Packard Co. Emp. Benefits Org. Income Prot. Plan, 349 F.3d 1098, 1104 (9t h Cir. 2003), Reliance’s failure to issue a decision within th e 45 days meant it failed to exercise its fiduciary discretion. A late decision, ab sent unusual circumstances not present here, is not entitled to deference because Reliance lacks the authority to take longer than the regulations and the Plan permit. 12 See Fessenden, 927 F.3d a t 1004. 12 Reliance argu es that Fesse nden is inapposite because here Reliance decided Cogdell’s internal appeal within 90 days of receiving Cogdell’s request for review, wh ile the decision in Fessenden was issued after the 90 - day window closed. This is a distinction without a difference for present purpo ses because Reliance was only entitled to 45 days to begin wit h. When ope rating wi thin a fiduciary world in which an administrator h as only 45 days in which to act, its d ecision on day 72 is just as u ntimely as one on day 92. Neith er are valid exercises of fiduciary discretion.

25 A pl an administrator’s com pliance with rules conditi oning the exercise of its discretion is fundamentally different fro m an administrator’s compliance with rules about its substantive exercise of that discretion. As to the former, compliance either exists or it does not— those form the boundaries within w hich it can exercise its discretion. As to th e latter, it has leeway to exercise discretion within those boundaries. This case illustrates that distinctio n. Along with her requ est for an internal appeal, Cogdell submitted new records and documents to Reliance to support her claim. Once Reliance failed to timely issue its decision, Cogdell’s claim was deemed denied and she was entitled to seek judicial review. S ee id. § 2560.503 - 1(l)(2)(i). At that point, however, Cogdell had no explanation from Reliance about how it reviewe d her claim on appeal. Thus, she coul d not “prepare an appeal for further administrative review or recourse to the federal courts.” Ellis, 126 F.3d at 237. And when Cogdell sued, still with no decision, the district court could not “perform th e task, entrusted to [it] by ERISA, of reviewin g a claim denial[,] ” id., b ecause there was nothing to review. Instead, “[t]he d istrict court was presented with a claim for benefits based on evidence that, for all [Cogdell] and the court knew, Reliance had not yet considered, and had certainly not accounted for in any decision on [Cogdell]’s claim.” 13 Fessenden, 927 F.3d a t 1005. 13 A fortiori, we reject Reliance’s argumen t that it exercised its discretion when it denied Cogdell’s claim initially (before the internal appeal) and th at th e district court should have afforded that decision deference. Opening Br. 39. T o do so woul d essent ially negate the internal appeal process. A fter all, “ [t] he purpose of the ERISA mandated appeal process is an important one. That process enab les a claimant who is denied benefits to hav e an impartial administrative review, but also make an administrative reco rd for a court review if that later occurs.” Gagliano v. Reliance St andar d Life Ins. Co., 547 F.3d 230, 23 5 (4th Cir. 2008). The initial decision is th erefore of no relevance here.

26 As the n- Judge Barrett explained in Fessenden: Reliance ’ s position that an administrator can change the standard of review with a late - breaking decision wou ld therefore be a novel application of the substantial compliance doctrine. And permitting that novelty would undercut the benefits of exhaustion for claimants. A claimant is entitled to sue as soon as a claim is deemed exhausted because the administrator has failed to make a timely decision. But Reliance ’ s position would leave such a claimant in an uncertain position. Should she wait a littl e bit longer just in case the administrator makes a decision? Or should she go ahead, attempting to frame her case in a way that is responsive to a decision that hasn't yet — but may still — come? Id. Like the Seventh Circuit, we conclude that the substantial co mpliance doctrine is incompatible with the applicab le ERISA time restraints. 14 Id. at 1004 – 05. 14 Accordingly, many cases Reliance cites are unpersuasive. Fo r example, Reliance urges us to adopt the Eighth Circuit’s ho lding in McIntyre v. Reliance Standard Life Insurance Co., 73 F.4th 993, 999 (8th Cir. 2023), that a “procedural irregularity” does n ot strip a plan administrator of its discretionary authority, bu t is “one of many factors” to consider when determining whether an administrator abused its discretion. Of critical distinction, the claim in McIntyre was filed before January 1, 2021, id. at 998, and therefore was not subject to the amended subsection (l) which now requires strict adherence. To the extent this rule still ap plies in the Eighth Circuit, it is inconsistent with our conclusion above that one cannot sub stantially comply with a regulatory time deadline in most circumstances. The Ninth Cir cuit’s holding i n Jebian — that “inconsequential violations o f the deadlines would not entitle th e claimant to de novo review, in the context of an ongoing, good faith exchange of information between the administrator and the claimant[,]” 349 F.3d at 1107 (cleaned up) — is unpersuasive for the same reason. T he same goes for th e Fifth Circuit’s decision in Southern Far m Bureau Lif e Insurance Co. v. Moore, which merely stated with no discussion or explanation that “the standard of review is no different whether the claim is actually denied or is deemed denied.” 993 F.2d 98, 101 (5th Cir. 1993). Having resolved the timeliness issue, we need not address today whether the substantial compliance doctrine could still apply in other circumstances.

27 b. Reliance next invokes the Supreme Court’s recent decision in Loper Bright Enterprises v. Raim ondo, 60 3 U.S. 369 (2024), 15 to a rgue that the 2018 am endment t o subsection (l) was an impermissibl e exercise of the Secretary’s ru lemaking authority. In particular, it challenges 29 C.F.R. § 2560.503 - 1(l)(2)(i), which provides that if a claimant opts to seek review of an entitlement to benefits in federal court, the claim is “ deemed denied on review without the exercise of discretion by an appropriate fid uciary.” 16 According to Reliance, even though ERISA does not grant the Secretary the authority to do so, that provision “sets forth the judicial co nsequences of a fiduciary’s failure to follow the procedures by specifically revoking discretion.” Opening Br. 33 (emphasis in original). We find no merit in this argument. Reliance ap pears to argue that its u ntimely decision would otherw ise be entitled to deferential review but for that one provision in subsection (l). As demonstrated b y our lengthy discussion above, however, our holding as to the applicable standard of review — that de novo review is necessary because R eliance did not timely decide Cogdell’s internal appeal — is no t mandated by subsection (l)(2)(i), but by Fire stone and the principles of trust law we must consider when determin ing the appropriate standard of review. F irestone, 489 U.S. at 110 – 11. Subsection (l) simp ly says that a certain set of circumstances leads to a 15 In Loper Bright, the Supreme Court held that courts may no t defer to an agency’s interpretation of a statute simply because a statute is am biguous. 603 U.S. at 413. 16 As far as we can tell, Reliance do es not challenge other portions of subsection (l), such as those requiring strict adheren ce to the claims processing regulations and a ddress ing when a claimant exhausts administrative remedies.

28 certain result. It does not, however, invade the role of courts in setting the standard of review. 17 W e need not decide whether the Secretary exceeded the broad exp ress delegation of authority to promulgate regulati ons by dictating standards of review because subsection (l) does not do so. Loper Bri ght is simply inapplicable here. 18 * * * 17 The Department of Labor recognized as much when promulgating subsection (l): The Department does no t intend to establish a general rule regard ing the level of deference that a reviewing court may choose to give a fiduciary ’ s decision interpreting benefit provision s in the plan ’ s governing documents. However, the cases reviewing a plan fiduciary ’ s decision under a deferential arbitrary or capricious standard are based on th e idea that the plan documents give the fiduciary discretionary authority to interpret the plan documents. By providing that the claim is deemed denied without the exercise of f iduciary discretion, the regulation relies on the regulatory authority granted the Department in ERISA sections 503 and 505 and is intended to define what constitutes a denial of a claim. The legal effect of the definition may be tha t a court would conclude th at de novo review is app ropriate because of the regulation that determines as a matter of law that no fiduciary discretio n was exercised in denying the claim. Claims Procedure for Plans Providing Disability Benefits, 81 Fed. Reg. at 92, 32 7–28 (emphasis added). 18 Loper Bright is all the more no t in play here since ER ISA’s grant of authority to the Secretary is exceptionally broad: “ERISA empowers the Secretary of Labor to ‘prescribe such regulations as h e finds necessary or approp riate to carry out’ the statutory provisions securing employee benefit rights.” Black & D ecker, 538 U. S. at 831 (quoting 29 U.S.C. § 1135); see 2 9 U.S.C. § 1133(2) (requiring an emp loyee benefit plan to, “ [i]n accordance with regulations of the Secretary . . . afford a reason able opportunity to any participant whose claim for benefits has been d enied for a full and fair review by the appropriate named fiduciary of the decision d enying the claim ” (emphasis added)); see also Midthun - Hen s en ex rel. K.H. v. Gr p. Health Coop. of S. Cent. Wisc., Inc., 110 F.4th 984, 988 (7th Cir. 2024) (“ER ISA authorizes rulemaking, see 29 U.S.C. § 1135, and we need not addres s how Loper Bright. . . applies to regulations adopted under an express delegation.”). Likewise, we see no ambiguity in th o se express and plain grants of authorit y which do not implicate th e very basis of Loper B right: that courts cannot defer to an agency’s interpretation of an ambig uous statute. See 603 U.S. at 413.

29 A court w ill review a plan administrator’s decision regarding a claimant’s entitlement to benefits for abu se of discretion only if the plan confers discretion to the administrator and the administrator ex ercises that discretion in accord ance with the plan, ERISA and i ts regul a tions. ERISA’s regulations define the extent to which an administrator can exercise that au thority, meaning that an administrator cannot exercise its discretion when it fails to meet regulatory deadlines. Without an exercise of discretion, there is no discretionary act to which deference is owed, and a federal cou rt in that circumstance should review de novo whether a claimant is entitled to benefits. The terms of the P lan and th e claims regulation provide that Reliance had 45 days to decide Cogdell’s internal ap peal. Those 45 days came and went with no decision fro m Reliance. T here was no exercise of d iscretion, much less a discretionary act to which the district court could defer. Thus, th e district court correctly reviewed d e novo whether Cogdell was entitled to benefits under th e P lan. D. With the threshold arguments relating to the district court’s standard of review now resolved, we turn to the merits of Cogdell’s claim. We review a district court’s decision following a de novo review of a claiman t’s entitlement to benefits under a mixed standard of review — factual findings for clear error an d conclusions of law de novo. Tekmen, 55 F.4th at 964. The district court con cluded that Cogdell was entitled to b enefits under the P lan. Finding no error in either the district court’s findings of facts or legal con clusions, w e reject Reliance’s contrary arguments and affirm the award of benefits to Cogdell.

30 Reliance first argues that the d istrict court erroneously evaluated Cogdell’s claim based on her specific job at MITRE rather than the duties of her “regular occupation.” Opening Br. 43. We disagree. To be entitled to benefits, the P lan requires Cogdell to have been “Totally Disabled,” meaning that “as a resu lt of [a sickness fo r a specified period she] cannot perform the material duties of [] her regular occupati on.” J.A. 59 (emphasis added). The P lan, however, does not d efine “regular occupation.” In that event, th e “applicable definition . . . shall be a p osition of the same general c haracter of the insured’s previou s job, requiring similar skills and training, and involving comparable duties.” Gallagher v. Reliance St andard Life Ins. Co., 305 F.3d 264, 270 – 71 (4th Cir. 20 02) (quot ing Kinstler v. First Reliance St andard In s. Co., 181 F.3d 243, 252 (2d. Cir. 1999)). The district court relied on a job description in the administrative reco rd for a “Business Process Engineer, Principal” position at MITRE from May 2023 to establish the “material duties” of Cogdell’s regular occupation. Cogdell, 748 F. Supp. 3 d at 399 – 400. According to Reliance, this was erro r because the job description says no thing about the physical or cognitive requirements. It further argues that because some of the medical records show that Cogdell can physically perform “light work,” the district co urt should have more broadly considered whether Cogdell could essentially perform “all the material duties of her regular occupation” — which Reliance argues is a “sedentary role.” Reliance also cites its internal vo cational rehabilitation specialist’s reliance on th e Dictionary of Occupational Titles (“DOT”) entry for “consultant, ” which lists generic and broad tasks, i.e., “conducts study or survey on need or problem to obtain data required for solution.” Opening Br. 46 (citing J.A. 384 – 86).

31 As the fact finder, and ow ing no deference to Reliance, the district co urt reasonably identified Cogdell’s occupation and its associated duties. The court was entitled to credit the job description (posted to backfill Cogdell’s position) and other evidence in the record (such as Cogdell’s resume and statements) to ascertain tho se “material duties.” Gallagher, 305 F.3d at 270 – 71; Tekmen, 55 F.4th at 9 61 (describing de novo review). Nor did the court clearly err in not crediting the DOT entry for “Consultan t” as many of the broad tasks it listed do not “involve comparable duties” to the work Cogdell performed in her role at MITRE. See Gallagh er, 305 F. 3d at 272 (“A general job description of the DOT, to be applicable, must involve comparable duties but not necessarily every duty.”). Lastly, R eliance’s argument that a sedentary task fi nding compels a denial of benefits relies on a fallacy: “sedentary occupations requ ire a certain physical capacity, you are capab le of meeting those physical requirements, your regular o ccupation is sedentary, therefore you can perform your occupation.” Ward v. Reliance S t andar d Life Ins. Co., No. 23 - 2147, 2 024 WL 3206709, at *7 (D. Md. June 21, 2024). T his reason ing leaves out any consideration of the cognitive requirements of Cogdell’s occupation, which the record shows the district court su fficiently (and correctly) considered. At b ottom, there is sufficient eviden ce to support the district court’s assessm ent of Cogd ell’s “regular occupation. ” Reliance next argues that the district cou rt erred by not con sidering the reports from the two in depende nt medical professionals that Reliance received after Cogdell’s claim was deemed denied and she filed suit. When, as here, a district court rev iews a claimant’s entitlement to benefits de novo, we have instructed th at it “ shoul d revie w only the evidentiary record that was presented to the plan administrator” unless it determin es “ that

32 additional evidence is necessary fo r resolution of the benefit clai m. ” Q uesinberry v. Life Ins. Co. of N. Am., 987 F. 2 d 1017, 1 026 – 27 (4th Cir. 1993). We again disagree with Reliance. T he district court expressly reco gnized the applicable standard and declined to exercise its d iscretion to consider additional ev idence w hen it noted that, “absent exceptional circumstances,” it was to look “only to the evidence in the administrative record presented by the claimant at the time the claim was administratively exh austed.” Cogdell, 748 F. Supp. 3d at 404. We see no abuse of discretion in the district court ’s decision not to consider evidence that the claims processing regulations req uire d be provided t o Cogdell with an opportunit y to respo nd withi n the appeals period because the evidence was not provided un til after the claim was deemed denied, leaving Cogdell with no opport unity to r espond. See 29 C.F.R. § 2560. 503 - 1(h)(4)(i). Had Reliance pro cessed Cogdell’s internal appeal in a ti mely manner, those reports could hav e been part of the administrative record. But a s discu ssed above, it did not and the district court did not err by not cons idering t hem. Last, Reliance argues that the district court impermissibly applied a “treating physician” rule, assigning more weight to certain reports from Cogdell’s treating physicians. But “d istrict courts are institutionally assigned the role of finder of fact” and that role encompasses “assessing credibility and determining the approp riate weight to assign evidence.” Tekmen, 55 F.4th at 961. We held in Tekm en that when “the district court determines that the accounts of treat ing physicians are more persuasiv e than t hose of physicians who only examined a paper record, it is not error for the district court to assign

33 those opini ons more w eight.” Id. at 966. Although Reliance may dispute the weight of the evidence, given the district court’s extensive review of the record evidence that suppo rts its conclusion that Cogdell was “Totally Disabled,” Reliance has failed to show anyth ing that would leave this Court “with the definite and firm conviction that a mistake has been committed.” Id. at 964. Having otherwise reviewed the district court’s merits det ermination and seeing no error, we reject Reliance’s remaining arguments, see, e.g., Reply Br. 20 – 24, and will affirm the district court’s decision. I V. For the reasons discussed above, the judgment of th e district court is AFFIRMED.