Denied Symetra Life Insurance Claims: Real Court Cases and Legal Insights from Our Life Insurance Law Firm
Symetra Life Insurance Company, like many major insurers, has a pattern of denying claims based on exclusions, alleged misrepresentations, or procedural technicalities. While some denials have been upheld in court, others were successfully challenged. As a life insurance law firm that represents beneficiaries nationwide, we understand how overwhelming and unfair these denials can be—and how crucial it is to fight back. Below are real cases involving denied Symetra life insurance claims and how courts ruled on each dispute.
1. Heroin Overdose Ruled Not Intentional—Widow Wins Appeal
Symetra denied accidental death benefits to a widow after her husband died of a heroin overdose, claiming the death was an intentionally self-inflicted injury. The district court ruled in favor of the widow, stating there was no proof of intent to die. Symetra appealed, but the Eighth Circuit affirmed, holding that accidental overdose deaths cannot automatically be classified as intentional without clear evidence. This case reinforces the burden insurers bear when denying claims on intent-based exclusions.
2. Heart Attack and Medical Misrepresentation—Symetra Prevails
Symetra denied a claim after a man died of a heart attack, alleging he misrepresented his medical history on the application. The beneficiary sued for breach of contract and bad faith, but the district court found in favor of Symetra. The Eleventh Circuit affirmed, agreeing that the misstatements were material and justified rescission of the policy. Courts frequently uphold denials when clear proof exists that the applicant withheld key health information.
3. Cancer Diagnosis Omitted—Court Upholds Denial
A woman’s death from cancer prompted a denied claim, with Symetra citing undisclosed prior diagnosis. The beneficiary sued for bad faith, but the district and Ninth Circuit courts sided with Symetra, finding the omission material and grounds for rescission. This ruling confirms the strict enforcement of contestability clauses when medical history is at issue.
4. Car Accident and Intoxication Exclusion—Symetra Wins
A widow filed for accidental death benefits after her husband died in a car crash. Symetra denied the claim, citing intoxication and reckless driving exclusions. The court found the policy excluded coverage for such behavior, and the Sixth Circuit affirmed summary judgment for Symetra. Many accidental death policies exclude losses involving DUI or illegal conduct.
5. Suicide Within Two Years—Exclusion Upheld by Court
Symetra denied benefits for a man who died of a gunshot wound, ruling the death was a suicide within the two-year exclusion window. The beneficiary alleged breach of contract and bad faith. However, both the district court and the Fifth Circuit upheld the denial, finding the exclusion applied and Symetra acted within the policy terms.
6. Drug Use Misrepresented—Symetra Denial Affirmed
A woman died of a drug overdose, and Symetra denied the claim, asserting that she misrepresented her drug use history. The district court ruled for Symetra, and the Fourth Circuit affirmed, concluding the misrepresentation was material and justified rescinding the policy. This shows how even non-fatal past drug use can jeopardize life insurance claims if not disclosed.
7. Stroke and Hypertension—Claim Denied and Upheld
After a man died of a stroke, Symetra denied the claim based on his failure to disclose hypertension. The beneficiary alleged bad faith, but the Third Circuit upheld summary judgment for Symetra, finding that the omission was significant enough to void the policy. Courts often focus on whether the misrepresentation impacted the insurer’s underwriting decision.
8. Motorcycle Accident and Helmet Law Violation—Exclusion Enforced
A man died in a motorcycle accident while not wearing a helmet, and Symetra denied the claim, citing exclusions for illegal activity and negligence. The widow sued, but the Second Circuit agreed with the district court that the policy language barred recovery. Policies that include specific behavioral exclusions (like failing to wear safety gear) can be difficult to overcome in court.
9. Family History of Disease Omitted—Denial Affirmed by First Circuit
Symetra denied a claim after a woman died of an aneurysm, arguing she failed to disclose her family history of cardiovascular disease. The court found the omission material and ruled for Symetra, with the First Circuit affirming. This case illustrates that even family history, if asked about directly, must be disclosed truthfully.
10. Policy Lapsed Due to Nonpayment—Claim Denied and Upheld
A man died of a heart attack, but Symetra denied the claim on grounds that his policy had lapsed due to unpaid premiums. The beneficiary sued, alleging wrongful denial. However, the district court and Tenth Circuit both ruled that the policy had legally terminated and Symetra owed no obligation. This ruling highlights the critical importance of keeping premium payments up to date.
What These Cases Reveal About Symetra Life Insurance Denials
Symetra’s denials often rest on a few key defenses:
Material misrepresentation during the application process
Suicide and self-inflicted injury exclusions, especially within two years of policy issuance
Policy exclusions for drug use, intoxication, or reckless behavior
Policy lapse due to nonpayment
While several courts upheld Symetra’s denials, the successful appeal in the overdose case shows that these denials are not final. With experienced legal help, many denials can be challenged and reversed.
Our Law Firm Fights Symetra Life Insurance Denials Nationwide
If you’re facing a denied life insurance claim by Symetra, you don’t have to navigate it alone. Our team evaluates denials for legal error, insurer misconduct, and unfair application of policy exclusions. Whether you’re dealing with a misrepresentation claim, a suicide clause, or an AD&D denial, we’re here to fight for your rightful benefits. If you have a South Dakota life insurance dispute call us.
FAQ
Does Symetra deny claims for drug overdoses?
Yes, but courts may reverse the denial if the insurer cannot prove intent. Accidental overdoses are not automatically excluded under all policies.
Can Symetra rescind a policy for misrepresentation?
Only if the misrepresentation was material and intentional. This must be proven by the insurer, and courts do not always side with the company.
What if my loved one died while the policy was supposedly lapsed?
We investigate whether the insurer followed proper notice procedures and grace periods. A wrongful lapse can be challenged.
Do I need an attorney to appeal a denial from Symetra?
Yes. Legal representation greatly increases your chances of reversing a wrongful denial, especially in federal appeals or complex medical disputes.