DeBofsky Law is proud to announce another significant victory for disability claimants. In Krueger v. Reliance Standard Life Insurance Company, our firm successfully secured long-term disability benefits for Jessica Krueger. Ms Krueger is an HR professional whose claim had been wrongfully denied under a pre-existing condition exclusion. This case marks a pivotal win in ensuring that insurance companies adhere to the legal standards set under the Employee Retirement Income Security Act (ERISA).
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Krueger v. Reliance Standard Life Insurance Company Case Overview
Jessica Krueger, a Senior Human Resources Manager at Cooper’s Hawk Intermediate Holdings, LLC, became disabled due to postural orthostatic tachycardia syndrome (POTS). However, when she applied for long-term disability benefits under her employer-sponsored policy with Reliance Standard, the insurer denied her claim by citing a pre-existing condition exclusion. Although strong medical evidence supported her disability, Reliance refused to overturn its decision. Consequently, Ms. Krueger sought legal action.
Legal Challenge and Court Findings
DeBofsky Law took action by filing suit under ERISA, arguing that Reliance Standard’s denial was unlawful. The U.S. District Court for the Northern District of Illinois reviewed the case under a de novo standard and ruled in favor of Ms. Krueger.
Key findings from the court included:
- Pre-Existing Condition Exclusion Did Not Apply: The court determined that Ms. Krueger’s prior diagnoses of migraine headaches and inappropriate sinus tachycardia were distinct from her later diagnosis of POTS. Reliance failed to prove that the symptoms she experienced before the policy’s effective date were directly related to POTS.
- Total Disability Established: The court found that Ms. Krueger’s symptoms—including dizziness, cognitive impairment, and fatigue—prevented her from performing the material duties of her occupation. The judge rejected Reliance’s insistence on objective proof beyond medical records and physician assessments, reinforcing that subjective symptoms can substantiate disability claims.
- Reliance’s Review Process Was Inadequate: The court criticized Reliance Standard’s reliance on a physician who never examined Ms. Krueger and summarily dismissed her symptoms as “subjective.” The judge highlighted the insurer’s failure to properly engage with the medical evidence presented.
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Impact of the Krueger v. Reliance Standard Disability Case Ruling
This decision reinforces the principle that disability insurers cannot deny claims based on speculative or unsupported arguments about pre-existing conditions. It also upholds the importance of considering both subjective and objective medical evidence in disability determinations, a crucial aspect for claimants suffering from conditions like POTS, which lack a single definitive diagnostic test.
Shareholder Mark DeBofsky represented the client.
For individuals battling insurers who unfairly deny benefits, Krueger v. Reliance Standard reminds us that claimants have legal rights. It also underscores that insurance companies must follow ERISA’s legal standards. Furthermore, DeBofsky Law remains committed to advocating for disability claimants and helping them receive the benefits they deserve.
If your disability benefits have been wrongfully denied, contact DeBofsky Law today to discuss your case.