Symetra Life Insurance Company issues both individual and employer provided life insurance policies. When a Symetra claim is denied, beneficiaries are often told the decision is based strictly on “policy language.” In reality, many denials turn on how the claim was investigated, what records were reviewed, and how specific terms were interpreted.
If your Symetra life insurance claim has been denied or delayed, the first step is understanding the type of policy involved and the exact basis for the decision.
Individual Policy vs Employer Group Policy
Symetra issues individually owned policies as well as group life policies through employers. The rules that apply can differ significantly.
Individually owned policies are governed by state contract law. Group policies provided through an employer may be governed by federal benefits law, which can impose strict internal appeal requirements and limit what evidence can be introduced later.
Identifying the policy type early is critical.
Common Reasons Symetra Denies Life Insurance Claims
Late contestability review
If the insured passed away within the contestable period, Symetra may conduct an in depth review of the application. This can involve collecting years of medical records, pharmacy data, and sometimes financial records.
Tobacco or health classification disputes
Symetra may argue that the insured misrepresented tobacco use, weight, blood pressure, or other underwriting factors. The company may claim the policy would have been issued at a different rate or not at all.
Eligibility and active at work disputes
In group life claims, denials may be based on whether the insured met the plan’s definition of full time employee or active at work status at the time coverage supposedly began.
Evidence of insurability issues
For supplemental coverage, Symetra may deny the claim if it believes required evidence of insurability was not approved before death.
Accidental death causation disputes
Where an AD&D rider is involved, the insurer may argue that illness, intoxication, or a pre existing condition contributed to the death, removing it from the definition of a covered accident.
How Symetra Handles Application Based Denials
When Symetra asserts misrepresentation, the denial usually depends on two issues:
First, whether the answer on the application was actually incorrect.
Second, whether the alleged inaccuracy was material under Symetra’s underwriting standards at the time the policy was issued.
Materiality is not determined by hindsight. It is determined by what the company would have done if it had known the full information at the time of underwriting.
Reviewing the underwriting guidelines that were in effect on the issue date can be important in evaluating the strength of the denial.
Employer Plan Problems
In group life claims, some denials stem from employer administrative mistakes rather than anything the insured did wrong.
Common issues include:
Incorrect hire dates
Miscalculated salary based coverage
Enrollment forms never transmitted to the carrier
Failure to notify employees of evidence of insurability requirements
Carrier changes during employment
When a claim is denied based on eligibility or coverage amount, payroll and HR records often become central evidence.
What to Request After a Symetra Denial
To properly evaluate a denial, request in writing:
The complete claim file
The full policy and certificate
All riders and amendments
The original application
Any paramed exam or underwriting notes
Medical records relied upon
Internal claim handling notes
For group policies, request:
The full administrative record
The summary plan description
Enrollment and eligibility records
Payroll data showing premium deductions
Without these documents, it is difficult to assess whether the denial is supported by the policy.
Reinstatement and Grace Period Disputes
If Symetra asserts that the policy lapsed, examine whether proper lapse notices were sent and whether the grace period was correctly calculated. In some cases, late premiums are accepted without clearly advising the policyholder that coverage has terminated.
Reinstatement applications can also create separate health representation issues if death occurs shortly after reinstatement.
Appeal and Litigation Considerations
If the policy is employer sponsored, an internal appeal may be required before filing suit. The appeal stage is often the only opportunity to add medical opinions, affidavits, or clarifying documentation to the record.
For individual policies, the strategy may differ depending on state law and the specific denial basis.
A Careful Review Is Essential
Symetra denial letters often cite policy provisions and assert that the decision is final. That does not automatically mean the insurer can legally support its conclusion.
Challenging a denial typically involves:
Comparing application answers with medical records
Evaluating whether the alleged omission was material
Reviewing how the policy defines key terms
Confirming that administrative requirements were properly followed
Each claim depends on its specific facts, but a thorough analysis of the policy and claim file is the starting point for determining whether the denial can be reversed.
If your Symetra life insurance claim has been denied or delayed, obtaining the complete record and understanding the precise grounds for the decision is critical before deciding your next step.