United States Court of Appeals

For the Eighth Circuit 

___________________________

No. 22-1093

___________________________ 

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. 

____________

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).
-3-

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-ofbenefits 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. 
-4-

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 
-5-

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 
-7-

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 
-8-

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 noncontractual 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). 
-10-

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. 
-11-

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.
-12-

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 selfinflicted 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 
-13-

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 selfinflicted 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 “selfinflicted-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 
-14-

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.