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DarrasLaw Victory Against Renaissance Life and Health Insurance Company

The case involves a young woman in her late 20s who worked from home as a customer service representative for Freedom Financial Bank. She suffered from a mixed connective tissue disorder and other autoimmune conditions, which caused significant symptoms, including cervical neck pain and potential cervical radiculopathy. These conditions made it impossible for her to continue working, even in a sedentary, work-from-home role with accommodations like flexible breaks. She filed for short-term disability with Renaissance Life and Health Insurance Company, which was approved and paid by her employer. However, during the transition to long-term disability, Renaissance denied her claim based on a review by an in-house nurse, who concluded there was no evidence to support disability through the elimination period. This denial was inconsistent with the prior approval of short-term benefits and relied on the nurse’s opinion over the client’s treating doctors, a cost-saving tactic criticized by the attorneys.

Attorney Stephen Jessup and his team appealed the denial, focusing on gathering objective evidence to counter the insurer’s claim of subjective complaints. Key steps included:

• Arranging a Functional Capacity Evaluation (FCE) with a work simulation focus, testing computer use and prolonged sitting, which demonstrated her inability to perform sedentary work due to neck pain and other limitations.
• Recommending medical imaging, including a cervical MRI, which revealed spondylolisthesis and cervical spine issues, and a brain MRI, which showed abnormal changes for her age, providing objective evidence of her condition.
• Securing strong support from her treating doctors, who wrote detailed letters emphasizing the severity and rarity of her condition, particularly given her young age.
• Highlighting the nurse’s overreach in suggesting hypothetical workplace accommodations without evidence that the employer would provide them.

The appeal was submitted to Renaissance, and unlike typical insurance company processes that involve delays or additional reviews, Renaissance approved the claim well before the 45-day appeal period expired. The rapid approval, without further correspondence or a new peer review, suggests the strength of the submitted evidence exposed the flaws in the initial nurse-led denial. The attorneys noted that Renaissance’s claims handling mirrored larger insurers, with policy language and denial tactics similar to industry norms. They also emphasized the challenges of work-from-home roles, where employer monitoring (e.g., keystroke tracking, call recording) makes breaks difficult, countering assumptions that such roles are inherently less demanding.

This case was a rare encounter with Renaissance, a smaller player in the disability insurance market since 2000, and marked one of the first long-term disability claims the attorneys handled against them. The victory not only reinstated the client’s benefits but also led to additional medical insights through MRIs, potentially aiding her treatment. Her Social Security disability claim remains pending, likely facing challenges due to her young age, but her proactive engagement with treatment strengthens her case. The attorneys underscored the importance of objective evidence and robust appeals in overcoming denials, particularly for complex conditions in remote work settings.