Background
An employee who had declined supplemental life insurance when hired later enrolled online, choosing coverage of five times his salary, about $429,000. The coverage appeared on his benefits election page, and the employer withheld about $10 from each biweekly paycheck for it until he died on June 27, 2010, after about $128 in premiums. MetLife denied his father’s claim. Because the enrollment was late, the plan required “evidence of insurability” satisfactory to MetLife, and MetLife had never received the statement-of-health form it used for that purpose.
The record had gaps. The 96-page plan did not define “evidence of insurability” or mention the form. No summary plan description separate from the plan appeared to exist. Neither the form nor the online prompt that supposedly told employees to submit it was in evidence. After the suit was filed, MetLife found that about 200 other employees at the company also lacked an approved form. They were allowed to fix it; the father was not.
What the court held
Because MetLife both decided claims and paid them, the court weighed that conflict in reviewing the denial for abuse of discretion. It held that disputed facts, including what the employee was actually told about the form, what the form asked, and whether his healthy presence at work could count as evidence of insurability, prevented summary judgment. It reversed on the benefits claim under ERISA § 502(a)(1)(B).
The court also held that the district court should have let the father add a fiduciary-breach claim under § 502(a)(3). That claim was not futile after CIGNA Corp. v. Amara. The court described three equitable theories the father could pursue on remand:
- Surcharge against the employer, for allegedly failing to give the employee a readable summary plan description that explained how to satisfy the requirement. A nearly 100-page technical plan was not a “clear” and “simple” substitute.
- Reformation against MetLife, on the theory that collecting premiums for coverage it later said was never approved amounted to a waiver, or to fraud on one side and mistake on the other.
- Equitable estoppel against MetLife, because the employee relied on the deductions and the coverage shown on his benefits page and bought no other supplemental life insurance.
The court said make-whole relief, the $429,000 benefit, may be available, quoting the Fourth Circuit’s reasoning in McCravy. A plaintiff may plead the two claims as alternatives, though he cannot recover twice. Judge Gruender joined the part allowing the amendment but dissented on the benefits claim. He would have held that MetLife reasonably required a statement of health.
Why it matters
Payroll deductions for supplemental coverage that the insurer says never took effect are a common evidence-of-insurability problem. Silva shows the questions that matter: what the plan documents actually required, what the employee was told and when, how the enrollment system worked, and whether other employees had the same problem. The decision sent the case back for more proceedings and did not decide who would win. See also McCravy v. MetLife.
Read the opinion
Silva v. Metropolitan Life Ins. Co., 762 F.3d 711 (8th Cir. 2014) (CourtListener). Opinion read in full November 2, 2026.
Not legal advice. This page summarizes general rules and the specific statutes cited. Your policy's wording, the state whose law applies, and whether the coverage came through an employer can all change the result. See the disclaimer and editorial policy.