ERISA Benefit Denial Litigation Outcomes

A Statistical Analysis of Plaintiff and Insurer Win Rates by Federal Circuit and District Court

Executive Summary

This report presents a comprehensive statistical analysis of plaintiff and insurer win rates in ERISA benefit denial cases decided by federal district courts from January 2015 to May 2026. The data is drawn from a Lexis/Nexis Lex Machina analysis of federal court filings, identifying all ERISA cases decided on the merits of whether a claim denial was “improper” or “not improper.”

Across 2,670 decided cases in 12 federal circuits, plaintiffs won 31.1% of adjudicated ERISA benefit denial cases nationally. But that national average masks a dramatic variation across circuits — from a high of 49.5% in the Ninth Circuit to a low of 16.3% in the Eleventh Circuit.

Key Findings at a Glance

National plaintiff win rate: 31.1% (831 wins out of 2,670 decided cases)

Highest circuit: 9th Circuit — 49.5% plaintiff win rate (265 of 535 cases)

Lowest circuit: 11th Circuit — 16.3% plaintiff win rate (32 of 196 cases)

Highest district: D. Or. (Portland) — 67.5% plaintiff win rate (27 of 40 cases)

Lowest district: M.D. Fla. (Orlando) — 13.2% plaintiff win rate (7 of 53 cases)

The difference between filing in the most favorable versus least favorable jurisdictions represents a more than five-fold difference in measured plaintiff outcomes.

The variation in outcomes is not random. It reflects three structural factors:

• The standard of review applied — de novo (claimant-favorable) versus abuse of discretion (insurer-favorable)
• Whether the plan is fully insured or self-funded — only fully insured plans are subject to state discretionary clause bans that mandate de novo review
• Whether plaintiff’s counsel correctly identifies and argues the applicable review standard — courts do not independently apply state law bans; if not raised, abuse of discretion applies by default

The Ninth Circuit’s dramatically higher plaintiff win rates trace directly to California’s Insurance Code § 10110.6, Washington’s WAC § 284-96-012, and Oregon’s OAR 836-010-0026, each of which bans discretionary clauses in fully insured disability policies. When those bans are properly invoked, de novo review applies and plaintiffs win at approximately twice the national average rate.

Methodology and Data Notes

Source Data

The data in this report is drawn from a Lexis/Nexis Lex Machina analysis of federal court filings. Lexis/Nexis Lex Machina identified all ERISA civil cases from January 1, 2015 to May 2026 that were decided on the merits of whether the benefit denial was proper.

Cases are categorized into two outcomes:

• Plaintiff win: Court found an “improper claim denial” — the benefit denial was wrongful and the plaintiff is entitled to relief
• Insurer win: Court found “no improper claim denial” — the benefit denial was upheld

What This Data Does Not Measure

Important Limitation

These figures are blended outcomes across all standards of review (both de novo and abuse of discretion) and plan types (both fully insured and self-funded), and all forms of ERISA litigation (pension, life, health, and disability). They do not isolate cases by review standard. This means:

1. The Ninth Circuit’s 49.5% blended rate understates the advantage available in properly litigated, fully insured, de novo cases specific to disability claims.

2. Even favorable jurisdictions produce lower blended rates than their de novo-only rate would suggest, because a large share of all ERISA cases involve plans governed by abuse of discretion review.

3. The national average of 28% under abuse of discretion and 68% under de novo review (Georgetown University Health Policy Institute 2004 study) is the appropriate benchmark for standard-specific win rates; the Lexis/Nexis Lex Machina figures represent the full panoply of ERISA litigation.

Cases excluded from the dataset include: ERISA preemption cases, delinquent contribution cases, cases dismissed for failure to exhaust administrative remedies, and other cases decided on grounds other than the merits of the benefit denial. Only cases with a final determination of “improper” or “no improper” claim denial are included.

National Results: Circuit-by-Circuit Comparison

The following table presents plaintiff and insurer win rates for all 12 federal circuits, sorted by plaintiff win rate.

The nine-circuit span between the highest (9th Circuit, 49.5%) and lowest (11th Circuit, 16.3%) represents a three-to-one difference in measured plaintiff outcomes — based on actual federal court decisions across more than a decade of litigation.

The Ninth Circuit: California, Washington, and Oregon

The Ninth Circuit’s 49.5% plaintiff win rate is the highest of any circuit in the nation. The circuit encompasses California, Washington, Oregon, Arizona, Nevada, Idaho, Montana, Alaska, and Hawaii. The elevated outcomes are concentrated in the California, Washington, and Oregon districts, each of which is subject to a state ban on discretionary clauses in fully insured disability insurance policies.

State Discretionary Clause Bans in the Ninth Circuit

• California Insurance Code § 10110.6 (eff. January 1, 2012): Voids discretionary clauses in any policy covering a California resident, upheld against ERISA preemption in Orzechowski v. Boeing Co. Non-Union LTD Plan, 856 F.3d 686 (9th Cir. 2017)
• Washington Administrative Code § 284-96-012 (eff. September 5, 2009): Prohibits discretionary clauses in all disability insurance policies issued in Washington
• Oregon Administrative Rule 836-010-0026: Self-executing ban prohibiting any policy from containing a discretionary clause or language reserving interpretation rights to the insurer; void provisions treated as unenforceable by operation of law

California, Washington, and Oregon District Outcomes

The following table breaks out plaintiff win rates for individual California, Washington, and Oregon districts within the Ninth Circuit, compared to the circuit overall.

The District of Oregon’s 67.5% plaintiff win rate — 27 wins out of 40 decided cases — is the highest measured rate of any district in the nation. The Western District of Washington (Seattle) at 61.3% is the second-highest. California districts collectively show a 46.8% blended rate and collectively are the highest after Washington and Oregon.

These figures represent blended outcomes across all plan types and standards of review. The win rate in these states with discretionary clause bans approaches the Health Policy Institute’s documented 68% de novo rate.

Full District Court Data by Circuit

The following tables present plaintiff and insurer win rates for every federal district court in the nation, organized by circuit. Districts are listed in the order they appear in the source data.

1st Circuit — MA, ME, NH, RI, PR

Circuit total: 106 cases | Plaintiff win rate: 21.7% (23 plaintiff wins, 83 insurer wins)

2nd Circuit — NY, CT, VT

Circuit total: 195 cases | Plaintiff win rate: 25.1% (49 plaintiff wins, 146 insurer wins)

3rd Circuit — PA, NJ, DE, VI

Circuit total: 194 cases | Plaintiff win rate: 25.8% (50 plaintiff wins, 144 insurer wins)

4th Circuit — MD, VA, NC, SC, WV

Circuit total: 164 cases | Plaintiff win rate: 28.0% (46 plaintiff wins, 118 insurer wins)

5th Circuit — TX, LA, MS

Circuit total: 264 cases | Plaintiff win rate: 16.7% (44 plaintiff wins, 220 insurer wins)

6th Circuit — OH, MI, KY, TN

Circuit total: 396 cases | Plaintiff win rate: 30.8% (122 plaintiff wins, 274 insurer wins)

7th Circuit — IL, IN, WI

Circuit total: 192 cases | Plaintiff win rate: 35.9% (69 plaintiff wins, 123 insurer wins)

8th Circuit — MN, MO, IA, NE, AR, ND, SD

Circuit total: 192 cases | Plaintiff win rate: 22.9% (44 plaintiff wins, 148 insurer wins)

9th Circuit — CA, WA, OR, AZ, NV, ID, MT, AK, HI

Circuit total: 535 cases | Plaintiff win rate: 49.5% (265 plaintiff wins, 270 insurer wins)

10th Circuit — CO, UT, KS, NM, OK, WY

Circuit total: 222 cases | Plaintiff win rate: 37.8% (84 plaintiff wins, 138 insurer wins)

11th Circuit — FL, GA, AL

Circuit total: 196 cases | Plaintiff win rate: 16.3% (32 plaintiff wins, 164 insurer wins)

DC Circuit — District of Columbia

Circuit total: 14 cases | Plaintiff win rate: 21.4% (3 plaintiff wins, 11 insurer wins)

City-by-City Comparison: Local vs. Ninth Circuit Outcomes

The following table compares plaintiff win rates in home district courts for major U.S. cities against the measured outcomes in the Western District of Washington (Seattle, 61.3%) and Northern District of California (San Francisco, 48.4%) — the two primary Ninth Circuit filing venues for employees of California- or Washington-administered ERISA plans.

† Denotes districts with fewer than 25 decided cases. These rates should be interpreted with caution; the circuit-level average is a more statistically reliable benchmark.

Legal Framework: Why Jurisdiction Determines Outcomes

The Standard of Review

The outcome of an ERISA benefit denial case is determined more by the legal standard of review than by almost any other factor. Two standards apply:

• De novo review: The court independently evaluates whether the claimant is entitled to benefits, giving no deference to the insurer’s prior decision. Health Policy Institute data documents a ~68% plaintiff win rate under de novo review.
• Abuse of discretion (arbitrary and capricious): The court defers to the insurer’s decision and upholds it unless unreasonable. The documented plaintiff win rate is approximately 28%.

The Supreme Court’s 1989 decision in Firestone Tire & Rubber Co. v. Bruch established de novo as the default standard, but allowed exception where the plan grants the administrator discretionary authority. The insurance industry universally adopted such language within years of that decision, converting the exception into the dominant standard.

The Role of Counsel

Courts do not independently research and apply state discretionary clause bans. If plaintiff’s counsel does not affirmatively argue that the applicable state ban voids the discretionary clause and request de novo review, the court will apply abuse of discretion review by default. This is one of the most consequential and avoidable errors in ERISA practice, and it directly lowers plaintiff win rates even in the most favorable jurisdictions.

Venue and Plan Administration

Under 29 U.S.C. § 1132(e)(2), ERISA plaintiffs may file suit in the district where the plan is administered, where the breach occurred, or where any defendant resides. Employees of employers headquartered in California, Washington, or Oregon may have proper venue in those districts regardless of where they live and work, enabling access to the Ninth Circuit’s more favorable legal framework for fully insured plans.

Important Disclaimers

This report is for informational purposes only and does not constitute legal advice.

The win rates presented are statistical aggregates of actual case outcomes and are not predictive of any individual case result. Outcomes vary based on plan terms, funding type, applicable law, quality of counsel, specific facts, and many other variables.

Whether a specific claimant can file in the Ninth Circuit, whether de novo review applies to their plan, and outcomes to expect depend on a detailed factual and legal analysis of the specific plan documents, plan funding, administration location, choice-of-law provisions, and forum selection clauses. Consult an attorney experienced in ERISA litigation before making any filing decisions.

Data current as of the date of analysis. District court assignments may change with redistricting or case transfers. Circuit court decisions affecting standard of review may alter the legal landscape described above.

Data Source: Lexis/Nexis Lex Machina Analysis of Federal Court Filings | January 2015 – May 2026 | Report Date: May 10, 2026. Cases identified as ERISA benefit denial matters decided on “improper claim denial” or “no improper claim denial”.