Kantor & Kantor represented a widow seeking accidental death benefits after her husband died from a heroin overdose. Symetra denied the claim under an ERISA-governed life insurance policy, cutting off benefits sought following the death.
Rather than addressing the merits of the accidental death claim, Symetra asserted that the beneficiary failed to exhaust administrative remedies. The insurer relied on exhaustion even though the plan documents did not clearly identify or explain any appeal process applicable to accidental death claims.
The Eighth Circuit rejected Symetra’s exhaustion defense and held that insurers may not rely on undisclosed or opaque review procedures to bar beneficiaries from court. The ruling strengthened procedural protections for life insurance claimants and forced insurers to clearly disclose appeal rights before invoking exhaustion.
