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:
- Tax returns.
- The need for more substantiating medical information.
- Informing him his requested information had not yet been received.
- Repeated status reports informing him that Trustmark was still waiting for requested information.
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.
Resources to Help You Win Disability Benefits
Disability Benefit Denial Options
Submit a Strong Trustmark Appeal Package
We work with you, your doctors, and other experts to submit a very strong Trustmark appeal.
Sue Trustmark
We have filed thousands of disability denial lawsuits in federal Courts nationwide against Trustmark.
Protect Your Benefits
Get Your Trustmark Disability Application Approved
We help claimants throughout the entire application process.
Prevent a Trustmark Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.
Negotiate a Trustmark Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Trustmark Reviews
(660)
Policy Holder Rating
5
0%
4
0%
3
0%
2
0%
1
0%
Timely Payments
0.0out of 5
Handling Claim
0.0out of 5
Customer Service
0.0out of 5
Dependable
0.0out of 5
Value
0.0out of 5
Showing 8 of 660 Reviews
Lincoln Financial
Uses every dirty trick in the book
It’s next to impossible to get $ out of them without a lawyer. They use plenty of intimidation and unfair tactics. They don’t want to pay. And yet, their CEO made 13 m... read more >
Unum
Unum is evil
On 11/3/2021 I got shot by my boyfriend and my spinalcord got hit, paralyzing me from the neck down and accepting Unum benefits was the worst decision I ever made. I sued ... read more >
Lincoln Financial
Every month I get paid on a different date
I will start by saying that my experience is not as horrible as others, like the folks who have valid claims but get nothing from Lincoln. I feel for you and hope to god y... read more >
MetLife
They will do anything to not approve your claim
MetLife’s handling of my short-term disability claim has been incredibly frustrating and stressful. I followed all the necessary steps prior to my surgery, providing the... read more >
Reply
Sedgwick
Don't trust them, they like to play games
They suck the life out of people that need help. They falsely advertise for helping people that they care. Sorry to tell you it's all about money, they do not care for any... read more >
New York Life
Lyme Disease Disability Claim Denial
I have had repeat claims for genuine medical leave and they have repeatedly been denied by NY Life. I have even been diagnosed with Lyme and going through treatments and t... read more >
New York Life
Disappointed with NY Life Disability Excuses
I am beyond disappointed with NY Life Disability Insurance’s handling of my father’s claim. My father, a 66-year-old man who has suffered two strokes and continues to ... read more >
New York Life
New York Life is a joke!
This company sucks when it comes to disability claims. They are slow at processing stuff, then they always say they didn't recieve the doctors information. You spend your ... read more >
Answered Questions by Our Lawyers
(0)
Helpful Videos
(910)
Showing 12 of 910 Videos
Disability Benefit Tips
(331)
Showing 8 of 331 Benefit Tips
Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?
When it comes to securing your disability insurance benefits, it's vitally important that your disability insurance lawyer thoroughly understands the symptoms and impact of your disabling condition. Doctors can help you create strong medical records, but they're not accustomed to dealing with the rigorous documentation disability insurance companies require. Lea... Read More >
Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak
If you're seeking long term disability benefits from an insurance company, you may be concerned that you're facing an uphill battle. Fortunately, the stronger your medical evidence, the greater the odds that your claim will be approved. On the other side of the coin, one of the most common reasons for denial of long term disability benefits involves too-weak med... Read More >
Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company
When you're seeking disability insurance benefits, your medical records and treating physician's statement are two of the most important components of your claim. But because the insurance company has a vested interest in denying your disability insurance claim, it often will rely on tactics like ambushing your doctor with a phone call in an attempt to get them ... Read More >
Disability Benefit Denial Reason #3 - Video & Social Media Surveillance
One thing many disability insurance claimants don't know about (or expect) from the claims review process involves video and social media surveillance. Disability insurance carriers often hire people to follow claimants around with a telephoto lens - or even send social media friend requests from fake accounts - to glean whatever information they can about the c... Read More >
How Do You Fight a Long-Term Disability Denial?
Getting a denial letter from your disability insurance company is one of the ultimate insults. You are sick and not able to work, yet your disability insurance company is telling you to return to work. The disability insurance company has denied your disability benefit claim and is basically calling you a liar. When receiving a disability denial letter or a ph... Read More >
Disability Denial Reason #2 - Change of Disability Definition & Vocational Review
One of the top reasons for terminating a claimant's long term disability benefits involves the change in the disability insurance policy's definition of "disability." This definition change often happens in conjunction with a vocational review, or an analysis of a claimant's medical records that tells the insurance company which jobs the claimant should be able ... Read More >
Disability Denial Reason #1 – Paper Review & IME
At Dell Disability Lawyers, we've seen insurance companies give countless reasons to deny long term disability benefits. However, most disability benefit denials tend to fall into one of a few categories - and one of the biggest ones is the paper review and independent medical exam (IME). Learn more about what this review process entails and what your claim file... Read More >
How to Apply for Reliance Standard Disability Benefits & Top 5 Reasons for a Claim Denial
At Dell & Schaefer we’ve handled hundreds of long term disability insurance claims against Reliance Standard, and have learned a few things in the process. When you’re experiencing an injury or illness that makes it difficult (or impossible) to work, it can be tempting to file a claim as quickly as possible – but unless a claimant has all their ducks in a row, this could actually delay the ultimate r... Read More >
Dell Disability Cases
(375)
Showing 8 of 375 Dell Disability Cases
Chiropractor receives total disability benefits despite neck exclusion language in a Trustmark Insurance Company disability policy
Our client, a chiropractor, was severely injured as a result of a mountain bike accident, which left him temporarily paralyzed. While he was only temporarily paralyzed, this accident has left him with permanent spinal cord and lower back injuries that render him unable to work as a chiropractor. The days that he once spent running from room to room, greeting people, and adjusting and manipulating his patients ... Read More >
Seven Surgeries and The Standard Still Denies Disability Insurance Benefits
Our client was employed with the State of Oregon as a Technical Support Representative. She sought disability through her employer provider LTD Policy with Standard due to low back, hip, and lower extremity pain. She had two hip, two knee and three back surgeries.After paying her for 1.5 years Standard hired a board-certified neurologist to perform a review ... Read More >
Sun Life Wrongfully Denies Disability After Paying For 23 Months
We represent a 57 year-old claimant who’s occupation was selling commercial vehicles for many years. Her job was very physical as it required her to climb in and out of semi-trucks multiple times a day as well as operate them which was very strenuous. She went out of work in due to ongoing and severe debilitating right hip, low back, and bilateral knee pain... Read More >
Nurse Denied Long-term Disability Benefits by Lincoln After the Definition of Disability Changed
Our client, a registered nurse for Dignity Health, found herself in a difficult situation after being diagnosed with lumbar spondylosis and left knee arthritis. She continued to work, however, struggled while attempting to work through chronic lower back pain and left lower extremity radicular symptoms on a daily basis. Sadly, her condition failed to improve and... Read More >
Lincoln Reverses Decision to Terminate LTD Benefits of Corporate Attorney after Dell Disability Lawyers Appeals the Decision
The claimant is an 64 year old former Corporate Attorney and at a prominent Florida business law firm who was forced to cease working in his highly successful and rewarding profession, job, and career on January 27, 2021, and to seek disability compensation under his policies with Lincoln due to severe symptomatology stemming from or following a viral COVID-19 i... Read More >
Transportation Manager with Brain Injury Wins Unum Disability Benefit Appeal
Unum unjustly terminated our client’s disability insurance claim after it had approved and accepted liability for six months. Unum unreasonably concluded, without any evidence of improvement, that the claimant had resumed the sustained work capacity to perform the material and substantial duties of her high level occupation as a Transportation Division Manage... Read More >
Prudential reverses decision to terminate LTD benefits of MRI Tech with Primary Progressive Multiple Sclerosis and degenerative Disc Disease
The claimant is a 58-year-old former MRI Technologist for Fairview Health Services who has long suffered from the debilitating effects of her chronic medical conditions. She has a history of neck pain as well as right arm pain and numbness dating back to 2005 with a reoccurrence of severe symptomatology in 2013. MRI of her cervical spine performed in August of ... Read More >
Engineer With Depression Wins Prudential LTD Appeal
The claimant is a former Senior Technology Services Engineer for Accolade, Inc. who was forced to cease working on May 25, 2021 and to apply for disability insurance benefits under his policy with Prudential because of severe symptomatology related to depression and anxiety. Prudential initially approved his claim for LTD benefits as his symptoms were demonstrat... Read More >
Disability Lawsuit Stories
(765)
Reviews from Our Clients
5 Ways We Help Get Your Benefits Paid
Get Your Disability Application Approved
Our goal is to get your application for disability insurance benefits approved. Applying for disability insurance benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their hired gun doctor.
Through our experience of having helped thousands of disability insurance claimants, our disability insurance lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.
Submit A Strong Appeal Package
If your disability insurance benefits have been wrongfully denied, then our disability insurance lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.
Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of disability. We encourage you to contact any of our long-term disability attorneys for a free immediate review of your disability denial.
Sue Your Disability Company
98% of the disability insurance lawsuits filed by our law firm have resulted in either the payment of benefits or a lump-sum settlement agreement. Our disability insurance attorneys have filed ERISA governed and private policy long term disability insurance lawsuits against every major disability insurance company in state and federal courts nationwide and we love fighting for the little guy against the multi-billion dollar insurance company giants.
We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.
Prevent A Disability Benefit Denial
Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.
Our disability insurance law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.
Negotiate a Lump-Sum Settlement
Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our disability insurance lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.
Questions About Hiring Us
Who are Dell Disability Lawyers?
We are disability insurance attorneys that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.
Our attorneys have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement in more than 98% of our cases. Our disability insurance lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.
We offer disability insurance attorney representation nationwide and we welcome you to contact any of our LTD lawyers for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 900 videos and regularly provide tips to help protect your disability benefits.
Who do you help?
Our disability insurance attorneys help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.
Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.
A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.
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 insurance 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 phone, email, fax, or video conferencing sessions. 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 insurance attorney. We can be reached at 800-698-9159 or by email. Lawyers 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.