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RevDex.com K Street NW 10th Floor Washington, DC 20005- RE: COMPLAINT ID: [redacted] COMPLAINANT: [redacted] POLICYHOLDER: [redacted] *** POLICY NUMBER: [redacted] CARRIER: [redacted] NAIC NO: [redacted] Dear Sir/Madame: This letter is in response to your correspondence regarding the above captioned complaint (the “Complaint”) Please be advised that [redacted] Insurance Company (“ [redacted] ”) has reviewed this matter The Complaint has been submitted by [redacted] (“Complainant”), an executive officer of [redacted] ***., a business previously insured by [redacted] Insurance CompanyBy way of background, [redacted] issued Workers’ Compensation and Employer’s Liability Insurance Policy number [redacted] to [redacted] ***on 10/13/for the period of 10/19/to 03/14/(the “Policy”) Complainant alleges that [redacted] is “trying to collect a debt on a service that was never provided” [redacted] investigated these allegations and has determined them to be false [redacted] did in fact provide Complainant with Workers’ Compensation and Employer’s Liability coverage for the period referenced above The application for such insurance (attached as Exhibit A) was received by [redacted] on 09/25/2015, and was quoted in anticipation of the Complainant’s hiring of an employee who would be subject to coverage under the applicable state of Illinois’ Workers’ Compensation ActThe application clearly indicates that upon receipt of said form, [redacted] was to bind and issue a policy to the Complainant (please see “Status of Submission”) [redacted] did so, and issued the Policy, effective as of 10/19/Further evidence of this coverage, and Complainant’s knowledge of such coverage, can be found under the State of Illinois State Board of Worker’s Compensation standard “Corporate Officer Rejection” form, which was executed by the Complainant and received as of 10/12/(attached as Exhibit B)Please note that this was prior to the issuance of the policy [redacted] asserts that the allegations by Complainant regarding a lack of services is falseFurther, [redacted] asserts that any and all actions subsequent to the issuance of the Policy, including cancellation and auditing procedures, were undertaken in good faith, in compliance with applicable law, and within the scope of the provisions of the policy As of 03/14/2016, the Policy was cancelled pro-rata, pursuant to the Notice of Cancellation and related cancellation endorsement (herewith attached as Exhibit C) for non-payment of premiumAn audit of the policy was conducted, with notice of an estimated audit mailed to the Complainant on 08/12/and for which a final audit was issued to the Complainant as of 08/29/After speaking with the Complainant, [redacted] adjusted the amount owed to reflect the minimum premium for the Complainant’s applicable Worker’s Compensation class code (7229)At no time throughout the period of coverage did Complainant indicate to [redacted] that he did not want coverageThe first notice that [redacted] received for such a request was after the cancellation and auditing procedures had been completed In consideration of all of the information contained within this letter, [redacted] asserts that it has practiced due diligence in attempting to resolve this matter prior to the filing of this ComplaintFurther, the disputed amount of $is owed by Complainant for coverage given for the applicable policy period, prior to cancellationIn the event of a claim, [redacted] would have been responsible as the carrier of record to provide coverage for such a claimAs such, we request that the Complainant pay all monies owed to resolve this matterNo further action will be undertaken by [redacted] once full payment has been received We hope the aforesaid is sufficiently responsive to your inquiries regarding this matter If I can be of further assistance in this matter, please contact me at your convenience Respectfully, Keoni J [redacted] MrKeoni J [redacted] , Legal Assistant Berkshire Hathaway GUARD Insurance Companies Phone: [redacted] Direct Extension: [redacted] Email: [redacted] @GUARD.com

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RevDex.com
1411
K Street NW
10th
Floor
Washington,
DC 20005-3404
 
            RE:                  COMPLAINT
ID:      [redacted]
COMPLAINANT:     [redacted]
POLICYHOLDER:    [redacted].
POLICY
NUMBER:  [redacted]
                                    CARRIER:                 [redacted]
                                    NAIC NO:                  [redacted]
 
Dear Sir/Madame:
This letter is in
response to your correspondence regarding the above captioned complaint (the “Complaint”).
Please be advised that [redacted] Insurance Company (“[redacted]”) has reviewed
this matter.
The Complaint has
been submitted by [redacted] (“Complainant”), an executive officer
of [redacted]., a business previously insured by [redacted] Insurance
Company. By way of background, [redacted] issued Workers’ Compensation and
Employer’s Liability Insurance Policy number [redacted] to [redacted]. on
10/13/2015 for the period of 10/19/2015 to 03/14/2016 (the “Policy”).
Complainant
alleges that [redacted] is “trying to collect a debt on a service that was never
provided”. [redacted] investigated these allegations and has determined them to
be false. [redacted] did in fact provide Complainant with Workers’ Compensation
and Employer’s Liability coverage for the period referenced above.  The application for such insurance (attached
as Exhibit A) was received by [redacted] on 09/25/2015, and was quoted in
anticipation of the Complainant’s hiring of an employee who would be subject to
coverage under the applicable state of Illinois’ Workers’ Compensation Act. The
application clearly indicates that upon receipt of said form, [redacted] was to
bind and issue a policy to the Complainant (please see “Status of Submission”).
[redacted] did so, and issued the Policy, effective as of 10/19/2016. Further
evidence of this coverage, and Complainant’s knowledge of such coverage, can be
found under the State of Illinois State Board of Worker’s Compensation standard
“Corporate Officer Rejection” form, which was executed by the Complainant and
received as of 10/12/2015 (attached as Exhibit B). Please note that this was
prior to the issuance of the policy. [redacted] asserts that the allegations by
Complainant regarding a lack of services is false. Further, [redacted] asserts
that any and all actions subsequent to the issuance of the Policy, including
cancellation and auditing procedures, were undertaken in good faith, in
compliance with applicable law, and within the scope of the provisions of the policy.
As of 03/14/2016,
the Policy was cancelled pro-rata, pursuant to the Notice of Cancellation and
related cancellation endorsement (herewith attached as Exhibit C) for
non-payment of premium. An audit of the policy was conducted, with notice of an
estimated audit mailed to the Complainant on 08/12/2016 and for which a final
audit was issued to the Complainant as of 08/29/2016. After speaking with the
Complainant, [redacted] adjusted the amount owed to reflect the minimum premium
for the Complainant’s applicable Worker’s Compensation class code (7229). At no
time throughout the period of coverage did Complainant indicate to [redacted]
that he did not want coverage. The first notice that [redacted] received for such
a request was after the cancellation and auditing procedures had been
completed.
In consideration
of all of the information contained within this letter, [redacted] asserts that
it has practiced due diligence in attempting to resolve this matter prior to
the filing of this Complaint. Further, the disputed amount of $409.00 is owed
by Complainant for coverage given for the applicable policy period, prior to
cancellation. In the event of a claim, [redacted] would have been responsible as
the carrier of record to provide coverage for such a claim. As such, we request
that the Complainant pay all monies owed to resolve this matter. No further
action will be undertaken by [redacted] once full payment has been received.
We
hope the aforesaid is sufficiently responsive to your inquiries regarding this
matter.  If I can be of further
assistance in this matter, please contact me at your convenience.
Respectfully,
Keoni
J[redacted]
Mr. Keoni
J[redacted], Legal Assistant
Berkshire
Hathaway GUARD Insurance Companies
Phone:
[redacted] Direct Extension: [redacted]
Email:
[redacted]@GUARD.com