Stewart C. Miller & Co., Inc. received a notification of a customer complaint against our company from the Revdex.com dated 4/13/2017. This letter is a response to the customer complaint, Case ID [redacted].There is a signed Administrative Contract between the Health and Welfare Plan...
and Stewart C. Miller & Co., Inc. In performing our services as Administrative Managers of the Health and Welfare Plan, the Administrator shall:1) Provide and maintain an adequate and properly trained staff to perform the services and answer the inquiries of Employees and the Fund with respect to Administrator's obligations and procedures as outlined by the Plan Document of the Plan. The Administrator has no authority to waive or change the Plan of benefits or provision without an agreement/amendment, in writing from the Fund.2) Maintain claims processing on a current basis with no more than a 14-day turn-around-time. The 14-day turn-around-time will be maintained provided that all of the information is available to properly adjudicate each claim.Timeline of Case ID [redacted]:1/30/2017-Stewart C. Miller & Co., Inc. received short term disability paperwork regarding gunshot wound to the abdomen which happened on 1/22/2017.2/02/2017-Stewart C. Miller & Co., Inc. mailed and faxed a letter requesting accident information, a copy of the police report and questioned third party liability.2/03/2017-Stewart C. Miller & Co., Inc. received a copy of the incident report completed by the County Sheriff Department along with a completed injury/accident information form and completed subrogation reimbursement form.The incident report summary: On the morning of Sunday, January 22, 2017 a male reported to 911 that he just shot someone who came to his shop. Upon the arrival of Detectives, the crime scene had been established and secured. Crime scene technicians were ordered and interviews were conducted. At the time of this report eh victim is unable to be interviewed and the investigation is ongoing. 2/06/2017-Stewart C. Miller & Co., Inc. received a phone call from a detective. The detective said the shooting incident was still under investigation with the sheriff's department before going to the prosecutor's office.2/16/2017-Stewart C. Miller & Co., Inc. called the prosecutor's office checking to see if any charges, if any, were going to be filed. The case was under review, no decision yet. 2/16/2017- Stewart C. Miller & Co., Inc. spoke to the Revdex.com Customer. The following plan limitations were explained to him. The Health & Welfare Plan excludes medical benefits payable for any expense which is incurred as a result of willful participation in or a a result of the commission of a criminal act (except for death benefit). The Health & Welfare Plan excludes a short term disability benefits payable for injuries sustained while participating in or as a consequence of having participated in a riot or the commission of a crime.2/24/2017-Stewart C. Miller & Co., Inc. mailed a letter to the Revdex.com Customer notifying him that the claim was still pending information from the prosecutor's office. The letter included a copy of the Plan's limitations/exclusions from the Plan Document. 2/27/2017-Stewart C. Miller & Co.,Inc. called the prosecutor's office. The case was still under review, no decision yet.3/08/2017- Stewart C. Miller & Co., Inc. called the prosecutor's office. The case was still under review, no decision yet.3/21/2017- Stewart C. Miller & Co., Inc. was told by the prosecutor's office that they could not give out information to the public without a subpoena. It was noted that the Revdex.com Customer hired an attorney.3/22/2017-The Revdex.com Customer called Stewart C. Miller & Co., Inc. He was going to have his attorney get the information needed so his disability and medical claims could be paid.4/06/2017- Stewart C. Miller & Co., Inc. received a copy of a letter written by the Revdex.com Customer addressed to the Board members. In the letter, the Revdex.com Customer states he received an email from the prosecutor. The email stated no charges will be filed against him.4/07/2017-Stewart C. Miller & Co., Inc. received a copy of a letter written to the Revdex.com Customer's attorney from the prosecutor. The letter was dated 4/07/2017 and stated no charges will be filed by this office concerning the shooting that happened in, Indiana which involved the Revdex.com customer and another male on 1/22/2017.4/07/2017- Stewart C. Miller & Co., Inc. faxed the prosecutor's letter to the Fund's attorney for review. Since the plan limitation/exclusion does not specifically state the Revdex.com Customer has to be convicted of a crime, but rather involved in a commission of a criminal act. 4/13/2017- Per email to Stewart C. Miller & Co., Inc. from the Fund's attorney, a request for public records was sent to the sheriff to see if the Revdex.com Customer did something illegal, like trespass or assault. The sheriff has 7 days to respond.4/17/2017 -Stewart C. Miller & Co., Inc. received a letter from the Revdex.com detailing the complaint, case ID [redacted] "failure to provide services".This case is on the agenda for the Board of Trustees of the Health and Welfare Plan to discuss at the next scheduled meeting, 4/19/2017. The Board of Trustees will decide if the Plan limitations/exclusions apply to this case.Best Regards, Stewart C. Miller & Co., Inc.
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.
Regards,
[redacted]
Stewart C. Miller & Co., Inc. received a notification of a customer complaint against our company from the Revdex.com dated 4/13/2017. This letter is a response to the customer complaint, Case ID [redacted].There is a signed Administrative Contract between the Health and Welfare Plan...
and Stewart C. Miller & Co., Inc. In performing our services as Administrative Managers of the Health and Welfare Plan, the Administrator shall:1) Provide and maintain an adequate and properly trained staff to perform the services and answer the inquiries of Employees and the Fund with respect to Administrator's obligations and procedures as outlined by the Plan Document of the Plan. The Administrator has no authority to waive or change the Plan of benefits or provision without an agreement/amendment, in writing from the Fund.2) Maintain claims processing on a current basis with no more than a 14-day turn-around-time. The 14-day turn-around-time will be maintained provided that all of the information is available to properly adjudicate each claim.Timeline of Case ID [redacted]:1/30/2017-Stewart C. Miller & Co., Inc. received short term disability paperwork regarding gunshot wound to the abdomen which happened on 1/22/2017.2/02/2017-Stewart C. Miller & Co., Inc. mailed and faxed a letter requesting accident information, a copy of the police report and questioned third party liability.2/03/2017-Stewart C. Miller & Co., Inc. received a copy of the incident report completed by the County Sheriff Department along with a completed injury/accident information form and completed subrogation reimbursement form.The incident report summary: On the morning of Sunday, January 22, 2017 a male reported to 911 that he just shot someone who came to his shop. Upon the arrival of Detectives, the crime scene had been established and secured. Crime scene technicians were ordered and interviews were conducted. At the time of this report eh victim is unable to be interviewed and the investigation is ongoing. 2/06/2017-Stewart C. Miller & Co., Inc. received a phone call from a detective. The detective said the shooting incident was still under investigation with the sheriff's department before going to the prosecutor's office.2/16/2017-Stewart C. Miller & Co., Inc. called the prosecutor's office checking to see if any charges, if any, were going to be filed. The case was under review, no decision yet. 2/16/2017- Stewart C. Miller & Co., Inc. spoke to the Revdex.com Customer. The following plan limitations were explained to him. The Health & Welfare Plan excludes medical benefits payable for any expense which is incurred as a result of willful participation in or a a result of the commission of a criminal act (except for death benefit). The Health & Welfare Plan excludes a short term disability benefits payable for injuries sustained while participating in or as a consequence of having participated in a riot or the commission of a crime.2/24/2017-Stewart C. Miller & Co., Inc. mailed a letter to the Revdex.com Customer notifying him that the claim was still pending information from the prosecutor's office. The letter included a copy of the Plan's limitations/exclusions from the Plan Document. 2/27/2017-Stewart C. Miller & Co.,Inc. called the prosecutor's office. The case was still under review, no decision yet.3/08/2017- Stewart C. Miller & Co., Inc. called the prosecutor's office. The case was still under review, no decision yet.3/21/2017- Stewart C. Miller & Co., Inc. was told by the prosecutor's office that they could not give out information to the public without a subpoena. It was noted that the Revdex.com Customer hired an attorney.3/22/2017-The Revdex.com Customer called Stewart C. Miller & Co., Inc. He was going to have his attorney get the information needed so his disability and medical claims could be paid.4/06/2017- Stewart C. Miller & Co., Inc. received a copy of a letter written by the Revdex.com Customer addressed to the Board members. In the letter, the Revdex.com Customer states he received an email from the prosecutor. The email stated no charges will be filed against him.4/07/2017-Stewart C. Miller & Co., Inc. received a copy of a letter written to the Revdex.com Customer's attorney from the prosecutor. The letter was dated 4/07/2017 and stated no charges will be filed by this office concerning the shooting that happened in, Indiana which involved the Revdex.com customer and another male on 1/22/2017.4/07/2017- Stewart C. Miller & Co., Inc. faxed the prosecutor's letter to the Fund's attorney for review. Since the plan limitation/exclusion does not specifically state the Revdex.com Customer has to be convicted of a crime, but rather involved in a commission of a criminal act. 4/13/2017- Per email to Stewart C. Miller & Co., Inc. from the Fund's attorney, a request for public records was sent to the sheriff to see if the Revdex.com Customer did something illegal, like trespass or assault. The sheriff has 7 days to respond.4/17/2017 -Stewart C. Miller & Co., Inc. received a letter from the Revdex.com detailing the complaint, case ID [redacted] "failure to provide services".This case is on the agenda for the Board of Trustees of the Health and Welfare Plan to discuss at the next scheduled meeting, 4/19/2017. The Board of Trustees will decide if the Plan limitations/exclusions apply to this case.Best Regards, Stewart C. Miller & Co., Inc.
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.
Regards,
[redacted]