Dear Ms*** This letter is in response to your correspondence dated and received in our office May 3, Thank you for allowing us the opportunity to address this matter In your correspondence you requested information regarding the above referenced complainant. In compliance with state and federal privacy laws, we are required to restrict access to information in our files and may not disclose such information to other persons, except as authorized in writing or otherwise permitted by lawSince at this time we do not have an authorization on file to release information to you, we have communicated directly with Mrs***, addressing her concernsWe want to assure you our continued commitment to provide the best possible customer serviceIf you have any questions, or if we may provide any further assistance, you may contact out customer service department at 800-541-Sincerely, Michael C*** Consumer Relations
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to me.
Special thanks to MrsHarris for her great work!Regards,
*** ***
Dear Ms***: This letter is in response to your correspondence dated and received in our office July 12,Thank you for allowing us the opportunity to address this matter We have communicated directly with Mr***addressing his concernsMr*** has been advised that
the policy is no longer being administered by Washington National Insurance Companyand that all inquiries for his policy should be made to *** *** ***., at *** ***Mr*** was also previously advised to contact *** *** ***., after his initial request on June 27, We want to assure you our continued commitment to provide the best possible customer serviceIf you have any questions, or if we may provide any further assistance, you may contact out customer service department at 800-541- Sincerely, Michael C***Consumer Relations
Washington National Insurance Company
PO Box 1916 Carmel IN 46082-March 3, Revdex.com of Central Indiana NDelaware St #Indianapolis, IN Re: Washington National Insurance Company Complainant: *** *** Case Number: *** Dear Revdex.com of Central Indiana: This letter is in response to your correspondence received in our office on February 25, 2016. Thank you for allowing us the opportunity to address this matterIn your correspondence you requested information regarding the above referenced complainant. In compliance with state and federal privacy laws, we are required to restrict access to information in our files and may not disclose such information to other persons, except as authorized in writing or otherwise permitted by law. Therefore, we require an authorization to release this information to you. We have communicated directly with Ms*** addressing her concernsWe want to assure you our continued commitment to provide the best possible customer service. If you have any questions, or if we may provide any further assistance, you may contact out customer service department at 800-541-Sincerely, Tanya *** Consumer Relations
Washington National Insurance CompanyPO Box 1916Carmel, IN 46082 March 7, 2017 *** ***Revdex.com Serving Central IndianaNDelaware Street #2020Indianapolis, IN 46204 RE: Washington National Insurance Company Consumer: *** ** *** Case ID: *** Dear Ms***: This letter is in response to your correspondence dated and received in our office on March 1, 2017, concerning the above-referenced case number. Thank you for allowing us the opportunity to address this matter. We have responded directly to Ms*** regarding this matter. We would like to note that we have previously responded to Ms***’s attorney and twice to the California Department of Insurance, to the Revdex.com and directly to Ms*** regarding this matter. Our position remains unchanged; the policy has been paid in accordance to the policy contract. Our check has not been negotiated. We want to assure you of our continued commitment to provide the best possible customer service. If you have any questions, or if we may be of further assistance, our office can be reached by calling (800) 525-7662. Sincerely, Angela LB***Consumer Relations
Company �...⇄ PO Box 1916 ...⇄ Carmel, IN 46082-1916 May 19, 2017 Revdex.com of Central Indiana Attn: [redacted] 151 N Delaware Street #2020 Indianapolis, IN 46204-2599 RE: Washington National Insurance Company Consumer: [redacted] Case Number: [redacted] Dear Ms. [redacted]: This letter is in response to your correspondence dated and received in our office on May 16, 2017. Thank you for allowing us the opportunity to address this matter. In your correspondence you requested information regarding the above referenced complainant. In compliance with state and federal privacy laws, we are required to restrict access to information in our files and may not disclose such information to other persons, except as authorized in writing or otherwise permitted by law. Since at this time we do not have an authorization on file to release information to you, we have communicated directly with [redacted], and have provided the requested information. We want to assure you our continued commitment to provide the best possible customer service. If you have any questions, or if we may provide any further assistance, you may contact out customer service department at (800) 541-2254. You may also contact me directly at (317) 817-5758. Sincerely, Michael C[redacted] Consumer Relations
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] First all, there has been no offer of settlement by the company. There insistence that there is no refund of premiums because there is a clause somewhere within a document that I signed over 15 years ago. I call the company to cancel my policy and get the refund to which I was due. The company did make good on the refund of premiums, however, their communication with me at the time over the phone was that I could continue the policy and cancel and any time they failed to mention that it constituted a new policy, of which, I never signed for, nor would I have initiated a new policy with refund of premiums 15 years in the future. It is my contention that the company fraudulently misrepresented the policy. A new policy in my estimation that I never signed for. I was not fairly advised of my options with the newly constituted policy of which I am sure Washington National Insurance Co will claim it not a new policy but a continuation of the same policy. I was never advised that there would be another 12 to 15 years before the return of premiums. I repeat, I would never have signed another policy to that effect. I think that the representative of the company did not deal in fairness or honesty and that I was persuaded to continue making premiums. It was my understanding after talking with the representative that they would refund my premiums and that I could continue the coverage, cancel at any time and receive any paid in premiums. The only settlement that will be to my satisfaction is a refund of premiums. I feel it is your responsibility as the Revdex.com to ensure that companies like this do not fraudulently misrepresent their policy and that you make aware to others of their underhanded practices. My correspondence with the company has been totally unacceptable, I hope that you will be able to resolve this issue. I would not recommend this Insurance Co. to anyone seeking coverage.
Dear Revdex.com of Central Indiana: This letter is in response to your correspondence dated and received in our office Apri13, 2017. Thank you for allowing us the opportunity to address this matter. We have communicated directly with Ms. [redacted] regarding 10 Number [redacted] Ms. [redacted]...
has agreed to a resolution in response to her request. We want to assure you our continued commitment to provide the best possible customer service. If you have any questions, or if we may provide any further assistance, you may contact out customer service department at (800) 541-2254. You may also contact me directly at (317) 817-5758. Sincerely, Michael C[redacted] Consumer Relations
This letter is in response to your correspondence received in our office on September 29, 2015, regarding the above-referenced complainant. Thank you for allowing us the opportunity to address this matter.Policyholder's information is considered to be confidential; therefore, we require an...
authorization to release this information to you. We wrote [redacted] directly on October 19,2015 addressing his concerns.We want to assure you of our continued commitment to provide the best possible customer service. If you have an questions, or if we may provide any further assistance, you may contact our customer service department by dialing (800) 541-2254. Sincerely, Kimberly H[redacted]Consumer Relations
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.
Typical response from Washington National: Delay, Deflect, Denial! The guaranteed maturity value shown by the Conseco Statement 31 December 20010 was $213,949.63, the maturity value on 20 January 2014 was $255,913, the value as of COB today 1 March 2017 is $272,170 at 2% interest since maturity. This amount is due and payable now. Responding to Washington National's claim the maturity value has been paid, please provide the cancelled check, the bank transaction statement, the date and signatories. For further history of our correspondence with Washington National please see more correspondence letters attached. Over the years the custodian of this annuity changed from American Life and Casualty to Conseco Annuity Assurance Company to Conseco Insurance Company to Washington National Insurance Company. At each change I was given assurances b y the new custodian all was well and my annuity remained safe and sound. WN should life up to their assurances. Give my regards to PI Steven K[redacted] and wish him well in his quest for justice in our matter.
Regards,
[redacted] Typicalv response from Washington National Insurance, Delay, Deflect, Denial! The guaranteed maturity value on 20 January 2014 was $255,913, as of COB today 1 March 2017 this value is $272,170. This is the maturity value of this account on 20 January 2014 plus intrest todate at 2%.
Thank you for your correspondence from [redacted], on behalf of [redacted], regarding Ms. [redacted] policy with Washington National Insurance Company.
Under the heading Benefit Provisions, the policy states:
Benefit Eligibility: To be eligible for benefits provided by this policy,...
you must give us periodic proof, in the form of a certification and assessment from a Doctor (or other proof approved by us) which demonstrates that the covered care, services or other items are necessary because you are: (a) Functionally Incapacitated and cannot perform at least two Activities of Daily Living; or (b) Cognitively Impaired.
The policy defines Cognitive Impairment as follows:
"Cognitive Impairment" means the deterioration or loss in intellectual capacity requiring substantial supervision for protection of self and others; as established by the clinical diagnosis of any licensed practitioner in this state authorized to make such a diagnosis. Such diagnosis shall include the patient's history and physical, neurological, psychological and/or psychiatric evaluations, and laboratory findings.
The policy defines Functional Incapacity as follows:
"Functional Incapacity" means the inability to perform, without human assistance, in two or more of the following Activities of Daily Living. The Activities of Daily Living used to measure Functional Incapacity are:
1. Bathing — the ability to wash oneself by sponge bath; or in either a tub or shower, including the task of getting into or out of the tub or shower.
2. Continence — the ability to maintain control of bowel or bladder function, or, when unable to maintain control of bowel or bladder function, the ability to perform associated personal hygiene (including caring for catheter or colostomy bag).
3. Dressing — the ability to put on or take off all items of clothing and any necessary braces, fasteners, or artificial limbs.
4. Eating — the ability to feed oneself by getting food into the body from a receptacle such as a plate, cup, or table or by a feeding tube or intravenously.
5. Toileting — the ability to get to and from the toilet, getting on and off the toilet, and performing associated personal hygiene.
6. Transferring — sufficient mobility to move into or out of a bed, chair, or wheelchair or to move from place to place, either via walking, a wheelchair or other means.
The evidence that we reviewed indicated that Ms. [redacted] did not meet the definition of Cognitive Impairment .or the definition of Functional Incapacity.
Amarillo Home Care Services provided a Plan of Care with a notation that they would not be providing any help with Activities of Daily Living (ADL's), but would only be performing homemaker services.
We reviewed the Aide Visit Notes that were completed by the caregivers from Amarillo Home Care Services. In the notes for each visit, it was documented that the only services performed were housekeeping and meal preparation, and that no assistance with the policy's Activities of Daily Living was provided. Each day's notes were signed by the caregiver and by Ms. [redacted].
An in-person assessment visit was conducted on October 5, 2014 by an independent nurse from an outside agency. The nurse's report showed that Ms. [redacted] required no assistance with any of the policy's specified Activities of Daily Living (ADL's), and that she did not have Cognitive Impairment as defined by the policy.
Ms. [redacted] subsequently verified by telephone on October 24, 2014 that she did not require assistance with any of the ADL's defined in the policy, and confirmed that she was able to perform them independently.
It was concluded therefore that Ms. [redacted] was not Functionally Incapacitated or Cognitively Impaired as required by the policy for benefit eligibility. Eligibility is not based on diagnosis. Benefits can only be paid in accordance with the terms and conditions of the policy. She was mailed a letter on October 30; 2014 advising of the denial.
An appeal was received December 20, 2014. Ms. [redacted] claim was then reviewed by management in a formal Appeals process. After careful review, it was determined that the denial of benefit eligibility would be upheld as she did not meet the policy's stated eligibility requirements.
A second appeal was received May 7, 2015, A review of Ms. [redacted] claim was then conducted by senior management. Benefits can only be approved in accordance with the policy contract. Therefore the denial of Home Health Care benefits was upheld as she did not meet the policy's stated eligibility requirements.
Under the heading Benefit Provisions, the policy states:
Independent Living Benefit: We will pay an Independent Living Benefit to you while this policy is in force. We will pay this benefit if it is determined by your doctor or Care Coordinator that you are having difficulty performing two or more Activities of Daily Living. The Independent Living benefit includes such services as shopping, housekeeping, transportation, and cooking. In no event will the amount of this benefit exceed the Independent Living Benefit Lifetime Maximum shown on the Schedule.
Please be advised that Ms. [redacted] benefits were considered under the Independent Living Benefit. On March 25, 2015, she was mailed a letter and plan of care advising her benefits were approved for dates of service September 16, 2014 through October 4, 2014. On April 1, 2015, she was issued a benefit payment of $378.00 for dates of service ranging from September 16, 2014 through September 30, 2014.
Enclosed is a copy of the policy, the Explanation of Benefits, medical records used in the
determination, aforementioned correspondence and call log. If you have any questions regarding this matter, please contact Ketrina [redacted], Supervisor, at (317) 566-7494 or fax them to (317) 5667588.
Sincerely,
Jaime [redacted]
Consumer Support Specialist
WASHINGTON NATIONAL INSURANCE COMPANY
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me.
Regards,
[redacted]
RE: Washington National Insurance CompanyCustomer: [redacted]Complaint ID: [redacted] Dear Ms. [redacted]: This letter is in response to your correspondence dated and received June 16, 2016, concerning the above-referenced ID number. Thank you for allowing us the...
opportunity to address this matter. We have responded directly to Ms. [redacted] and have answered her concerns. We want to assure you of our continued commitment to provide the best possible customer service. If you have any questions, or if we may be of fut1her assistance, you may contact me directly by calling (317) 817-5311. Sincerely, Angela L. B[redacted] Consumer Relations
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.
Delay deflect, deny, that is the MO of Washington National. NO payment was deposited, show me the canceled check. Amount due since 20Jan 2014. Amount due with interest now $271,772.
Regards,
[redacted]
This letter is in response to your correspondence dated and received in our office June 16, 2016. Thank you for allowing us the opportunity to address this matter.In your correspondence you requested information regarding the above referenced complainant. In compliance with state and federal privacy...
laws, we are required to restrict access to information in our files and may not disclose such information to other persons, except as authorized in writing or otherwise permitted by law. Since at this time we do not have an authorization on file to release information to you, we have communicated directly with Mrs. [redacted], addressing her concerns.We want to assure you our continued commitment to provide the best possible customer service. If you have any questions, or if we may provide any further assistance, you may contact out customer service department at 800-541-2254.Sincerely,Michael C[redacted]Consumer Relations
Dear Ms. [redacted]: This letter is in response to your March 28, 2016 correspondence regarding the above referenced case number. This matter has been referred to my attention for review and response. We appreciate the opportunity to respond. Keeping policy information secure and private is one of our...
top priorities. In compliance with state and federal privacy laws, we are required to restrict access to policy information to the owner of the policy. We are allowed to disclose information only as authorized in writing by the policy owner, or as otherwise permitted by law. Because we have not received written authorization from the policy owner to disclose information to you, we cannot provide you any information on the policy. Thus, your request for information will be addressed directly with the policy owner. Should you have any further questions or need additional information, please contact me directly at (254) 750-[redacted]. My email address is R[redacted]@texaslife.com. Sincerely, Robbin [redacted], PCS, FLMJ, AJRC, ARA/cs Senior Associate/Customer Service Specialist
Company �...⇄ PO Box 1916 ...⇄ Carmel IN 46082-1916 January 25, 2016 Revdex.com of Central Indiana 151 N. Delaware St. #2020 Indianapolis, IN 46204 RE: Washington National Insurance Company Complainant: [redacted] Case Number: [redacted] Dear Revdex.com of Central Indiana: This letter is in response to your correspondence dated and received in our office January 21, 2016. Thank you for allowing us the opportunity to address this matter. In your correspondence you requested information regarding the above referenced complainant. In compliance with state and federal privacy laws, we are required to restrict access to information in our files and may not disclose such information to other persons, except as authorized in writing or otherwise permitted by law. Therefore, we require an authorization to release this information to you. We have communicated directly with Mr. [redacted] addressing his concerns and the issue has been resolved to his satisfaction. We want to assure you our continued commitment to provide the best possible customer service. If you have any questions, or if we may provide any further assistance, you may contact our customer service department at 800-541-2254. Sincerely, Tanya D[redacted] Consumer Relations
Company �...⇄ PO Box 1916 ...⇄ Carmel IN 46082-1916 November 11, 2016 Revdex.com of Chicago and Northern Illinois 330 N. Wabash, Suite 3120 Chicago, IL 60611-7621 VIA: Revdex.com Portal RE: Washington National Insurance Company Consumer: [redacted] Case ID Number: [redacted] To Whom It May Concern: This letter is in response to the correspondence received in our office on November 6, 2016. Thank you for the opportunity to respond. You stated in your letter that the original complaint was received on October 25, 2016, and no response from Washington National Insurance Company. We were unable to locate your first complaint; however, we have resolved Ms. [redacted] issue. We want to assure you of our continued commitment to provide the best possible service. If we may be of further service, please contact our customer service department at (800) 525-7662. Sincerely, Nina B[redacted] Consumer Relations
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.
As of yesterday's mail, I have not received a copy of the contract that I have requested. I notified, via voice message to Ms B[redacted], of this, yesterday.
Regards,
[redacted]
Dear Ms*** This letter is in response to your correspondence dated and received in our office May 3, Thank you for allowing us the opportunity to address this matter In your correspondence you requested information regarding the above referenced complainant. In compliance with state and federal privacy laws, we are required to restrict access to information in our files and may not disclose such information to other persons, except as authorized in writing or otherwise permitted by lawSince at this time we do not have an authorization on file to release information to you, we have communicated directly with Mrs***, addressing her concernsWe want to assure you our continued commitment to provide the best possible customer serviceIf you have any questions, or if we may provide any further assistance, you may contact out customer service department at 800-541-Sincerely, Michael C*** Consumer Relations
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to me.
Special thanks to MrsHarris for her great work!Regards,
*** ***
Dear Ms***: This letter is in response to your correspondence dated and received in our office July 12,Thank you for allowing us the opportunity to address this matter We have communicated directly with Mr***addressing his concernsMr*** has been advised that
the policy is no longer being administered by Washington National Insurance Companyand that all inquiries for his policy should be made to *** *** ***., at *** ***Mr*** was also previously advised to contact *** *** ***., after his initial request on June 27, We want to assure you our continued commitment to provide the best possible customer serviceIf you have any questions, or if we may provide any further assistance, you may contact out customer service department at 800-541- Sincerely, Michael C***Consumer Relations
Washington National Insurance Company
PO Box 1916 Carmel IN 46082-March 3, Revdex.com of Central Indiana NDelaware St #Indianapolis, IN Re: Washington National Insurance Company Complainant: *** *** Case Number: *** Dear Revdex.com of Central Indiana: This letter is in response to your correspondence received in our office on February 25, 2016. Thank you for allowing us the opportunity to address this matterIn your correspondence you requested information regarding the above referenced complainant. In compliance with state and federal privacy laws, we are required to restrict access to information in our files and may not disclose such information to other persons, except as authorized in writing or otherwise permitted by law. Therefore, we require an authorization to release this information to you. We have communicated directly with Ms*** addressing her concernsWe want to assure you our continued commitment to provide the best possible customer service. If you have any questions, or if we may provide any further assistance, you may contact out customer service department at 800-541-Sincerely, Tanya *** Consumer Relations
Washington National Insurance CompanyPO Box 1916Carmel, IN 46082 March 7, 2017 *** ***Revdex.com Serving Central IndianaNDelaware Street #2020Indianapolis, IN 46204 RE: Washington National Insurance Company Consumer: *** ** *** Case ID: *** Dear Ms***: This letter is in response to your correspondence dated and received in our office on March 1, 2017, concerning the above-referenced case number. Thank you for allowing us the opportunity to address this matter. We have responded directly to Ms*** regarding this matter. We would like to note that we have previously responded to Ms***’s attorney and twice to the California Department of Insurance, to the Revdex.com and directly to Ms*** regarding this matter. Our position remains unchanged; the policy has been paid in accordance to the policy contract. Our check has not been negotiated. We want to assure you of our continued commitment to provide the best possible customer service. If you have any questions, or if we may be of further assistance, our office can be reached by calling (800) 525-7662. Sincerely, Angela LB***Consumer Relations
Washington National Insurance...
Company �...⇄ PO Box 1916 ...⇄ Carmel, IN 46082-1916 May 19, 2017 Revdex.com of Central Indiana Attn: [redacted] 151 N Delaware Street #2020 Indianapolis, IN 46204-2599 RE: Washington National Insurance Company Consumer: [redacted] Case Number: [redacted] Dear Ms. [redacted]: This letter is in response to your correspondence dated and received in our office on May 16, 2017. Thank you for allowing us the opportunity to address this matter. In your correspondence you requested information regarding the above referenced complainant. In compliance with state and federal privacy laws, we are required to restrict access to information in our files and may not disclose such information to other persons, except as authorized in writing or otherwise permitted by law. Since at this time we do not have an authorization on file to release information to you, we have communicated directly with [redacted], and have provided the requested information. We want to assure you our continued commitment to provide the best possible customer service. If you have any questions, or if we may provide any further assistance, you may contact out customer service department at (800) 541-2254. You may also contact me directly at (317) 817-5758. Sincerely, Michael C[redacted] Consumer Relations
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] First all, there has been no offer of settlement by the company. There insistence that there is no refund of premiums because there is a clause somewhere within a document that I signed over 15 years ago. I call the company to cancel my policy and get the refund to which I was due. The company did make good on the refund of premiums, however, their communication with me at the time over the phone was that I could continue the policy and cancel and any time they failed to mention that it constituted a new policy, of which, I never signed for, nor would I have initiated a new policy with refund of premiums 15 years in the future. It is my contention that the company fraudulently misrepresented the policy. A new policy in my estimation that I never signed for. I was not fairly advised of my options with the newly constituted policy of which I am sure Washington National Insurance Co will claim it not a new policy but a continuation of the same policy. I was never advised that there would be another 12 to 15 years before the return of premiums. I repeat, I would never have signed another policy to that effect. I think that the representative of the company did not deal in fairness or honesty and that I was persuaded to continue making premiums. It was my understanding after talking with the representative that they would refund my premiums and that I could continue the coverage, cancel at any time and receive any paid in premiums. The only settlement that will be to my satisfaction is a refund of premiums. I feel it is your responsibility as the Revdex.com to ensure that companies like this do not fraudulently misrepresent their policy and that you make aware to others of their underhanded practices. My correspondence with the company has been totally unacceptable, I hope that you will be able to resolve this issue. I would not recommend this Insurance Co. to anyone seeking coverage.
Dear Revdex.com of Central Indiana: This letter is in response to your correspondence dated and received in our office Apri13, 2017. Thank you for allowing us the opportunity to address this matter. We have communicated directly with Ms. [redacted] regarding 10 Number [redacted] Ms. [redacted]...
has agreed to a resolution in response to her request. We want to assure you our continued commitment to provide the best possible customer service. If you have any questions, or if we may provide any further assistance, you may contact out customer service department at (800) 541-2254. You may also contact me directly at (317) 817-5758. Sincerely, Michael C[redacted] Consumer Relations
This letter is in response to your correspondence received in our office on September 29, 2015, regarding the above-referenced complainant. Thank you for allowing us the opportunity to address this matter.Policyholder's information is considered to be confidential; therefore, we require an...
authorization to release this information to you. We wrote [redacted] directly on October 19,2015 addressing his concerns.We want to assure you of our continued commitment to provide the best possible customer service. If you have an questions, or if we may provide any further assistance, you may contact our customer service department by dialing (800) 541-2254. Sincerely, Kimberly H[redacted]Consumer Relations
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.
Typical response from Washington National: Delay, Deflect, Denial! The guaranteed maturity value shown by the Conseco Statement 31 December 20010 was $213,949.63, the maturity value on 20 January 2014 was $255,913, the value as of COB today 1 March 2017 is $272,170 at 2% interest since maturity. This amount is due and payable now. Responding to Washington National's claim the maturity value has been paid, please provide the cancelled check, the bank transaction statement, the date and signatories. For further history of our correspondence with Washington National please see more correspondence letters attached. Over the years the custodian of this annuity changed from American Life and Casualty to Conseco Annuity Assurance Company to Conseco Insurance Company to Washington National Insurance Company. At each change I was given assurances b y the new custodian all was well and my annuity remained safe and sound. WN should life up to their assurances. Give my regards to PI Steven K[redacted] and wish him well in his quest for justice in our matter.
Regards,
[redacted] Typicalv response from Washington National Insurance, Delay, Deflect, Denial! The guaranteed maturity value on 20 January 2014 was $255,913, as of COB today 1 March 2017 this value is $272,170. This is the maturity value of this account on 20 January 2014 plus intrest todate at 2%.
Thank you for your correspondence from [redacted], on behalf of [redacted], regarding Ms. [redacted] policy with Washington National Insurance Company.
Under the heading Benefit Provisions, the policy states:
Benefit Eligibility: To be eligible for benefits provided by this policy,...
you must give us periodic proof, in the form of a certification and assessment from a Doctor (or other proof approved by us) which demonstrates that the covered care, services or other items are necessary because you are: (a) Functionally Incapacitated and cannot perform at least two Activities of Daily Living; or (b) Cognitively Impaired.
The policy defines Cognitive Impairment as follows:
"Cognitive Impairment" means the deterioration or loss in intellectual capacity requiring substantial supervision for protection of self and others; as established by the clinical diagnosis of any licensed practitioner in this state authorized to make such a diagnosis. Such diagnosis shall include the patient's history and physical, neurological, psychological and/or psychiatric evaluations, and laboratory findings.
The policy defines Functional Incapacity as follows:
"Functional Incapacity" means the inability to perform, without human assistance, in two or more of the following Activities of Daily Living. The Activities of Daily Living used to measure Functional Incapacity are:
1. Bathing — the ability to wash oneself by sponge bath; or in either a tub or shower, including the task of getting into or out of the tub or shower.
2. Continence — the ability to maintain control of bowel or bladder function, or, when unable to maintain control of bowel or bladder function, the ability to perform associated personal hygiene (including caring for catheter or colostomy bag).
3. Dressing — the ability to put on or take off all items of clothing and any necessary braces, fasteners, or artificial limbs.
4. Eating — the ability to feed oneself by getting food into the body from a receptacle such as a plate, cup, or table or by a feeding tube or intravenously.
5. Toileting — the ability to get to and from the toilet, getting on and off the toilet, and performing associated personal hygiene.
6. Transferring — sufficient mobility to move into or out of a bed, chair, or wheelchair or to move from place to place, either via walking, a wheelchair or other means.
The evidence that we reviewed indicated that Ms. [redacted] did not meet the definition of Cognitive Impairment .or the definition of Functional Incapacity.
Amarillo Home Care Services provided a Plan of Care with a notation that they would not be providing any help with Activities of Daily Living (ADL's), but would only be performing homemaker services.
We reviewed the Aide Visit Notes that were completed by the caregivers from Amarillo Home Care Services. In the notes for each visit, it was documented that the only services performed were housekeeping and meal preparation, and that no assistance with the policy's Activities of Daily Living was provided. Each day's notes were signed by the caregiver and by Ms. [redacted].
An in-person assessment visit was conducted on October 5, 2014 by an independent nurse from an outside agency. The nurse's report showed that Ms. [redacted] required no assistance with any of the policy's specified Activities of Daily Living (ADL's), and that she did not have Cognitive Impairment as defined by the policy.
Ms. [redacted] subsequently verified by telephone on October 24, 2014 that she did not require assistance with any of the ADL's defined in the policy, and confirmed that she was able to perform them independently.
It was concluded therefore that Ms. [redacted] was not Functionally Incapacitated or Cognitively Impaired as required by the policy for benefit eligibility. Eligibility is not based on diagnosis. Benefits can only be paid in accordance with the terms and conditions of the policy. She was mailed a letter on October 30; 2014 advising of the denial.
An appeal was received December 20, 2014. Ms. [redacted] claim was then reviewed by management in a formal Appeals process. After careful review, it was determined that the denial of benefit eligibility would be upheld as she did not meet the policy's stated eligibility requirements.
A second appeal was received May 7, 2015, A review of Ms. [redacted] claim was then conducted by senior management. Benefits can only be approved in accordance with the policy contract. Therefore the denial of Home Health Care benefits was upheld as she did not meet the policy's stated eligibility requirements.
Under the heading Benefit Provisions, the policy states:
Independent Living Benefit: We will pay an Independent Living Benefit to you while this policy is in force. We will pay this benefit if it is determined by your doctor or Care Coordinator that you are having difficulty performing two or more Activities of Daily Living. The Independent Living benefit includes such services as shopping, housekeeping, transportation, and cooking. In no event will the amount of this benefit exceed the Independent Living Benefit Lifetime Maximum shown on the Schedule.
Please be advised that Ms. [redacted] benefits were considered under the Independent Living Benefit. On March 25, 2015, she was mailed a letter and plan of care advising her benefits were approved for dates of service September 16, 2014 through October 4, 2014. On April 1, 2015, she was issued a benefit payment of $378.00 for dates of service ranging from September 16, 2014 through September 30, 2014.
Enclosed is a copy of the policy, the Explanation of Benefits, medical records used in the
determination, aforementioned correspondence and call log. If you have any questions regarding this matter, please contact Ketrina [redacted], Supervisor, at (317) 566-7494 or fax them to (317) 5667588.
Sincerely,
Jaime [redacted]
Consumer Support Specialist
WASHINGTON NATIONAL INSURANCE COMPANY
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me.
Regards,
[redacted]
RE: Washington National Insurance CompanyCustomer: [redacted]Complaint ID: [redacted] Dear Ms. [redacted]: This letter is in response to your correspondence dated and received June 16, 2016, concerning the above-referenced ID number. Thank you for allowing us the...
opportunity to address this matter. We have responded directly to Ms. [redacted] and have answered her concerns. We want to assure you of our continued commitment to provide the best possible customer service. If you have any questions, or if we may be of fut1her assistance, you may contact me directly by calling (317) 817-5311. Sincerely, Angela L. B[redacted] Consumer Relations
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.
Delay deflect, deny, that is the MO of Washington National. NO payment was deposited, show me the canceled check. Amount due since 20Jan 2014. Amount due with interest now $271,772.
Regards,
[redacted]
This letter is in response to your correspondence dated and received in our office June 16, 2016. Thank you for allowing us the opportunity to address this matter.In your correspondence you requested information regarding the above referenced complainant. In compliance with state and federal privacy...
laws, we are required to restrict access to information in our files and may not disclose such information to other persons, except as authorized in writing or otherwise permitted by law. Since at this time we do not have an authorization on file to release information to you, we have communicated directly with Mrs. [redacted], addressing her concerns.We want to assure you our continued commitment to provide the best possible customer service. If you have any questions, or if we may provide any further assistance, you may contact out customer service department at 800-541-2254.Sincerely,Michael C[redacted]Consumer Relations
Dear Ms. [redacted]: This letter is in response to your March 28, 2016 correspondence regarding the above referenced case number. This matter has been referred to my attention for review and response. We appreciate the opportunity to respond. Keeping policy information secure and private is one of our...
top priorities. In compliance with state and federal privacy laws, we are required to restrict access to policy information to the owner of the policy. We are allowed to disclose information only as authorized in writing by the policy owner, or as otherwise permitted by law. Because we have not received written authorization from the policy owner to disclose information to you, we cannot provide you any information on the policy. Thus, your request for information will be addressed directly with the policy owner. Should you have any further questions or need additional information, please contact me directly at (254) 750-[redacted]. My email address is R[redacted]@texaslife.com. Sincerely, Robbin [redacted], PCS, FLMJ, AJRC, ARA/cs Senior Associate/Customer Service Specialist
Washington National Insurance...
Company �...⇄ PO Box 1916 ...⇄ Carmel IN 46082-1916 January 25, 2016 Revdex.com of Central Indiana 151 N. Delaware St. #2020 Indianapolis, IN 46204 RE: Washington National Insurance Company Complainant: [redacted] Case Number: [redacted] Dear Revdex.com of Central Indiana: This letter is in response to your correspondence dated and received in our office January 21, 2016. Thank you for allowing us the opportunity to address this matter. In your correspondence you requested information regarding the above referenced complainant. In compliance with state and federal privacy laws, we are required to restrict access to information in our files and may not disclose such information to other persons, except as authorized in writing or otherwise permitted by law. Therefore, we require an authorization to release this information to you. We have communicated directly with Mr. [redacted] addressing his concerns and the issue has been resolved to his satisfaction. We want to assure you our continued commitment to provide the best possible customer service. If you have any questions, or if we may provide any further assistance, you may contact our customer service department at 800-541-2254. Sincerely, Tanya D[redacted] Consumer Relations
Washington National Insurance...
Company �...⇄ PO Box 1916 ...⇄ Carmel IN 46082-1916 November 11, 2016 Revdex.com of Chicago and Northern Illinois 330 N. Wabash, Suite 3120 Chicago, IL 60611-7621 VIA: Revdex.com Portal RE: Washington National Insurance Company Consumer: [redacted] Case ID Number: [redacted] To Whom It May Concern: This letter is in response to the correspondence received in our office on November 6, 2016. Thank you for the opportunity to respond. You stated in your letter that the original complaint was received on October 25, 2016, and no response from Washington National Insurance Company. We were unable to locate your first complaint; however, we have resolved Ms. [redacted] issue. We want to assure you of our continued commitment to provide the best possible service. If we may be of further service, please contact our customer service department at (800) 525-7662. Sincerely, Nina B[redacted] Consumer Relations
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.
As of yesterday's mail, I have not received a copy of the contract that I have requested. I notified, via voice message to Ms B[redacted], of this, yesterday.
Regards,
[redacted]
Please see attached.