Court Rules Plaintiff Filed Lawsuit Before Trustmark Denied His Claim

The case of Sunil Srinivasan, DDS v. Continental Assurance Company and Trustmark Insurance Company (Trustmark) presents one issue: Did Trustmark deny Plaintiff’s claim for total disability or has it yet to make a final decision.

Plaintiff was a self-employed endodontist when he developed back and leg pain so severe, he quit work. He had a disability insurance benefit through Trustmark that would provide him total disability income if, according to the terms of the policy, he proved he was unable to perform the substantial and material duties of his own occupation.

The policy also allowed for a claim for residual disability which applied if the insured was gainfully employed at [his] own occupation, but because of injury or sickness, the person was working less and the “Loss of Earnings Rations is 20% or more.”

Plaintiff filed a lawsuit against Trustmark, asserting that Trustmark denied his claim for Total Disability and by doing so, it breached the insurance contract and that it also breached the implied duty of good faith and fair dealing. He based his lawsuit on a letter he received on May 2, 2018, which he alleged denied his claim.

Trustmark answered by arguing that it never denied Plaintiff’s claim, and that the May 2 letter was not a denial letter, but a status report which clearly stated the claim for disability was still pending.

The sole issue in the case was whether the May 2, 2018, letter was the equivalent of a denied disability claim. After evaluating all the undisputed evidence, The United States District Court for the Northern District of California found in favor of Trustmark. The Court concluded that “what is plainly stated on the face of the May 2018 letters – i.e., that a final review was still pending.”

Therefore, Plaintiff’s lawsuit was filed prematurely and the Court denied his motion for partial summary judgment.

Trustmark’s Review of Plaintiff’s Claim

Plaintiff submitted a claim for disability to Trustmark on November 17, 2017. Between that date and the May 2, 2018, letter that is the subject of the lawsuit, Trustmark sent Plaintiff many letters. The letters generally were status reports and often asked for more information. Some status updates and information that was requested of Plaintiff included:

Trustmark set up a personal interview with Plaintiff with its representative, Jon Cipro that took place on April 11, 2018. Plaintiff recorded the interview and the recording and transcript became part of the record the Court evaluated in making its decision on Plaintiff’s motion for partial summary judgment.

Mr. Cipro informed Plaintiff that its medical consultant felt that he could still work at least on a part-time basis, so Trustmark may determine he was “partially disabled versus totally disabled” so might qualify for residual disability.

Mr. Cipro noted that Plaintiff had another “MRI coming up” and that might “change the way the company looks at the condition…” Mr. Cipro also stated, “as far as I know, there’s been no determination that’s been made at this time.” In the administrative record, Mr. Cipro noted that the “insured requests the company’s position in writing before he could consider any next steps on his behalf.”

On May 2, 2018, Trustmark sent Plaintiff a letter which stated, inter alia, “We are writing to update you regarding your claim.” The letter mentioned other information that it had recently obtained, and added, “At this time the information on hand does not support a claim for Total Disability under your policy. Prior to a final review, we request that you submit any additional medical information in support of your claim. Be sure to include any recent MRI reports and actual studies. Any information you wish to submit should be remitted within 30 days of this letter.”

The letter also included a standard provision telling Plaintiff how long he had to file legal action and his right to request a review by the California Department of Insurance.

In early June, Trustmark paid a private investigator to conduct surveillance on Plaintiff. On June 13, 2018, Trustmark sent a request to the exam coordinators for Plaintiff to undergo an independent medical exam (IME). On that same date, Plaintiff filed this lawsuit. Trustmark was not served with the complaint until June 20, 2018. On June 21, 2018, a letter was sent to Plaintiff telling him that “Prior to a final review of your claim, we will be arranging for an Independent Medical Exam (IME).”

Reasons the Court Ruled the Letter was Not a Denial of Total Disability Benefits

The Court carefully reviewed the May 2 letter and concluded “The letter expressly states that ‘final review’ was still pending – and hence no final decision had taken place.” That view was supported by subsequent letters telling Plaintiff he had 14 days to submit more information.

Finally, the court agreed that Trustmark would not have spent money on an IME, and on surveillance conducted on Plaintiff, if it had already denied his claim.

The Court also found that the “boilerplate” language in the May 2 letter advising the Plaintiff of his right to request review “does not negate the clear and unequivocal language in the letter specifically stating a ‘final review’ was still pending.

Contact Attorneys at Dell & Schaefer

This case was not handled by our office, but it may provide claimants guidance in their pursuit of obtaining a final decision from their disability insurance company that is reviewing the disability claim. If you need assistance with a similar matter, please contact a disability attorney at Dell & Schaefer for a free consultation.

Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

View videos, articles, resolved cases and claimant reviews about your specific disability insurance company.

Leave a comment or ask us a question


Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.


Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us