Seaside Construction

December 17, 2014Dear [redacted] :Thank you for your electronic mail dated December 15, forwarding an official complaint from the Complainant, [redacted] ***, spouse and beneficiary of record, regarding the denial of her claim on the deceased, [redacted] ***, owner and spouse.BACKGROUND• On May 25, 2013, [redacted] completed and signed an Individual Silver Premier Whole Life Application carrying a face value of $5, [redacted] answered No to all the Statement of Health questions except in Section Two, question 1, which states: "Have you ever been diagnosed or treated by a licensed member of the medical profession for: chronic hepatitis, chronic bronchitis, emphysema, chronic obstructive lung disease or chronic obstructive pulmonary disease (COLD/COPD) or any chronic lung disorder (excluding asthma or sleep apnea)?" A copy of the application is provided at Tab "A."On May 21, 2013, [redacted] completed and signed the Star Life Checkmatic Authorization Form authorizing Star Life Insurance Company to debit his checking account at [redacted] on the 23rd day of each monthA copy of the Authorization Form is provided at Tab "B."On May 31, 2013, [redacted] was issued life insurance coverage on his life, effective June 23, A copy of the issue documents are provided at Tab “C.”On June 19, 2013, [redacted] signed, dated, and returned the Delivery Receipt confirming receipt of the life insurance documentsA copy of the Delivery Receipt is provided at Tab “D."On June 23, 2013, [redacted] was informed that his next scheduled premium payment would be debited from his bank accountA copy of the letter is provided at Tab “E."On February 27, 2014, [redacted] contacted Star Life Insurance Company to change his banking information from [redacted] to [redacted] ***The form was completed internally and noted "verbal signature" on the Authorization FormA copy of the Authorization Form is provided at Tab "F."On February 27, 2014, Star Life Insurance Company informed [redacted] that his next scheduled premium payment would be deducted from his bank accountA copy of the correspondence is provided at Tab “G."On April 29, 2014, Star Life Insurance Company advised [redacted] that his attempted draft against his checking account was returned unpaidA copy of the correspondence is provided at Tab “H.”On May 1, 2014, [redacted] completed, signed, and submitted an ***/5Star Life Checkmatic Authorization Form updating his banking contact information to [redacted] ***Debits were to occur on the 3rd day of each monthA copy of the instruction page and Authorization Form is provided at Tab “I.”• On September 17, 2014, Star Life Insurance Company was informed that [redacted] had expiredA copy of the Report of Death is provided at Tab “J”• On September 17, 2014, Star Life Insurance Company contacted the beneficiary of record, [redacted] ***, to request that the provided forms needed to initiate the claims process be signed and returnedStar Life Insurance Company also requested a copy of the official certificate of deathA copy of the correspondence is provided at Tab "K."• On September 30, 2014, Star Life Insurance Company received the Certification of Death issued by the Florida Office of Vital StatisticsThe date of death was confirmed as September 17, The cause of death was recorded as "Chronic Obstructive Pulmonary Disease” – COPDA copy of the Certification of Death is provided at Tab "L."• On December 2, 2014, Star Life Insurance Company informed [redacted] that her claim was not validThe medical records indicated [redacted] used home oxygen prior to the application date [redacted] was informed that all premiums received and applied to the account would be refunded under separate coverA copy of the correspondence is provided at Tab "M."???According to the information obtained in the medical files submitted by the various attending physicians, our medical underwriters, ***, reviewed the medical information and concluded the claim was not validHaving the COPD alone was insurable, but at the Graded vsPreferred typeIn addition to the COPD, [redacted] also smoked and used oxygen on a daily basis.Section One, question 3, of the Statement of Health section states:"Have you ever been diagnosed or treated by a licensed member of the medical profession for chronic kidney disease (with or without dialysis), renal insufficiency, cirrhosis of the liver, liver disease or liver failure, Alzheimer's, dementia, Lou Gehrig's disease (ALS), Huntington's disease, had an organ transplant, or do you use oxygen equipment to assist in breathing on a daily basis?" [redacted] responded "No."Section Two, question 3, of the Statement of Health section states:"In the past months, have you required use of home oxygen equipment more than times per week to assist in breathing?" [redacted] responded "No."During the period April 21, through March 7, 2013, Dr [redacted] recorded: "Continues to use 3L of O'all the time." Uses supplemental when delivering newspapers for occupation." Per Dr [redacted] 's notes, "still continues to smoke 2-cigarettes every other day, stopped 2010." Dr [redacted] 's notes from April 21, indicated a recent hospitalizationSmoking pp.dHx of CVA noted."Star Life Insurance Company refunded all premiums received and applied to this account of December 4, The amount refunded was $ [redacted] cashed the check on December 8, A copy of the check is enclosed at Tab "N."The decision to deny the claim remains.If additional information is required, please feel free to contact me at (703) or via e-mail at [redacted] Our hours of operation are Monday through Friday, 8:a.mto 5:p.m., E.S.T.Respectfully submitted, Mildred H MSLSDirector, Compliance

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: [redacted] I am rejecting this response because:Claims papers were mailed and was told verbally by your company they had been received (attached) Also a letter claiming that the policy was terminated was not mailed until December see attached I did receive a letter with the return check the check was made out to my brother I am returning the check and asked that the company resend the check in my name since I made the payment They have responded and is waiting on me to return the check.If this policy is not in effect that is ok My problem, is why would it take so long for the company to know this It actually took submitting the claim to find this out I had spoke with them several times during the process and was told the policy was active From September to December is to long to know this This was time consuming, and stressful to deal with during this time The last bill of did not mention anything about a policy lapse It seems to me that company would have accepted the payment and kept the policy enforced if the deceased was still alive They continue to try to collect on a policy that they say was terminated back in September If my brother was still alive, would the payment had been accepted and would the policy be active.Regards, [redacted]

December 11, 2014Dear [redacted] :Thank you for your electronic mail dated December 3, 2014 in which you forwarded a complaint submitted by the beneficiary of the decedent, [redacted] . In [redacted] 's complaint, she alleges she was misinformed about the status of the decedents, [redacted] ... [redacted] , life insurance coverage.BACKGROUND• On August 23, 2014, [redacted] completed and signed an Individual Silver Premier Whole Life Application for life insurance coverage in the amount of $15,000.00. The monthly premiums were assessed at $44.60. A copy of the application is provided at Tab "A."• On August 23, 2014, [redacted] completed and signed the ***/5Star Life Credit Card Authorization Form authorizing 5 Star Life Insurance Company to debit his credit card on the 20th of each month beginning September 20, 2014. A copy of the Authorization Form is provided at Tab "B."On September 4, 2014, [redacted] was issued coverage on his life with an effective date of September 20, 2014. A copy of the issue documents is provided at Tab “C.”On September 20, 2014, 5 Star Life Insurance Company informed [redacted] that his first credit card premium payment had been declined by his financial institution. As a result, his payment mode was changed to monthly direct billing. A copy of the correspondence is provided at Tab "D."On September 20, 2014, 5 Star Life Insurance Company issued [redacted] a Life Insurance Account Statement for the period September 20 through November 20, 2014. Premiums due totaled $89.18. A copy of the Statement is provided at Tab “E.”On October 5, 2014, 5 Star Life Insurance Company issued [redacted] a Life Insurance Account Statement alerting the insured his life insurance account was past due in the amount of $89.18. A copy of the Statement is provided at Tab "F."On October 21, 2014, 5 Star Life Insurance Company issued [redacted] a Life Insurance Account Statement alerting the insured his life insurance account was past due for the period November 20, through December 20, 2014 in the amount of $133,77. A copy of the Statement is provided at Tab "G."On November 4, 2014, 5 Star Life Insurance Company issued [redacted] a Life Insurance Account Statement alerting the insured his life insurance account was past due. The amount owed was $133.77. A copy of the Statement is provided at Tab “H.”On November 10, 2014, 5 Star Life Insurance Company incurred a contestable claim reported by his sister and beneficiary, [redacted] . A copy of the Report of Death form is provided at Tab “I."On November 10, 2014, 5 Star Life Insurance Company's Claims Department informed [redacted] her brother carried a $15,000.00 life insurance policy. The Claims Department provided the required forms to be completed by the beneficiary of record and, in addition, requested an original Certificate of Death. A copy of the correspondence is provided at Tab “J.”• On November 20, 2014, the Policy Accounting System automatically generated notification to the insured that coverage on his life was terminated, effective September 20, 2014 due to non-payment of premiums. A copy of the correspondence is provided at Tab "K."• On November 21, 2014, 5 Star Life Insurance Company received and accepted a credit card payment, via telephone, in the amount of $44,59. The Policy Accounting System automatically generated confirmation of the premium payment. A copy of the correspondence is provided at Tab "L."???One premium payment was debited from [redacted] 's credit card and, on the same date, reversed. [redacted] received numerous Payment Statements from 5 Star Life Insurance Company advising him that premiums were due. No premium payments were received and applied to the account. An electronic copy of [redacted] 's payment history from September 20 through December 11, 2014 is provided at Tab “M."The complainant contacted 5 Star Life Insurance Company on November 21, 2014, after the death of the insured, to determine the status of [redacted] 's account and to make a premium payment on his behalf. It is conceivable that the Policy Accounting System had not updated or the customer service representative misinterpreted the screen and accepted payment on a policy that had lapsed. The policy was 60 days delinquent. Per the language of the life insurance contract,“PREMIUMS. Premiums shall be made to Us at our administrative office. Premiums as of the Date of Issue are shown in the Policy Specifications. They are scheduled to be paid on the first day of their payment interval.”"GRACE PERIOD. Any premium, other than the first, not paid when due may, prior to the Maturity Date as shown on your Policy Specifications document, be paid within a grace period of 31 days after its due date if premiums have been paid to that due date. The policy will continue in full force during that period.""If the Insured dies while this policy is in full force, we will refund or charge premiums to effect payment to the end of the policy month in which the Insured dies. We will pay any refund to you if you are not the Insured: otherwise, we will pay it to the Beneficiary. We will deduct any charge from any proceeds."The premium payment made by [redacted] on November 21, 2014 was reimbursed. [redacted] states in her complaint that "I have documentation to dispute their claim. To this date I have not received any notice of cancellation." 5 Star Life Insurance Company encourages [redacted] to submit any additional information for review. The notice of cancellation was mailed to the address of the owner, [redacted] .5 Star Life Insurance Company is still awaiting the documents requested to process the claim. Until all the required documents are received and reviewed, the claim remains open.The facts dictate coverage lapsed on date of issue for non-payment of premiums. At the time death was reported, death cannot be confirmed as the Certificate of Death has not been provided, coverage was not in force.If additional information is required, please feel free to contact me.Sincerely Yours,Mildred H. MSLSDirector, Compliance