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 ____________ 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).

-2- 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 i