United States Court of Appeals
For the Eighth Circuit
___________________________
No. 22-1093
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Terri M. Yates
Plaintiff - Appellee
v.
Symetra Life Insurance Company
Defendant - Appellant
___________________________
No. 22-2257
___________________________
Terri M. Yates
Plaintiff - Appellee
v.
Symetra Life Insurance Company
Defendant - Appellant
____________
Appeal from United States District Court
for the Eastern District of Missouri - St. Louis
____________
Submitted: September 20, 2022
Filed: February 23, 2023
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Before SHEPHERD, KELLY, and GRASZ, Circuit Judges.
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KELLY, Circuit Judge.
After her husband died of a heroin overdose, Terri M. Yates sought accidental
death benefits under an employer-sponsored benefit plan governed by the Employee
Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§ 1001–1461. The
plan’s insurer, Symetra Life Insurance Company, denied her claim, and Yates sued.
The district court1 granted summary judgment in Yates’s favor. Symetra now
appeals, arguing that Yates’s suit is barred by her failure to exhaust internal review
procedures and that her husband’s death otherwise falls under an exclusion to
coverage. Having jurisdiction under 28 U.S.C. § 1291, we affirm.
I.
At the time of her husband’s death, Yates worked at Phelps County Bank and
participated in the company’s employee benefit plan (the Plan). Her husband was
also covered under the Plan as a dependent. The Plan was issued and managed by
Symetra and governed by ERISA. Its various benefits were summarized in an
“Employee Benefits Insurance Certificate” issued to covered employees, and that
Certificate included the policies and Plan language at issue in this case.2
1
The Honorable Ronnie L. White, United States District Judge for the Eastern
District of Missouri.
2
The district court found that the “Employee Benefits Insurance Certificate”
and a “Group Insurance Policy” issued to Phelps County Bank by Symetra’s
predecessor company in 1981 “constitute[d]” the ERISA plan documents at issue
here. See 29 U.S.C. § 1102(a)(1) (“Every employee benefit plan [governed by
ERISA] shall be established and maintained pursuant to a written instrument.”).
Neither party challenges that finding on appeal. Accordingly, we will treat those
documents as providing all of the relevant terms of Yates’s employee benefit plan.
See U.S. Airways, Inc. v. McCutchen, 569 U.S. 88, 92 n.1 (2013).
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Among the Plan’s benefits was an “Employee Accidental Death and
Dismemberment Insurance” policy, under which Symetra paid a “benefit amount”
if a covered individual “suffer[ed]” certain losses, including a “[l]oss of life,” due to
“accidental bodily injury.” A qualifying injury must have been “a sudden and
unforeseen event, definite as to time and place.” The policy also included seven
exclusions to coverage, including one, as is relevant here, that excluded “any loss
caused wholly or partly, directly or indirectly by . . . intentionally self-inflicted
injury, whi[le] sane.”
On December 20, 2016, Yates’s husband was found dead in his bedroom. The
parties do not dispute that he died of a heroin overdose. Yates subsequently filed a
claim with Symetra for spousal life insurance and accidental death benefits under
the Plan. Symetra awarded the former benefits but denied the latter. The company
explained in a June 27, 2017 denial letter (the Denial Letter) that “in view of the fact
that” Yates’s husband’s death was caused by his “intentional act of using [h]eroin,”
Yates was not entitled to accidental death benefits because losses caused by an
“intentionally self-inflicted injury” were excluded from coverage.
The Denial Letter further provided that Yates could “request a review” of
Symetra’s decision by “submit[ting] a written request . . . within 60 days of [her]
receipt of th[e] letter.” The letter outlined this internal review process in detail and
also noted that Yates “ha[d] the right to file a civil action” under ERISA “following
completion of” Symetra’s “appeal review process.” The written Plan documents
issued by Symetra make no mention of this internal review process, nor do they
provide for any other appeal or review procedures following a denial of benefits.
Yates did not request that Symetra review its denial of her claim. Instead, she
brought suit in Missouri state court, alleging breach of contract. Symetra removed
her case to federal court, and Yates amended her complaint to assert a denial-of-
benefits claim under ERISA, see 29 U.S.C. § 1132(a)(1)(B). Symetra moved for
summary judgment, arguing that Yates’s failure to exhaust the internal review
process described in the Denial Letter precluded her from bringing an ERISA suit.
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Symetra argued in the alternative that Yates’s claim for accidental death benefits
was properly denied under the “intentionally self-inflicted injury” exclusion. The
district court initially granted summary judgment to Symetra after concluding that
Yates failed to exhaust her administrative remedies. After Yates moved to alter or
amend judgment, the district court reversed course, this time concluding that Yates
was not required to exhaust administrative remedies before bringing suit and that
Symetra’s denial of her claim for accidental death benefits was erroneous. The
district court vacated its prior dismissal order, denied Symetra’s motion for summary
judgment, and granted summary judgment, sua sponte, to Yates. Symetra appeals.
II.
ERISA authorizes a plan participant to bring a civil action “to recover benefits
due to him under the terms of his plan.” 29 U.S.C. § 1132(a)(1)(B). Before bringing
such an action, however, a participant generally “must exhaust the administrative
remedies required under [his] particular ERISA plan.” Angevine v. Anheuser-Busch
Cos. Pension Plan, 646 F.3d 1034, 1037 (8th Cir. 2011); see Chorosevic v. MetLife
Choices, 600 F.3d 934, 941 (8th Cir. 2010) (“Where a claimant fails to pursue and
exhaust administrative remedies that are clearly required under a particular ERISA
plan, his claim for relief is barred.”). Symetra concedes that Yates’s written Plan
documents do not provide for any internal review or appeal procedures that a covered
participant may or must exhaust following a denial of a claim for Plan benefits. It
argues that Yates’s ERISA suit is nonetheless barred because she failed to exhaust
the administrative remedies Symetra described in the Denial Letter. “Exhaustion is
a threshold legal issue we review de novo.” Chorosevic, 600 F.3d at 941 (quoting
Kinkead v. Sw. Bell Corp. Sickness & Accident Disability Benefit Plan, 111 F.3d
67, 68 (8th Cir. 1997)).
The requirement that a plan participant exhaust her administrative remedies
before bringing a denial-of-benefits claim under ERISA “finds its genesis” in 29
U.S.C. § 1133. Brown v. J.B. Hunt Transp. Servs. Inc., 586 F.3d 1079, 1084 (8th
Cir. 2009). That provision provides in relevant part that “every employee benefit
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plan” governed by ERISA “shall . . . afford a reasonable opportunity to any
participant whose claim for benefits has been denied for a full and fair review by the
appropriate named fiduciary of the decision denying the claim.” 29 U.S.C.
§ 1133(2). The statute does not include an express exhaustion requirement. But
federal courts, including this one, “have universally construed § 1133 to require
exhaustion.” Brown, 586 F.3d at 1084; see Heimeshoff v. Hartford Life & Accident
Ins. Co., 571 U.S. 99, 102 (2013) (“Courts have generally required participants to
exhaust [an ERISA] plan’s administrative remedies before filing suit to recover
benefits.”). We have underscored on several occasions the “many important
purposes” this “judicially created exhaustion requirement serves,” including “giving
claims administrators an opportunity to correct errors,” “promoting consistent
treatment of claims,” and “decreasing the cost and time of claims resolution.”
Angevine, 646 F.3d at 1037 (quoting Galman v. Prudential Ins. Co. of Am., 254 F.3d
768, 770 (8th Cir. 2001)). Accordingly, “[w]e excuse the exhaustion requirement
only when pursuing an administrative remedy would be futile or there is no
administrative remedy to pursue.” Id.; see Brown, 586 F.3d at 1085.
Here, the district court did not excuse Yates from an otherwise applicable
exhaustion requirement. Rather, it concluded that she was not subject to such a
requirement in the first place because her written Plan documents do not provide for
or describe any appeal or review procedures for her to exhaust. On appeal, Symetra
argues that the Denial Letter, which detailed an internal review process she could
have used to challenge the company’s denial of her claim for accidental death
benefits, triggered an exhaustion requirement. We agree with the district court. A
participant in an employee benefit plan governed by ERISA is not required to
exhaust administrative remedies before challenging a denial of benefits in court
when the written plan documents make no mention of any review process or
administrative remedies that can be exhausted.
We reach this conclusion for several reasons. First, a review of our cases
confirms that the requirement that a plan participant first exhaust her administrative
remedies before bringing an ERISA suit has consistently been premised on such
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remedies being expressly prescribed in the participant’s written plan documents. See
Angevine, 646 F.3d at 1037 (“Before filing in federal court, however, a claimant
must exhaust the administrative remedies required under the particular ERISA
plan.” (emphasis added)); Chorosevic, 600 F.3d at 941 (“Where a claimant fails to
pursue and exhaust administrative remedies that are clearly required under a
particular ERISA plan, his claim for relief is barred.” (emphasis added)); Brown,
586 F.3d at 1084 (same); see also Wert v. Liberty Life Assurance Co. of Boston,
Inc., 447 F.3d 1060, 1063 (8th Cir. 2006) (“[W]e hold that exhaustion of contractual
remedies is required in the context of a denial of benefits action under ERISA when
there is available to a claimant a contractual review procedure . . . .” (emphasis
added)); Galman, 254 F.3d at 770 (“ERISA provides that every plan must provide a
benefits appeal procedure . . . . In this circuit, benefit claimants must exhaust this
procedure before bringing claims for wrongful denial to court.”). That is, we have
said that the exhaustion requirement bars a denial-of-benefits claim under ERISA if
a plan participant “fails to pursue and exhaust administrative remedies that are
clearly required under a plan.” McKennan v. Meadowvale Dairy Emp. Benefit
Plan, 973 F.3d 805, 808 (8th Cir. 2020) (emphasis added). Nowhere have we said
that a denial-of-benefits claim is barred by a failure to exhaust administrative
remedies when the applicable written plan documents provide for no such remedies.
Second, our conclusion finds support in a recent Sixth Circuit case that
addressed the very exhaustion issue Symetra raises here. In Wallace v. Oakwood
Healthcare, Inc., 954 F.3d 879 (6th Cir. 2020), an administrator of an employee
benefit plan covered by ERISA argued that a plan participant’s denial-of-benefits
claim was barred by her failure to exhaust administrative remedies, even though the
participant’s written plan documents “did not describe either the claim review
process or an exhaustion requirement.” Id. at 885. The plan administrator
maintained that it was not required to describe its claims and internal appeal
procedures in the written plan documents because those procedures were detailed in
a “benefits denial letter” that was sent to the plan participant. Id. at 887. Yet the
Sixth Circuit observed that “one of ERISA’s central goals is to enable beneficiaries
to learn their rights and obligations at any time” by “examining” their written plan
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documents. Id. (quoting Curtiss-Wright Corp. v. Schoonejongen, 514 U.S. 73, 83
(1995)). And “[i]n keeping with th[at] intent,” the court held that for a plan
administrator “to avail itself” of a judicially created exhaustion requirement, “its
underlying plan document[s] must—at minimum—detail its required internal appeal
procedures.” Id. at 888.
Third, we have consistently recognized the primacy of written plan documents
when resolving ERISA claims. See Vercellino v. Optum Insight, Inc., 26 F.4th 464,
469 (8th Cir. 2022) (“Courts are instructed to enforce the terms of ERISA plans as
they are written.”); Admin. Comm. of Wal-Mart Stores, Inc. Assocs.’ Health &
Welfare Plan v. Shank, 500 F.3d 834, 838 (8th Cir. 2007) (“Among the primary
purposes of ERISA is to ensure the integrity of written plans and to protect the
expectations of participants and beneficiaries.”); see also Heimeshoff, 571 U.S. at
108 (describing ERISA’s “focus on the written terms of the plan” as the statute’s
“linchpin”). ERISA requires that the terms of an employee benefit plan be
committed to written plan documents, see 29 U.S.C. § 1102(a)(1), so that plan
participants, by reviewing those documents, can “learn their rights and obligations
under the plan at any time.” Curtiss-Wright Corp., 514 U.S. at 83. Yates’s written
Plan documents gave her no such opportunity. Requiring Yates to exhaust internal
review procedures that cannot be found in the Plan documents would thus render her
reliance on those documents largely meaningless in this context. See id. Moreover,
“[t]he plan . . . is at the center of ERISA,” and the statute’s “principal function” is to
“protect contractually defined benefits.” U.S. Airways, 569 U.S. at 100–01 (quoting
Mass. Mut. Life Ins. Co. v. Russell, 473 U.S. 134, 148 (1985)). Symetra asks that
we impose on Yates a requirement to exhaust remedies that are not in the contract
the parties entered. We decline to do so. See Wert, 447 F.3d at 1063 (requiring
“exhaustion of contractual remedies . . . in the context of a denial of benefits action
under ERISA” (emphasis added)).
Finally, our conclusion that Yates is not subject to an exhaustion requirement
aligns with ERISA’s implementing regulations. See 29 C.F.R. § 2560.503-1(a)
(2017) (setting forth “minimum requirements for employee benefit plan procedures
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pertaining to claims for benefits by participants and beneficiaries”).3 Those
regulations require that ERISA plans “establish and maintain reasonable procedures
governing the filing of benefit claims . . . and appeal of adverse benefit
determinations.” Id. § 2560.503-1(b); see id. § 2560.503-1(h)(1) (“Every employee
benefit plan shall establish and maintain a procedure by which a claimant shall have
a reasonable opportunity to appeal an adverse benefit determination to an
appropriate named fiduciary of the plan, and under which there will be a full and fair
review of the claim and the adverse benefit determination.”). A plan’s appeal
procedures “will be deemed to be reasonable only if,” among other requirements, a
“description” of those procedures “is included as part of a summary plan description
meeting the requirements of 29 CFR [§] 2520.102-3.” Id. § 2560.503-1(b)(2). The
requisite summary plan description must describe, among other things, “[t]he
procedures governing claims for benefits[,] . . . applicable time limits, and remedies
available under the plan for the redress of claims which are denied in whole or in
part.” Id. § 2520.102-3(s). By failing to provide for post-denial remedies, Symetra’s
written Plan documents thus do not appear to satisfy the applicable regulations. See
id. § 2560.503-1(b)(2), (h)(1). And when that is the case, those same regulations
provide that a plan participant whose claim for benefits has been denied “shall be
deemed to have exhausted the administrative remedies available under the plan,”
allowing that participant to immediately seek relief in court. 4 Id. § 2560.503-1(l)(1);
3
We cite to the regulations in force at the time Yates’s claim for benefits was
denied but note that the relevant regulations have remained unchanged to today.
4
We note that 29 C.F.R. § 2560.503-1(l)(1) does not appear to be squarely on
point here. That regulation provides that when a plan “fail[s] . . . to establish or
follow claims procedures consistent with the requirements” found elsewhere in the
section, “a claimant shall be deemed to have exhausted the administrative remedies
available under the plan.” Id. (emphasis added). But under Yates’s written Plan
documents, no administrative remedies were “available” to her at all. We have
previously described § 2560.503-1(l)(1) as a means by which a plan participant can
be excused from an otherwise applicable exhaustion requirement. See Grasso
Enters., LLC v. Express Scripts, Inc., 809 F.3d 1033, 1039 (8th Cir. 2016)
(indicating that a plan participant “may sue without exhausting plan remedies” if
“the plan’s failure to follow claims procedures consistent with the requirements of
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see Wallace, 954 F.3d at 887 (“[W]e conclude that, because [the plan administrator]
did not describe any internal claims review process or remedies in its plan document,
the plan did not establish a reasonable claims procedure pursuant to ERISA
regulations; therefore, Plaintiff’s administrative remedies must be deemed
exhausted.”).
Symetra relies heavily on our decisions in Kinkead and Wert to argue that the
Denial Letter Yates received “trigger[ed]” an exhaustion requirement, irrespective
of whether the procedures described in the letter were also included in the written
Plan documents. In Kinkead, we held that exhaustion of administrative remedies is
required even when a denial-of-benefits letter does not expressly notify a plan
participant that internal review procedures must be exhausted before the participant
can bring an ERISA suit. 111 F.3d at 69. Notice to the participant that review
procedures are available, we said, is sufficient on its own to trigger the exhaustion
requirement. See id. But notably, the plan documents in Kinkead “contain[ed]
provisions . . . establishing an internal procedure for further review” of denied
claims. Id. at 68. Indeed, we underscored that ERISA plans “are required by law to
include a claim review procedure” and that the “judicially imposed duty to exhaust”
administrative remedies is “trigger[ed]” so long as a plan participant is given
“notice” of that plan-based review procedure. Id. at 69–70. Thus, we affirmed the
dismissal of the plaintiff’s case for “failure to exhaust” her plan’s “contractual
appeal procedures.” Id. at 68 (emphasis added). We did not comment on the
situation presented here: whether a plan participant is required to exhaust non-
contractual review procedures not included in the written plan documents.
[§ 2560.503-1] denied the claimant a reasonable opportunity for full and fair review
of” a denial of benefits). Here, however, the judicially created exhaustion
requirement does not apply to Yates because her written Plan documents are silent
as to any internal review or appeal procedures she must exhaust. Thus, our holding,
while consistent with § 2560.503-1(l)(1), is not necessitated by it. And we need not
address under what circumstances administrative remedies that are actually
prescribed in written plan documents can still “be deemed . . . exhausted” when a
plan’s appeal procedures fail to comply with ERISA’s implementing regulations. 29
C.F.R. § 2560.503-1(l)(1).
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Wert also does not address the issue here. In that case, we rejected the
argument that exhaustion was not required when “contract language” in an employee
benefit plan suggested that an internal review process for denied claims was
“optional rather than mandatory.” 447 F.3d at 1061. We instead held that an
exhaustion requirement applies so long as a plan participant “has notice of” the
internal review procedures made available to her in her written plan documents, even
if those documents “do not explicitly describe” such procedures “as mandatory or as
a prerequisite to suit.” Id. at 1063. Crucially, we reiterated that exhaustion is
required “when there is available to a claimant a contractual review procedure” that
comports with ERISA’s statutory and regulatory requirements. Id. (emphasis
added). But we said nothing about whether exhaustion is likewise required when a
plan participant’s written plan documents provide for no contractual review
procedures at all. In short, neither Kinkead nor Wert resolved the exhaustion issue
presented here, and neither case controls the result.
In sum, a participant in an employee benefit plan covered by ERISA is not
required to exhaust administrative remedies before bringing a denial-of-benefits suit
when their written plan documents do not provide for any internal review or appeal
procedures that can be exhausted. Because Yates’s suit is not barred by a failure to
exhaust, we proceed to the merits of her claim.
III.
We review de novo a district court’s adjudication of a denial-of-benefits claim
brought under ERISA, “applying the same standard of review to the plan
administrator’s decision as the district court.” McClelland v. Life Ins. Co. of N.
Am., 679 F.3d 755, 759 (8th Cir. 2012). A plan administrator’s denial of ERISA
benefits is subject to de novo review by the district court “unless the benefit plan
gives the administrator . . . discretionary authority to determine eligibility for
benefits or to construe the terms of the plan.” Waldoch v. Medtronic, Inc., 757 F.3d
822, 829 (8th Cir. 2014) (quoting Firestone Tire & Rubber Co. v. Bruch, 489 U.S.
101, 115 (1989)); see McKeehan v. Cigna Life Ins. Co., 344 F.3d 789, 792 (8th Cir.
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2003) (noting that an ERISA plan’s “express grant of discretion” to a plan
administrator otherwise “trigger[s] the deferential abuse-of-discretion standard of
review”). Because Symetra and Yates agreed that “no explicit discretion-granting
language is found” in Yates’s written Plan documents, the district court reviewed
Symetra’s denial of benefits de novo. Neither party challenges that decision on
appeal, and we too review Symetra’s denial decision de novo. See Bond v. Cerner
Corp., 309 F.3d 1064, 1066–67 (8th Cir. 2002).
Symetra argues it properly denied Yates’s claim for accidental death benefits
under an “intentionally self-inflicted injury” exclusion to coverage.5 “[W]e begin
[our analysis] by examining the language of the [P]lan documents.” Id. at 1067. We
must “interpret the terms” of the Plan “by giving the language its common and
ordinary meaning as a reasonable person in [Yates’s] position . . . would have
understood the words to mean.” Kitterman v. Coventry Health Care of Iowa, Inc.,
632 F.3d 445, 448 (8th Cir. 2011) (quoting Adams v. Cont’l Cas. Co., 364 F.3d 952,
954 (8th Cir. 2004)). And because Symetra’s denial of Yates’s claim for benefits
was based on an exclusion to coverage, Symetra “has the burden of proving that the
exclusion applies.” Nichols v. UniCare Life & Health Ins. Co., 739 F.3d 1176, 1184
(8th Cir. 2014).
The exclusion at issue provides that “Symetra will not pay for any loss caused
wholly or partly, directly or indirectly, by . . . intentionally self-inflicted injury,
whi[le] sane.” According to the written Plan documents, the relevant “loss” here is
Yates’s husband’s “[l]oss of life.” Because the exclusion distinguishes between a
“loss” and the “injury” causing that loss, the relevant “injury” is the cause of Yates’s
husband’s death, namely, his heroin overdose. The dispositive question is thus
whether that overdose “injury” was “intentionally self-inflicted.”
5
The district court concluded as a threshold matter that Yates’s husband’s
death was an “accident” and therefore a potentially covered “loss” under Symetra’s
accidental death insurance policy. Symetra does not challenge that conclusion on
appeal.
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Our decision in King v. Hartford Life & Accident Insurance Co., 414 F.3d
994 (8th Cir. 2005) (en banc), is instructive. In King, an employee covered by an
ERISA plan died in a motorcycle accident, and his beneficiary sought accidental
death benefits under the plan. 414 F.3d at 996–97. At the time of the fatal crash,
the employee’s blood-alcohol level exceeded the legal limit, prompting the plan
administrator to deny the beneficiary’s claim in part based on an exclusion to
coverage for losses caused by an “intentionally self-inflicted injury, suicide, or
suicide attempt, whether sane or insane.” Id. at 997. We held that the plan
administrator’s denial of benefits could not be sustained because its initial reason for
that decision was different from the one it advanced during litigation. See id. at 1003
(“We thus conclude that this case falls in the category where an administrator offers
a post hoc rationale during litigation to justify a decision reached on different
grounds during the administrative process.”). But we also rejected the plan
administrator’s claim that the employee’s death fell under the plan’s “intentionally
self-inflicted injury” exclusion, deeming such an “interpretation” of the plan
“unreasonable.” Id. at 1004.
We explained that the “most natural reading” of the “intentionally self-
inflicted injury” exclusion did not include “injuries that were unintended by the
[plan] participant, but which were contributed to by alcohol intoxication.” Id.
Implicit in this reasoning was the idea that drinking alcohol to the point of
intoxication was not itself an “intentionally self-inflicted injury.” See id. (describing
a conclusion to the contrary as a “startling construction”). For instance, “[o]ne rarely
thinks of a drunk driver who arrives home safely as an ‘injured’ party.” Id. The
question then was whether the “injuries” at issue—namely, those resulting from the
employee’s motorcycle crash—were “intentionally self-inflicted.” Id. And we
concluded they were not because it was undisputed that the employee “did not intend
to injure himself by driving his motorcycle on the night of his death.” Id.; see
Kovach v. Zurich Am. Ins. Co., 587 F.3d 323, 338–39 (6th Cir. 2009) (relying on
King to hold that a plan participant’s loss of a leg following a drunk-driving accident
did not fall under a self-inflicted-wound exclusion to coverage because “[a]lthough
[the participant] acted intentionally in drinking to excess and then riding his
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motorcycle, nothing in the record indicates that he did so with a mind towards
harming himself”).
Like consuming alcohol, using heroin is not itself an “intentionally self-
inflicted injury”; for example, a person who uses heroin to get high would not
necessarily be thought of as an “injured” party. See King, 414 F.3d at 1004. Yet
like the employee’s consumption of alcohol in King, Yates’s husband’s heroin use
“contributed to” an injury—in this case, an overdose. Id. And, like the employee’s
motorcycle crash injuries in King, Yates’s husband’s overdose “injury” was
unintentional. Symetra does not claim that Yates’s husband intended for his heroin
use to result in an overdose, let alone a fatal one. Symetra nonetheless denied
Yates’s subsequent claim for accidental death benefits based on an “intentionally
self-inflicted injury” exclusion to coverage. As in King, we reject the application of
this exclusion to an injury that, while no doubt “contributed to” by heroin use, was
“unintended,” which is the very opposite of “intentionally self-inflicted.” Id.
Symetra’s proposed construction of the “intentionally self-inflicted injury”
exclusion is untenable for other reasons as well. Symetra contends, for instance, that
the exclusion applies to Yates’s husband’s death because he “purposely” used
heroin. But just because the act of using an illegal substance is purposeful does not
mean that an injury stemming from that act, including a fatal overdose, was too. See
Kovach, 587 F.3d at 339 (rejecting a plan administrator’s interpretation of a “self-
inflicted-wound” exclusion to coverage for conflating “intentional actions with
intentional results”). Symetra also maintains that Yates’s husband, as a “longtime
drug user,” was surely aware of the risks of using heroin and that his “generalized
knowledge” of such risks is sufficient for his death to fall under the “intentionally
self-inflicted injury” exclusion. Even if we assume Symetra’s characterization of
Yates’s husband’s drug use is accurate, the argument attempts to replace an
exclusion that applies only to “intentionally self-inflicted” injuries with one that also
includes injuries resulting from reckless, or even negligent, conduct. See Vercellino,
26 F.4th at 469 (“We are bound to enforce the plan according to its plain language.”).
Using heroin is undoubtedly risky, much like driving while intoxicated. But whether
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an “intentionally self-inflicted injury” exclusion applies depends on whether the
injury in question was indeed intentional. It does not depend on whether the injury
was generally foreseeable or even likely, or whether the injury-causing conduct was
risky or even reckless. Yates’s husband’s death does not fall under Symetra’s
“intentionally self-inflicted injury” exclusion simply because it was caused by
inherently risky conduct.
The plain language of Symetra’s “intentionally self-inflicted injury” exclusion
does not apply to unintended injuries like Yates’s husband’s heroin overdose. See
King, 414 F.3d at 1004; see also Kitterman, 632 F.3d at 448 (“Our task is to ‘interpret
the terms of the plan by giving the language its common and ordinary
meaning . . . .’” (quoting Adams, 364 F.3d at 954)). Thus, Symetra’s denial of
Yates’s claim for accidental death benefits based on that exclusion was erroneous,
and the district court properly concluded the same.
IV.
For the reasons explained above, we affirm the district court’s judgment.6
______________________________
6
Following the district court’s entry of summary judgment in her favor, Yates
moved for attorney’s fees and costs pursuant to 29 U.S.C. § 1132(g)(1). The district
court awarded Yates $54,058.50 in attorney’s fees, denied her motion for costs, and
amended its judgment accordingly. Symetra separately appealed the attorney’s fees
award. Yates v. Symetra Life Ins. Co., No. 4:19-CV-154, 2022 WL 1618787 (E.D.
Mo. May 23, 2022), appeal docketed, No. 22-2257 (8th Cir. June 14, 2022).
However, the parties have jointly stipulated that the outcome of that separate appeal
depends entirely on the outcome of this one. Accordingly, because we affirm the
district court’s grant of summary judgment to Yates, we affirm its grant of attorney’s
fees to her as well.
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