Nationwide

We are in receipt of your request dated July 25, 2016 for information regarding the above referenced file. Ms. [redacted] states that the processing of the above claim was excessively delayed and beyond the 30 day time frame Nationwide states for claims turn around. She is requesting for her...

claim to be processed and paid immediately.Ms. [redacted] has a Whole Pet With Wellness Plan with a $100.00 annual deductible for her cat [redacted]. On May 11, 2016 we received a claim with a diagnosis of “Fractured Rear Tooth, Severe Periodontal Disease. Dental Prophylaxis.” Received with [redacted]’s claim was an invoice totaling $651.92 for treatment on May 10, 2016. This claim was reviewed and processed by our claims department on May 12, 2016. Given the close proximity to the policy effective date, this claim was temporarily denied and medical records were requested back to April 1, 2015 to verify eligibility.
Although reimbursement of Ms. [redacted]’s claim was still pending additional information to determine eligibility, it was processed and closed the day after it was received. The explanation of benefits was sent out on May 13, 2016 and our claims department operated well within the 30 day turn around time.
Please see the timeline below for an explanation of our underwriting and claims department’s review:? May 11, 2016: Claim 201605114431 received.? May 12, 2016: Claim was temporarily denied and medical records were requested.? May 25, 2016: [redacted]’s medical records were received.? June 15, 2016: A letter was sent to Ms. [redacted] advising her that an additional 30 days would be required for the review to be completed.? July 21, 2016: Underwriting review was completed. [redacted] was noted to have moderate to severe dental disease on May 5, 2016. Based on information provided by [redacted]’s veterinarian, it would require more than 4 days for dental disease of this degree to manifest and is therefore pre-existing, per the terms of the policy. The veterinarian also clarified that there was no tooth fracture present. As a dental cleaning had been performed, future claims may be eligible after May 24, 2016. Please note that since records also indicated [redacted] had been vomiting prior to the PED, an exclusion for gastroenteritis was added to her policy (diagnosis code 4500).
? July 22, 2016: A letter was sent to Ms. [redacted] advising her of the results of the underwriting review.As outlined in the Whole Pet With Wellness policy:Section 5. What We Do Not Cover – ExclusionsA. “Diagnosis or treatment of any pre-existing condition.”Section 2. DefinitionsK. “Pre-existing condition means any condition that began or was contracted, manifested, orincurred within twelve months of the effective date of this policy or during any waiting period,whether or not the condition was discovered, diagnosed, or treated. A chronic condition is a preexistingcondition unless it began after the effective date of this policy.”Claim 201605114431 was reopened and reprocessed post underwriting review with no reimbursement sincethe periodontal disease being treated was found to be pre-existing. A revised explanation of benefits was sentto Ms. [redacted] on July 22, 2016. This claim was processed correctly and within the terms of Ms. [redacted]’spolicy.
While the processing of this claim was never delayed, the underwriting review did take additional time tocomplete in order to determine if the condition being treated was eligible for coverage. Ms. [redacted] cancelledher policy for [redacted] effective July 22, 2016. She was issued a refund of her unearned premium July 24, 2016.Should you require any further assistance in this matter, please contact our [redacted]Patty G[redacted], at [redacted] or via email at [redacted]
Sincerely,
Vincent G[redacted]

This letter is in response to your inquiry regarding the above referenced policy owner [redacted].
Policy [redacted] was bound effective July 18, 2013, with a term premium of $932.70.
The prior insurance information provided with the application did not...

list Mr. [redacted] as a rated driver; therefore, we were unable to accept the information as sufficient Proof of Prior Insurance. 
Unfortunately, we did not receive the required Proof of Prior Insurance; therefore, a lapse in coverage surcharge was added to the policy effective July 18, 2013, increasing the term premium by $900.30.  A Revised Declarations was mailed to the address on file advising of the change and the impact to the premium.
On November 5, 2013, the policy cancelled for non-payment of the October 18, 2013 bill.  Upon cancellation, a collection balance of $641.15 remained on the account.
On November 12, 2013, a collection notice was mailed to the address on file.
Nationwide received proof of new insurance from the member on November 22, 2013 and the cancellation date was adjusted to October 18, 2013, reducing the collection balance to $461.55.
The collection amount, of $461.55, is accurate for coverage provided up to the cancellation date of October 18, 2013.
According to [redacted], the collection agency, the collection amount was reported to them on December 31, 2013, and Mr.  [redacted] has 60 days from the day [redacted] received it to pay the balance or it will be reported to the credit agencies.  [redacted] confirmed they mailed two notices and called Mr. [redacted] seven times.  Mr. [redacted] will need to make the payment soon if he does not wish for the collections to be reported to the credit bureaus.
We appreciate Mr. [redacted]’s feedback regarding his experience with [redacted]; however she is no longer with Nationwide. We've reviewed his issues with the new agency owner and the [redacted] Agency has expressed concern that the level of customer service was not to his satisfaction. Their intent is always to provide the best possible service for all of their policyholders. We do value his business, and hope to provide Mr. [redacted] with the best possible service in the future.
Please feel free to contact me if you have any further questions regarding this issue.

[redacted] indicates the rise in replacement cost @ 2.5% .fine. I accept a 2.5% increase. $522x2.5%=$13.05 I do not accept an 18.79% or $98.00 increase(please check my math. premium was increased from $522.00 to $620.00) this , my main complaint, was not addressed in her response please let Ms Weber know that I have also filed a complaint with the [redacted] Dept of Insurance. she states her rates are in accordance with state regulations. maybe , but arbitrary and excessive increases are not.   18.79% per year, REALLY? 
Regards,
[redacted]

For policy number [redacted]:
-0.25in; MARGIN: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1" class="MsoListParagraphCxSpFirst">·         The balance on the billing account for the Automobile policy as of November 13, 2014 equaled $1,263.17.
·         Nationwide sent a bill for $255.03 due by December 9, 2014. This bill was removed and the account was re-billed for $213.53
·         On November 20, 2014, we received a payment of $213.53 leaving a total balance due of $1,049.64.
·         The policy cancelled short rate, effective December 9, 2014 as requested, and $869.67 was credited to the billing account for unearned premium leaving a balance due of $179.97.
The amount due is for insurance protection provided up until the December 9, 2014 cancellation, plus a short rate fee.  Short rate means you may cancel your policy on the policy renewal date without being charged any additional fee.  But, should you cancel after the renewal date; the premium charge will be on a short rate basis.  This means that we will retain premium for the days covered, plus a percentage figure charge for cancelling during the policy period.  Attached is a copy of page G2 of our policy jacket that explains cancellation. All rating plans are filed with the [redacted] Department of Insurance. 
 In regards to claim [redacted] with a date of loss on 11/18/2014, the claim is with our subrogation department and we are in the process of attempting to negotiate with the at fault carrier [redacted] to reimburse the damages including the policy holder's deductible of $500.00.  This accident was a disputed lane change and we are not sure that [redacted] is accepting responsibility for this.  If they accept responsibility and issue payment to us, we will then reimburse the deductible.  If they deny liability, then we will move this to our arbitration department to have the case heard in arbitration by an independent party.  We are not able to reimburse the deductible until we recover damages from [redacted].
 
Thank you for allowing us to respond to our customer’s concerns.
 
Sincerely,
 
[redacted]
###-###-####

Nationwide has not addressed my concern, which is that they are using contractors who are not bonded and insured because they are unwilling to pay for qualified contractors.  
The first contractor they provided from their preferred providers list uses subcontractors to do the work.  I was not able to find any information on the Internet about the subcontractor he chose to do the work except that he was not bonded or insured.  I found that information on [redacted], but [redacted] did not provide any other information about him.  I even called [redacted] to ask for more information.  I told the contractor about this and he said the subcontractor was bonded and insured and that he would email documents to me to prove it.  The document he eventually sent to me was for himself, not for the subcontractor who would be doing the work and it was only for liability insurance, which wouldn't help with worksite medical claims.   I asked him again about the subcontractor, and he sent me documents to show that some other subcontractor had insurance but no information about bonding.  I don't know why he sent me information about a different subcontractor.  He had never said the new one would be doing the work and the new contractor's name did not indicate any connection with the siding industry.  In any case, the new subcontractor was not bonded.  
I complained to Nationwide and they said they did not have any other preferred contractors, but not long afterwards, they called and had a new contractor on the phone.  This time, it was a company that does crime scene cleaning.  It was apparent at this point that Nationwide was dealing with unqualified contractors to save money, so I said I would find a contractor on my own.  
On March 21, 2016, I got a letter with a new estimate, this time for metal siding, which is what I need to match the other three sides of my house.  The previous estimate had been for plastic siding even though the insurance estimator knew that I had metal siding on my house.  In any case, the new estimate includes this comment, "The payment is for the actual cash value of property covered by your policy less the deductible.  The actual cash value is the amount the actual property items are worth now less the depreciation.  You may be eligible for additional payment because your policy includes replacement cost coverage." First, there was no payment with this estimate.  Second, why wouldn't the payment based on my coverage?  In fact, the letter says I "may" be eligible for more money, not that I am.  It is apparent that I am going to have trouble getting Nationwide to pay what it actually costs to have a bonded and insured contractor repair my siding.  I have an appointment with a contractor I selected next Monday.   
I shouldn't have this kind of aggravation over an insurance claim.  Nationwide would have no difficulty selecting a bonded and insured contractor for their preferred provider list.  There are a number of them available in this area.  If they used such contractors, the siding that was blown off by the storm would have been replaced two months ago.
Regards, [redacted]

Attached is the form you requested.

I am in receipt of your reply regarding the above captioned loss and would like to take this opportunity to respond.
I have discussed this file with [redacted] of [redacted]. He will contact a local roofer to inspect the property to assist in determining the cause of the damage to the roof. Harleysville Insurance agrees to pay for the cost of pulling up the tarp and putting it back. Harleysville Insurance will not be liable for any damage to the roof from prior tarps.”
[redacted] advised me that [redacted] recently bought this home and was unaware of any past issues with the roof. We would request a copy of the home inspection that was completed prior to the purchase of the home so we can verify the condition of the roof at the time of the purchase. [redacted] will be requesting this from [redacted].
Should you require any further assistance in this matter, please contact our Customer Relations Coordinator, [redacted], at ###-###-#### or via email at [redacted].
Regards,[redacted]
############

...

 
Dear [redacted]
 
Thank you for the opportunity to respond to the Revdex.com regarding policy number [redacted] for [redacted] and to address her concerns about the policy.
 
On 12/18/2009, [redacted] purchased a six month insurance policy from the [redacted] with a bill plan of 25% down and 5 installments. 
 
On 02/08/2010, [redacted]’s policy was set up for an underwriting cancel effective 02/28/2010 due to no proof of insurance for members of her household and a Cancellation Notice was mailed.
 
On 02/28/2010, no proof of insurance was received and [redacted]’s policy cancelled per the 02/08/2010 notice. [redacted] owed a balance of $352.00 for the coverage that was provided up to the cancellation date. Collection notices were mailed to [redacted] from our collections company – CCS Collections.
 
On 06/08/2015, [redacted] contacted the service center to dispute the balance owed as she had duplicate coverage effective 02/10/2010. A resolution support analyst advised [redacted] that with proof of the duplicate coverage and a signed cancellation request we could backdate and cancel the policy effective 02/10/2010.
 
On 06/10/2015, the resolution support analyst received the proof of coverage and the signed cancellation request. The cancellation was backdated to 02/10/2010. Our company processes all mid-term cancellations at the customer’s request as a short-rate calculation or unearned pro-rate premium x .90. This process has been filed and approved by the [redacted] Department of Insurance. The balanced due decreased from $352.00 to $287.38.
 
On 06/11/2015, a member of the Office of Customer Advocacy contacted [redacted] and advised we were willing to waive the short-rate calculation as a courtesy to her. That reduced the balance owed from $287.38 to $121.00. [redacted] stated that was not good enough and that she would be filing a complaint with the Revdex.com.
 
Presently, [redacted] has a balance due of $121.00 for the coverage from 01/14/2010 to 02/10/2010. The balance is comprised of premium only and she is not being assessed any fees. We will not be waiving the $121.00 as she did not have duplicate coverage until 02/10/2010 and coverage was provided from our company.
 
I trust that I have addressed the issues within [redacted]’s complaint.  If I can be of further assistance, please contact me at ###-###-####.
 
Sincerely,
 
 
[redacted]

The company will kick me out of the rental on Monday. My loan has yet to be paid off. Nationwide have not sent the check to lender. Therefore another car cannot be purchased. I have to walk from the rental car place on Monday because I will not have a ride (Scared). I was unable to sleep the entire weekend.
We paid for window tint a week before the accident and we are being told we will not be reimbursed. We did not get a chance to enjoy the tint. [redacted] says that the windows had tint. I did not see any tint. Do to health conditions I have to have tinted windows (that is why we got the tint). Now when we get a new truck I will have to pay again (We should be reimbursed) this was an addition to the car.
Nationwide is leaving my family in a bad situation and the accident was not our fault.

I have reviewed the response made by the business in reference to complaint ID ########, and find that this resolution is satisfactory to me.
Regards,
[redacted]

This review is for VPI-Pet Insurance:
I have paid over $10,000 in premiums for my two cats for 8 years. They have reimbursed less than 10%. They just denied a catastrophic illness claim for one of my cats that they've covered for 8 years. She's never been ill! Unfortunately, you don't know how good your insurance company is until you use it....and VPI is criminally horrible!

As I stated previously we were aware of previous damage and it was noted in our inspection however the inspector and another roofing company stated the roof would be ok for a couple more years. We had no water damage in the house prior to winter even when it rained. I gave that report the [redacted] when he was here for adjustment from a roofer. We have hired a roofer already and he will be replacing our roof in a couple weeks. We can't let the water keep coming in damaging our house so the inspection would need to be done soon. 
What we are upset about is not how the roof was not covered but my complaint in the first place was about how unprofessional, unreliable the company is. We have been lied to multiple times and no communication has been made to us. Also the amount of time it has taken to resolve anything. The main issue is still being ignored despite everything. We were told partial roof would probably be covered. We are not blaming the insurance company for the whole roof. My complaint to the Revdex.com was not about money it was about how Harleysville treats their customers. I will be talking to my lawyer this afternoon for advise on how to proceed.
Regards,
[redacted]

This is an additional response to complaint [redacted]. To resolve the issue of the
siding, we have asked for documentation from the customer and/or his contractor toconfirm it is discontinued. If we are unable to find a reasonable match of style/profile,we will re-evaluate our resolution strategy.
If you have any additional questions, please contact Susan H[redacted], Office ofCustomer Advocacy, Nationwide Insurance, One Nationwide Plaza, Columbus OH,43215
Sincerely,Tricia P[redacted]
[redacted]

This is an inaccurate account. They made a mistake in my account and cancelled my auto payment which resulted in the cancellation of my account. This is something they acknowledged. All of their calls are recorded and they went back and listened. When attempting to reinstate my account, the informed me that they did not intend to continue to insure me. As a result, I thought I was in a race to gain insurance before a deadline. At the end of the day, I am not asking for much. Simply for them to recall the account from the collection agency and let me handle it with them directly. I don't believe I owe the money but I am willing to pay it if they delete it from my credit record. But I am being held hostage via my credit and would rather pay the ransom. They can surely see how they contributed to this issue. I find it odd that they tell me they are going to cancel for using the service I pay for and then send me to collections. Odd business practice. 
They have also told me that the collection agency has stated they will delete it from credit file. In researching this company online, this does not happen more than it does. 
Regards,
[redacted]

Per the agent, Jim J[redacted], the request to cancel the homeowner policy was properly handled.  For reasons they are unable to determine, the auto policy was not cancelled at the same time.  The file...

documentation shows that, after discussing the original problem with Mr. [redacted] they did attempt to cancel the auto policy but were not allowed to do so by the customer service department and underwriting department without obtaining proof of Mr. [redacted]'s new auto insurance policy.  They explained, in detail, that they had a signed cancel request form and had failed to cancel the policy on a timely basis, but were still not allowed to cancel the policy without proof of other auto insurance.   They then sent requests to Mr. [redacted] on 5/13, 5/18, and 5/31 asking for a copy of his new auto policy declarations page.  Mr. [redacted] called the agency on Monday 6/13 at 6:41 pm (office closed) and left a voice mail for me to call him.  I was not in my office the entire day Tuesday 6/14.  He called again at 2:02 pm on Tuesday 6/14 and left a message with Darnell for me to call him (apparently he only wanted to talk to me). I arrived at my office around 11:30 am on Wednesday 6/15 and became aware of Mr. [redacted]'s OCA complaint before I had a chance to call him.  We have reviewed our phone logs back to the beginning of March and can find no unanswered calls from Mr. [redacted] other than the two calls on 6/13 at 6:41 voice mail and the 6/14 at 2:02, both of which where not answered due to my not being in the office.  No emails were unanswered.  
After research on policy 6132C 377817, there is no longer an amount due. The Auto policy cancelled for Non-pay on April 9, 2016 leaving a collection amount of $89.99. Mr. [redacted] called the Service Center on June 13, 2016 to question the collection amount. Mr. [redacted] was advised of the incorrect cancellation date and was asked to provide proof of coverage elsewhere to adjust the date. Nationwide received that proof on June 14, 2016 and the cancellation date was adjusted to February 19, 2016. With this adjustment, there is a credit of $75.50 on the cancelled account, which will be sent out as a refund. CCS collections has been contacted and the original collection amount has been removed and was not reported to the Credit Bureau. The credit of $75.50 has been sent to processing to be mailed to Mr. [redacted] within five to seven business days.

Nationwide insurance refused to pay on a claim where a pipe busted in my basement and caused damage. They hired a tech to come purchase water outside of foundation and say water came from that way, however I saw no water in basement. They took over two monthes to let me know their decision and I had to fix the damage myself during this time. I have several policies through them and have for years. I am taking my business elsewhere I would not recommend this company to anyone.

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. Attached is a copy of my bank statement showing the total amount from [redacted] Rental Car. If additional information is needed please contact me. I have the original receipt that I can scan and email if needed. Thank you for the immediate resolution.

[redacted]
[redacted]
[redacted]
[redacted]...

[redacted]
                                    [redacted]      [redacted]   [redacted]
                                        ...⇄ [redacted]  [redacted]          
                                        ...⇄ [redacted]       
Please accept this letter in response to your correspondence dated May 29, 2014 regarding the above cited claim. I am the assigned manager over this claim and I appreciate the opportunity to provide additional facts and information regarding our claim service.
[redacted]’s claim was filed on Friday February 21, 2014 at 3:30 PM.  We spoke to [redacted] on Monday Feburary 24, 2014.  [redacted] explained to us that she had multiple buildings on her property that were damaged.  At that time, [redacted] advised us that her roof had been leaking for some time and she had tried to repair the roof on her own with black tar.  
We hired an independent adjustor, [redacted] to do an inspection of the property.  [redacted] found that the outbuildings being claimed were poorly maintained.  There were no storm related damages found.  Based on photographs taken by the adjustor and his narrative report a denial was issued to [redacted].
On March 18, 2014 [redacted] advised us that her contractor had found storm related damages to her outbuildings. Based on [redacted]’s request for a reinspection of her property, we hired an independent structural engineer named [redacted].  Due to inclement weather the inspection with the engineer was postponed until April 4, 2014. 
 The structural engineer did find hail damage to the roof therefore an estimate to repair this damage was prepared for [redacted].  Structural engineers do not write estimates; therefore we contacted the independent adjustor, [redacted] to write an estimate.  [redacted] was no longer in the area therefore [redacted] was assigned to complete the estimate.  [redacted] wrote an estimate for the impacted buildings.  A payment for $4,619.72 was issued to [redacted] on May 16, 2014.  This payment represents the actual cash value of her damages.  The claim remains open in order that [redacted] can make a claim for her replacement cost coverage once the damages to the roof have been completed. 
Please let me know if there is any further information we can provide to you to resolve this concern. 
Sincerely,   [redacted]
[redacted], AMCO Insurance Company
Phone: ###-###-####
[redacted]

This is in response to the additional inquiry received for the above policyholder and her property policy.
 
Ms. [redacted] alleges our Company did a false inspection on her home. Our vendor [redacted], performed the inspection on July 23, 2015 with her spouse, Ryan [redacted]’s permission. Mr. [redacted] was interviewed by the inspector and allowed the inspector to enter the home to perform an interior review as well as the exterior revew. A copy of the inspection report has been enclosed.
 
Ms. [redacted] has shared that her siding is not wood shakes, but vinyl that look like wood. In review of the pictures within the inspection, the siding does appear to be wood shakes. If they are vinyl, our replacement cost would only decrease by $1530 to $277,325.
 
Our Company was insuring Mr. and Ms. [redacted]’s home at 100% replacement cost and through the inspection it was found to be $278,855. We cannot answer how other companies rate for replacement cost.
 
Ms. [redacted] is also concerned on her billing account and the payment our Company received on April 20, 2016 to reinstate her policy. The following is a breakdown of her billing account: 
On June 23, 2015 a transaction processed binding policy 5106HO729223 effective June 25, 2015 with a term premium of $859.09. 
On July 16, 2015 a check payment was received via the mail in the amount of $859.09. 
On August 31, 2015 a change was processed to the policy increasing the coverage limits effective the June 25, 2015 inception date. This change was made based on an inspection completed and resulted in an increase in premium of $274.78. 
On March 1, 2016 a bill was issued advising that a payment of $274.78 was due by March 25, 2016. 
On March 31, 2016 a Notice of Cancellation was issued advising that a payment of $274.78 must reach Nationwide by April 14, 2016 or the policy would be cancelled effective April 15, 2016. 
On April 18, 2016 a transaction was processed to cancel the policy effective April 15, 2016. $220.54 in unearned premium was removed from the account leaving a collection balance of $54.24 due for coverage provided until April 15, 2016. 
On April 20, 2016 a check payment was received via the mail in the amount of $274.78. Per our records this payment was made on behalf of the insured by her mortgage company Wells Fargo Bank. A copy of the redacted check has been included. 
On April 21, 2016 a transaction was automatically processed to reinstate the policy effective April 20, 2016. As the automobile policy had been cancelled, the policy was reinstated without the Home and Car discount leaving an amount due of $59.75. 
As Ms. [redacted] has advised that she has obtained coverage elsewhere and does not desire to be insured with Nationwide we are able to process a cancelation of the policy per her request. The policy has been request cancelled effective April 20, 2016 and a $220.54 refund has been issued on the policy.
 
Thank you for the opportunity to review our business handling of the insured’s personal property policy.
 
If you require further assistance, please contact our [redacted], Cathy D[redacted]r, at ###-###-#### or by email at [redacted]
 
            Sincerely, Bridget M. D[redacted]

Dear [redacted]
Please accept this letter in response to [redacted]'s concerns related to the
online account on this contract. I regret this situation and hope you find the
following information helpful.
Contract details
[redacted]...

[redacted]
What we found
We have researched this online account and didn't locate any issues related to
accessing other Annuity accounts under [redacted]'s online profile. We have
viewed the account from [redacted]'s perspective and only saw Annuity
contract ###### owned by [redacted]
We don't have any record of [redacted] contacting us previously on this
matter.
For help when you need it
If you have any questions or need additional information, contact our service
center at ###-###-####. Our specialists are available Monday through Friday,
8 a.m. to 8 p.m., Eastern time. Or you can contact [redacted] by calling (#######
or by emailing [redacted] For TDD service, call #########
Sincerely,
[redacted]
Nationwide Life Insurance Company