Crawford US Property & Casualty

December 3, 2014Dear *** ***,
We are in receipt of your correspondence dated November 24, 2014, Crawford & Company is the third party administrator for the carrier, *** Insurance Company for the above captioned matter*** Insurance Company issued the
above referenced Voluntary Accident Insurance policy to *** ** *** - *** Teachers Credit Union, which provides coverage for Accidental Death and Dismemberment.The complainant, *** *** indicates dissatisfaction with the benefit of $13,000, stating this is only half of the benefit amount and that his mom would not have purchased the policy had she been aware “she was paying full price for half the payout amount.’' *** ***'s desired outcome is to obtain a copy of the original agreement that his mother signed.Pertinent policy language for this Voluntary AccidentInsurance is as follows:Reduction of Principal SumIf an Insured Person is age or older on the date of an Accident causing Loss, then the Principal Sum payable will be reduced according to the following schedule:Age on Date of Accident: Amount of Principal Sum after reduction: 70- 50% of the Principal Sum shown above
75- 50% of the Principal Sum shown above
80-84 50% of the Principal Sum shown above
and over 50% of the Principal Sum shown above
We will increase the Principal Sum according to the formula below if an Accidental Bodily Injury causes an Insured Person’s covered LossThe increase in the Principal Sum is calculated by multiplying the Insured Person’s Principal Sum by:1) 2.5%;and2) the number of full calendar years elapsed since the Insured Person elected or last changed the Principal Sum,The increase in the Principal Sum shall not exceed 25% of the Principal Sum.Given the above noted policy provisions, the claimant's principal sum of $26,would be reduced by 50% due to her age of However the benefit would inciude .075% inflation or .025% for years given the effective date of the policy was 7/1/In conclusion, the total benefit payable to *** *** would be $13,975.00, This benefit check is currently in process for delivery to *** ***.In regards, to *** ***’s request for the policy or the original agreement his mother signed, Crawford and Company cannot release a copy of the policy since we are not the policyholderHowever, I enclose a copy of the enrollment form signed by ** *** which clearly states at the bottom of the form, that ‘‘all coverage is reduced by 50% at age and older".Copies of referenced documents are attached for your review.Should you have any additional questions or concerns, please do not hesitate to contact the undersigned.Yours very truly,Corinne WTeam ManagerAffinity Claims

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***

Review: my mother purchased an accidental death and dismemberment policy with this company through our credit union for the sum of $25,000. she died in a car accident. the company has been dragging their feet paying the claim. they now state that since my mom was over 70 years old that they will only pay out half the amount. I'm certain that she wouldn't have purchased the policy if she was aware that she was paying full price for half the payout amount.Desired Settlement: I would like a copy of the original agreement with terms and conditions that my mother signed to obtain this policy. I need to see what she signed.

Business

Response:

December 3, 2014Dear [redacted],We are in receipt of your correspondence dated November 24, 2014, Crawford & Company is the third party administrator for the carrier, [redacted] Insurance Company for the above captioned matter.[redacted] Insurance Company issued the above referenced Voluntary Accident Insurance policy to [redacted] - [redacted] Teachers Credit Union, which provides coverage for Accidental Death and Dismemberment.The complainant, [redacted] indicates dissatisfaction with the benefit of $13,000, stating this is only half of the benefit amount and that his mom would not have purchased the policy had she been aware “she was paying full price for half the payout amount.’' [redacted]'s desired outcome is to obtain a copy of the original agreement that his mother signed.Pertinent policy language for this Voluntary Accident. Insurance is as follows:Reduction of Principal SumIf an Insured Person is age 70 or older on the date of an Accident causing Loss, then the Principal Sum payable will be reduced according to the following schedule:Age on Date of Accident: Amount of Principal Sum after reduction: 70-74 50% of the Principal Sum shown above 75-79 50% of the Principal Sum shown above 80-84 50% of the Principal Sum shown above 85 and over 50% of the Principal Sum shown aboveWe will increase the Principal Sum according to the formula below if an Accidental Bodily Injury causes an Insured Person’s covered Loss. The increase in the Principal Sum is calculated by multiplying the Insured Person’s Principal Sum by:1) 2.5%;and2) the number of full calendar years elapsed since the Insured Person elected or last changed the Principal Sum,The increase in the Principal Sum shall not exceed 25% of the Principal Sum.Given the above noted policy provisions, the claimant's principal sum of $26,000 would be reduced by 50% due to her age of 93. However the benefit would inciude .075% inflation or .025% for 3 years given the effective date of the policy was 7/1/2011. In conclusion, the total benefit payable to [redacted] would be $13,975.00, This benefit check is currently in process for delivery to [redacted].In regards, to [redacted]’s request for the policy or the original agreement his mother signed, Crawford and Company cannot release a copy of the policy since we are not the policyholder. However, I enclose a copy of the enrollment form signed by [redacted] which clearly states at the bottom of the form, that ‘‘all coverage is reduced by 50% at age 70 and older".Copies of referenced documents are attached for your review.Should you have any additional questions or concerns, please do not hesitate to contact the undersigned.Yours very truly,Corinne W.Team ManagerAffinity Claims

Consumer

Response:

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,

Review: I am **. [redacted], and this is the second claim I have submitted within guidelines and have been denied services. The first claim was submitted in 09/2009 after a bad thunderstorm came through breaking a tree limb causing it to put a hole in my roof causing damages of over $3000 dollars for repairs. In May/2013 I filed a claim in which before an adjustor was sent out to my home I was told by the receptionist that my claim was going to be denied and of course it was. Even after the adjustor went out and took the pictures that was needed and saw the damages that was made to my roof I received a denial letter.Desired Settlement: I am seeking compensation from 2009 as well as 05/2013. I request that repairs are done to my home as needed without any prejudice.

Business

Response:

See Attachment:

Business

Response:

See Attachment: