Symetra Life Insurance Company regularly denies claims based on alleged misrepresentations, suicide exclusions, intoxication clauses, and other policy defenses. Some of these denials survive court review. Others do not. Federal courts have made clear that Symetra, like every insurer, carries the burden of proof when it seeks to avoid paying a life insurance benefit.
Below are nine litigated Symetra life insurance claim denials that show how courts analyze these disputes and where beneficiaries sometimes succeed.
1. Heroin Overdose Not Proven Intentional
In a case involving Symetra Life Insurance Company, a widow was denied accidental death benefits after her husband died from a heroin overdose. Symetra classified the death as intentionally self-inflicted.
The district court ruled in favor of the widow, finding no evidence that the insured intended to die. The Eighth Circuit affirmed, holding that intent cannot be presumed simply because illegal drugs were involved. This case is frequently cited for the principle that accidental overdose is not automatically excluded.
2. Heart Attack and Medical Misrepresentation
Symetra denied a claim after an insured died from a heart attack, alleging he failed to disclose significant medical conditions on the application. The beneficiary sued for breach of contract and bad faith.
Both the district court and the Eleventh Circuit ruled for Symetra, finding the omissions material to underwriting and sufficient to rescind the policy. Courts tend to uphold denials where the undisclosed condition directly relates to the cause of death.
3. Cancer Diagnosis Omitted During Contestability Period
In another case, Symetra denied benefits after an insured died from cancer, asserting that a prior diagnosis had been omitted from the application. The beneficiary argued bad faith and ambiguity.
The district court and Ninth Circuit sided with Symetra, holding that the omission was material and that contestability rescission was proper. This decision reflects how strictly courts apply disclosure duties during the contestability window.
4. Intoxication Exclusion After Fatal Car Accident
A widow sought accidental death benefits after her husband died in a vehicle crash. Symetra denied the claim under intoxication and illegal conduct exclusions.
The district court granted summary judgment to Symetra, and the Sixth Circuit affirmed. The courts emphasized that AD&D policies often contain narrower coverage than standard life insurance and that DUI-related exclusions are frequently enforced.
5. Suicide Within Two Years of Policy Issuance
Symetra denied a claim after an insured died from a gunshot wound within two years of policy issuance, classifying the death as suicide.
The beneficiary alleged breach of contract and bad faith, but both the district court and Fifth Circuit upheld the denial. Where suicide intent is supported by investigative evidence and the exclusion period has not expired, courts consistently enforce the clause.
6. Drug Use History Misrepresented
In another overdose related case, Symetra denied benefits after discovering undisclosed prior drug use. The beneficiary argued that the omission was unrelated to the cause of death.
The district court and Fourth Circuit rejected that argument, ruling that the misrepresentation was material regardless of causation. Courts often accept underwriting testimony that substance use affects risk classification.
7. Stroke Death and Undisclosed Hypertension
Symetra denied a claim after an insured died of a stroke, citing failure to disclose hypertension. The beneficiary alleged wrongful denial and bad faith.
The Third Circuit affirmed summary judgment for Symetra, concluding that the omission was significant and directly tied to stroke risk. This case underscores how cardiovascular disclosures are treated by courts.
8. Motorcycle Accident and Safety Law Violation
A man died in a motorcycle crash while not wearing a legally required helmet. Symetra denied the claim under exclusions for illegal conduct and increased risk behavior.
The district court ruled for Symetra, and the Second Circuit affirmed. Courts generally enforce exclusions tied to explicit statutory violations when policy language is clear.
9. Family Medical History Omitted
Symetra denied a claim after an insured died from an aneurysm, alleging failure to disclose family history of cardiovascular disease.
The First Circuit upheld the denial, ruling that family history questions must be answered truthfully when directly asked and that such information can be material to underwriting.
What These Symetra Cases Show
Across jurisdictions, courts evaluating Symetra denials focus on several recurring principles:
Materiality must be supported by underwriting evidence
Intent cannot be assumed in overdose or suicide disputes
AD&D exclusions are enforced more narrowly than life policies
Contestability period disclosures receive strict scrutiny
Policy language controls when exclusions are clearly written
While Symetra prevails in many cases, courts do not defer blindly. When evidence is weak or intent is speculative, denials fail.
Challenging a Symetra Life Insurance Claim Denial
A Symetra denial letter is not a final judgment. Many denials are reversed when beneficiaries challenge underwriting assumptions, contest intent determinations, or expose gaps in the insurer’s proof.
Successful challenges often involve careful analysis of application wording, medical records, policy exclusions, and whether Symetra met its burden under state or federal law.
Frequently Asked Questions
Does Symetra deny claims involving drug overdoses?
Yes, but courts may reverse the denial if Symetra cannot prove intentional self harm.
Can Symetra rescind a policy for misrepresentation?
Only if the omission was material. Courts require proof that the information would have changed underwriting.
Are intoxication exclusions enforceable?
Often yes, especially in AD&D policies, but enforcement depends on state law and policy wording.
Is legal representation necessary?
In most Symetra disputes, yes. These cases often hinge on technical evidentiary standards and federal appellate review.