Clark Stones

We regret that [redacted] is not satisfied with his life insurance and has not accepted our explanation of what occurred. Western & Southern Life has, in good faith, provided [redacted] coverage on his life for more than 11 years. Had his death occurred during this time, a...

claim would have been honored. Although we are not able to comply with his request for a full refund, the last deduction from his bank account has been refunded since he has now notified us to stop the deductions. No further premiums will be deducted from his bank account. In 2006 when his policy was issued, [redacted] authorized premiums to be deducted from his bank account in exchange for insurance coverage. The authorization stated it would remain in effect until revoked in writing. Although [redacted] claims that in 2006 he informed his representative he no longer wished to continue his policy, we do not have any written notice from him to revoke his authorization and no notification was received from his agent to stop the withdrawals from his bank account.   All the deductions appeared on [redacted]’s bank statements every month. [redacted] was given the Terms and Conditions of the PAC Plan, which state it is the responsibility of customers to reconcile their bank account on a monthly basis and notify the company home office immediately of any discrepancy. This would alert [redacted] the deductions continued to draft from his account. However, [redacted] did not contact our company at any time over the years to question this. This would indicate his agreement with the deductions.  On May 12, 2016, a notification was sent to [redacted] informing him of the automatic renewal of his term policy. The notice advised him to contact us prior to his next scheduled draft if he did not wish to continue the policy.  However, [redacted] did not contact our company, which would indicate his agreement with the notification. The drafts continued as he authorized.

There are two issues that Mr. [redacted] raised: 1) the Payment Amount and 2) the Statement of Account. Payment Amount Attached are pages 5 and 7 of the policy contract defining the covered benefit for which Mr. [redacted] submitted a claim and the benefit payable amount. Mr. [redacted] submitted a claim for First Coronary Artery Bypass Surgery. As shown in the contract, this procedure has a benefit payment amount of 25% of the maximum benefit amount. Although Mr. [redacted] indicated he suffered a heart attack, we do not have medical documentation Mr. [redacted] suffered a heart attack, as Claims has not yet received the medical records requested from the hospital. We notified Mr. [redacted] we are awaiting the documents for review. The claim Mr. [redacted] submitted was paid in the amount of $3,750.00 under the Critical Illness Benefit. The policy continues to provide coverage for the remaining 75% should Mr. [redacted] be diagnosed with another covered benefit. Statement of Account. Attached is a copy of the Statement of Account attached to the check Mr. [redacted] received in payment for his Critical Illness claim. Personal information has been blacked out. A Statement of Account is a generic document for various types of individual claims paid for our clients. The document lists four general categories for the type of covered benefits offered below. ·         Critical Illness Benefit·         Hospital Confinement Benefit·         Mammogram Screening/Pap Smear·         Return of Premium Since the covered benefit for Mr. [redacted] was a Critical Illness benefit, the heading on the Statement of Account is Critical Illness Payment. Also, the full benefit payment amount is listed under the heading Critical Illness Benefit. The other three categories, including the Mammogram Screening/Pap Smear category, do not pertain to this claim. Note there is no payment amount listed under any other category.

[A default letter is provided here which indicates your acceptance of...

the business's response.  If you wish, you may update it before sending it.  If you and the business have reached an agreement and compliance is set for a future date, we trust the business will comply.  Please contact us after that time if the matter is not resolved as agreed and we will review the complaint and proceed accordingly.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. 
Regards,
[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
Regards,
[redacted]

Because I was not notified of this loan untill after signing papers to take on my policy. I was never notified that my insurance had lapsed and that it was set to a term life policy..

We regret that Ms. [redacted] did not accept our previous response to her complaint. The owner of a policy has control of such policy, including rights to the cash value and dividends. The owner may withdraw cash value in the form of a loan and withdraw dividend value as well. When the policy changes owners, the new owner assumes these same rights along with any loan obligation the previous owners may have had. At age 21 in 2012, Ms. [redacted] became the owner of the policy and, as such, assumed all the rights to the policy as well as any loan obligations from the previous owners. Each year prior to the policy lapse, interest notices, along with capitalization notices, were mailed informing her of the loan balance. She chose to discontinue premium payments and the policy lapsed to extended term coverage. The amount of term insurance is the face amount plus any dividend value, less the policy loan. The net cash value determines the length of time the extended insurance will be in force, which, in this case, is until November 29, 2026. At that time, the coverage will end.  Extended term insurance may be surrendered at any time for the remaining cash value, which decreases as it is used to continue the coverage. Ms. [redacted] may be confusing the amount paid into the policy with the coverage amount.

[redacted] was owner of two policies on her father. As mentioned in the first response, both policies lapsed for nonpayment of premiums. All premiums paid into these policies were used to provide coverage.
In the follow up complaint, [redacted] refers to a policy issued in 1964. That policy was surrendered by [redacted] in 1983. Another policy issued in 1980 was surrendered in 1984.

Our company regrets we are unable to approve the rating change [redacted] requested. Rating changes are subject to underwriting review and must qualify for the same standard rating of the policy. Unfortunately, [redacted]’s current health does not meet these qualifications.

We would like to apologize to [redacted] for the difficulty she experienced when she requested to withdraw funds from the annuity for her daughter. The funds were wired to her bank on January 20, 2016, as requested.

A letter was sent to Ms. [redacted] on November 18, 2016, in response to her Revdex.com complaint, and we regret she has not accepted our explanation. As we explained before, when she automatically became owner of the policy at her age 21, she assumed all the rights as well as all the obligations of the policy. Also, as previously stated, each year we sent the owner of the policy interest notices, capitalization notices and loan balance information. As we have explained to Ms. [redacted], the current death benefit for her extended term coverage is almost $10,000 ($9,874, to be precise) and will be in effect until November 29, 2026. At that time, the coverage will cease and the policy will end, which is how term life insurance works. However, it is important to note, as we have informed Ms. [redacted], because premiums for the policy are being taken from the cash value, that amount will decrease until depleted in 2026 when the policy will end. The cash value of this policy, which is different from the face value listed above, is now $170.13 and will continue to decrease until it is depleted in 2026.The company will be contacting Ms. [redacted] with a follow up letter addressing her concerns.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
Regards,
[redacted]   I just want what I was always told that I would get if I quit smoking. They just want my money even tho I have done what they said I had to do to get the lower rate.

A letter was sent to Ms. [redacted] on November 18, 2016, in response to her Revdex.com complaint, and we regret she has not accepted our explanation. As we explained before, when she automatically became owner of the policy at her age 21, she assumed all the rights as well as all the obligations of the policy.   Also, as previously stated, each year we sent the owner of the policy interest notices, capitalization notices and loan balance information. As we have explained to Ms. [redacted], the current death benefit for her extended term coverage is almost $10,000 ($9,874, to be precise) and will be in effect until November 29, 2026. At that time, the coverage will cease and the policy will end, which is how term life insurance works. However, it is important to note, as we have informed Ms. [redacted], because premiums for the policy are being taken from the cash value, that amount will decrease until depleted in 2026 when the policy will end. The cash value of this policy, which is different from the face value listed above, is now $170.13 and will continue to decrease until it is depleted in 2026.

While we regret that Mr. [redacted] is unsatisfied with our decision,
we are unable to approve the claim for either policy. When a policy is still
contestable at the time of a claim, it is our routine practice to conduct a
review of medical information provided by the insured. A review...

uncovered
medical conditions not disclosed during the application process. Had our
company been aware of the medical conditions, the waiver of premiums rider
would not have been issued on the insurance policies. A letter was sent to Mr.
[redacted] indicating the medical conditions uncovered during our review. Under
the Incontestability provision of the contracts, the claim for benefits was
denied and the waiver of premium rider rescinded from both policies. Premiums
paid for the riders were refunded to Mr. Harrison. The policies will otherwise
remain in benefit subject to the their terms.

We want to extend our deepest sympathy to Ms. Ann [redacted] and her family for their loss. We strive to pay claims as soon as possible. However, because the beneficiary died before the insured, we need additional documents to determine the proper persons to pay the proceeds. We have been waiting...

for the completed Statement of Claimant forms from Mr. Chris [redacted], and the Trust Verification documents from both Ms. [redacted] and her brother, Mr. [redacted]. We will be able to pay the claim once we receive the necessary documents.

We regret that Mr. [redacted] is not satisfied. As stated in his
policy contract, the Disability Premium Credit Rider Benefit that Mr. [redacted] has
in his policy provides a monthly benefit equal to one-twelfth of the annual
selected premium. Therefore, as long as he remains permanently...

disabled, a
total of $27.75 ($30 minus the premium charge of $2.25) will be added to his
cash value each month by the Disability Premium Credit Rider Benefit. Mr. [redacted]
is responsible for the monthly insurance cost beyond that.

Several
calls were made and messages were left for Ms. [redacted]. Unfortunately, she
never called back. A letter was also sent to her on Nov. 18, 2014.
 
The
premiums for these policies were deducted through the Pre-Authorized Check
Plan. Ms. [redacted] received a discount...

when paying in this manner, however,
she called to remove the policies from PAC. The last draft was returned un-honored
by her bank. The overdue notices asked for the full premiums due since
she no longer would receive the discount.
 
When the policies were due to cancel, we extended
the grace period. However, since we did not hear from Ms. [redacted], the policies
have lapsed. Because her whole life
policy had some cash value, a surrender form was enclosed with the letter.