July 24, 2025
Life Claim represented the widow of a man who drowned in a lake while on vacation in California. After conducting an autopsy, the Medical Examiner determined that the man had a rare heart defect and was mildly obese, and that both were factors that contributed to the drowning accident. Based on the Medical Examiner’s conclusion, Symetra Life Insurance Company denied the widow’s claim for accidental death benefits, citing an exclusion clause that says the company does not have to pay losses when an underlying medical condition causes or contributes to the loss.
Our own forensic pathologist determined that the Medical Examiner’s conclusions were speculative, and we were able to get the Medical Examiner to reluctantly admit that his conclusions were not based on any forensic evidence found in the autopsy. Following an appeal challenging the denial decision, Symetra overturned its denial decision and paid the claim in full with interest.