Perimeter Construction Management & Cons

August 4, 2015Dear [redacted]:Thank you for the electronic file in which you provided a complaint filed by the daughter of the decedent - [redacted]. [redacted] alleges 5 Star Life Insurance Company claims her mother, [redacted], had heart disease and COPD.BACKGROUND:• On June 11, 2013,...

[redacted] completed, dated, and signed an Individual Silver Premier Whole Life Application carrying a face value of $5,000.00. Her spouse, [redacted]., was the payor. The beneficiary designations were: [redacted]. (Primary) and [redacted] (Secondary). A copy of the application is provided at Tab "A."• On June 14, 2013, 5 Star Life Insurance Company informed [redacted] life insurance coverage on her life was approved and issued, effective June 13, 2013. Acopy of the issue documents is provided at Tab "B."• On May 13, 2015, 5 Star Life Insurance Company was advised by the spouse, [redacted]., that [redacted] had expired. A copy of the Report of Death is provided at Tab "C."On May 13, 2015, 5 Star Life Insurance Company advised [redacted] that, at the time of death, [redacted] had an active $5,000.00 Individual Silver Premiere Whole Policy in force. He was also advised that since his wife died within the two-year contestability period, the claim would be under investigation. In addition, enclosed were forms [redacted] needed to complete, date, sign, and return before the claims process could begin. A copy of the correspondence is provided at Tab "D."On June 4, 2015, [redacted], Esq., [redacted] Law in Pottsville, Pennsylvania, returned the completed, dated, and signed claims forms. A copy ofthe forms is provided at Tab "E."On July 15,2015, 5 Star Life Insurance Company advised [redacted], Esq. that his client's death claim was denied based upon her medical history. A copy of the correspondence is provided at Tab "F."MEDICAL HISTORY:• On January 28, 2009, [redacted], D.O., wrote in his records: "ASSESSMENT: anxiety, depression, COPD."• On February 18, 2010, [redacted], D.O., wrote in his records "pt here for lab/EKG results. No complaints." "ASSESSMENTS: depression, anxiety..."• On April 26, 2010, [redacted], D.O., wrote in his records: "ASSESSMENT: COPD, neoplasm of chest...."• On May 28, 2010, [redacted], M.D., Pottsville [redacted], Inc., recorded in his Echocardiography Report: "IMPRESSION: "1. Normal left ventricular size and systolic function with an ejection fraction of about 60%. "2. Regional wall motion abnormality suspicious for coronary artery disease. "3. Presence of Moderate Mitral Valve Calcification involving the tips. "4. Mild mitral and tricuspid regurgitation. "5. E/A reversal consistent with diastolic dysfunction."6. No evidence of pulmonary hypertension. "7. No previous echo available for comparison. "8. Will suggest repeat echocardiogram after 1 year to reevaluate degree of left ventricular diastolic dysfunction. "9. Echocardiogram was performed at the office of [redacted], D.O."On March-12, 2012, [redacted], MD, Pottsville Internists Associates, Inc., wrote in his Echocardiography Report: "IMPRESSION: "1. Normal left ventricular size and systolic function with an ejection fraction of about 60%. "2. Regional wall motion abnormality. "3. Moderate mitral and tricuspid regurgitation. "4. Tissue Doppler study is consistent with LV diastolic dysfunction. "5. Compared to previous echo report dated 05/28/10, the degree of mitral and tricuspid regurgitation is worse. "6. Will suggest repeat echocardiogram after about 1 year to reevaluate above-mentioned findings. "7. Echocardiogram was performed at the officeof [redacted], D.O."On March 30, 2015, [redacted], M.D., P.C., Pottsville [redacted] Clinic,wrote: "ChiefComplaint Non Small Cell Right Lunt Cancer with mets" "[redacted] was seen in the office for an adenocarcinoma of the lung, stage IV disease. As you know, she is a most pleasant 52-year-old [redacted] female, who noticed a lump on the right side of the skull in December 2014. In January 2015, she started to have some headaches around that area, which were dull. The patient also had decreased appetite and lost about 20 pounds of weight. She has been one pack per day smoker for about 40 years and underwent MRI scan of the brain, which showed a 4 cm expansile lesion in the parietoccipital skull above and behind the right ear...." "Past Medical History "Neoplasm of lung (disorder) "COPD "Hyperlipidemia "Hypertension "Lung cancer."Per the language of the Individual Silver Premier Whole Life Policy, it states:"INCONTESTABILITY "We rely on the statements made in the Application for this policy. We also rely on statements made in any subsequent request for a change of this policy. Such statements are deemed representations and not warranties. In addition to the other reasons permitted by law, we can contest the validity of this policy or any reinstatement of this policy, if:a) Any material misrepresentation of fact is made in the Application or subsequent request for a change to this policy that is material to the risk accepted by the Company; and b) A copy of that Application or subsequent request for a change is attached to this policy when issued or delivered or is later made a part of this policy. We will not contest the validity of this policy after it has been in full force, during the insured's life, for 2 years from the Effective Date of Issue. With respect to any reinstatement of this policy, we will not contest the validity of the change or reinstatement after this policy has been in effect, during the Insured's life, for 2 years. However, we can always contest the validity of this policy for the non payment of any premium due."Based upon a long history of COPD, cancer, heart disease, and other health matters, dating back to 2008 and up to and until her death, [redacted] was not insurable. The Complainant noted "That is completely false. My mother was not diagnosed with any condition until 3/2015 when we found out that she had Stage 4 lung and bone cancer..." Yet, Dr. [redacted] noted the first episode occurred in December 2014.Given the medical facts found in this case, 5 Star Life Insurance Company's decision to deny the death claim remains.If additional information is required, please do not hesitate to contact me. Our hours of operation are Monday through Friday, 8:30 a.m. to 5:30 p.m., E.D.S.T.Sincerely Yours, Mildred H. Director, Compliance

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.   I appreciate the assistance of the Revdex.com in this matter and also the decision of the 5 Star Life (dba [redacted]) Director, Compliance, in final resolution.  
Regards,
[redacted]

" We are able to provide a more detailed response to [redacted], and to further ensure we protect her personal information, we will be doing so under separate cover" This is what [redacted] stated for now this will do because I would love to know what medical  condition I have.Regards, 
[redacted]

We apologize to [redacted] for any inconvenience she has experienced. The early draft was a result of the timing of completion and submission of the application in relation to the preferred date of deduction chosen by the applicant and oversight on behalf of the agent. The agent would have needed...

to either hold the groups’ applications until later in the month to correct for those applicants who chose a draft date (15th) so close to the application date (14th) as in this case, or indicate on the forms that drafting should not occur before August. As a result of [redacted]’s request of 7-20-16, overdraft refunds were issued on 8-5-16 and effective dates for the policies were changed from 7-15 to 8-15.   As requested via telephone on 8-9, [redacted]’s coverage has been terminated. At that time [redacted] was informed that her spouse must contact us directly to terminate his coverage. Because we have not yet heard from him, his coverage is still active and a draft of $8.50 was deducted from [redacted]’s account on 8-15 to pay the premium.   Please let me know if you have any questions or additional information is required. Sue W[redacted], Legal Analyst

When [redacted] initially obtained coverage in 1979, our system did not have space allocated to register identifying information specific to spouse or dependents. This coverage is shown only as “Rider” coverage in the member’s record. However, in 2014 when she applied, and was declined, for Group...

Select Term-15 Year coverage, a record specific to [redacted] was created. As a result, any search conducted using her name would retrieve information specific to that event only. [redacted] notes that the information he received in June 2017 shows the monthly allotment total of $300 represents a premium payment of $177.00 for his coverage and $123.00 for [redacted] under policy #[redacted]. No coverage was ever in effect as a result of the 2014 applications, so he has only ever been paying premiums for the Group Decreasing Term coverage initially obtained in 1979. As requested, the coverage was terminated effective/paid to December 1, 2017. The $102 refund represents a discrepancy of an increase or reduction in premium and the timing of the allotment adjustment. In January 2013 there was an overpayment of $30 when the allotment was adjusted early with a premium increase from $306 to $336, and an overpayment of $36 each in February and March 2014 when the premium was reduced from $336 to $300 but the allotment didn’t change until April. As the coverage was terminated as requested by the [redacted]’ signed termination notice received on November 4, 2017, no additional refund is due.  Please let me know if you have any questions or require additional information.Sue W[redacted], Legal Analyst

[A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.  I would also like to ensure that no other bills be sent to me in my name.  My family and myself do not wish to do business with your company ever again.
Regards,
[redacted]

This is in response to Complaint ID [redacted] filed by [redacted], Jr., on 5/19/2016. [redacted] was correct in that the premium refund issued previously on this contestable claim was incorrect. A new check for total premiums received minus the amount previously refunded was mailed out this...

week. 5 Star Life Insurance Company continually strives to provide the best possible service to our members, regardless of whether contact is with our office directly or through our agents. Agents are provided with ongoing training materials to assist them with day-to-day operations and suggested guidelines as to how they are expected to conduct business on behalf of 5 Star Life. If [redacted] requires additional information, we suggest he contact our office at ###-###-####.  Sue W[redacted], Legal Analyst

This is in response to Complaint ID [redacted] filed by [redacted] on 4/12/2016. The referenced life insurance policy involves coverage owned and obtained by her former spouse. Ms. [redacted] was the designated primary beneficiary when coverage was obtained in 2008. However, Ms. [redacted]’s designation was...

removed as a result of divorce in 2012, making the proceeds payable to the secondary co-beneficiary minor children. Per applicable law, specifically WA Rev. Code Ann. §11.07.010, a prior “non-probate transfer” naming the former spouse is revoked upon dissolution of marriage. In addition, because full life insurance proceeds cannot be paid directly to minors, the proceeds will be paid when the children reach the age of majority or upon receipt of a court-appointed guardian being named for each child. Once Ms. [redacted] provides the required documentation, 5 Star Life Insurance Company can proceed with the payment of benefits. Sue W[redacted], Legal Analyst, 5 Star Life Insurance Company

September 22, 2015Dear [redacted]:Thank you for graciously extending 5 Star Life Insurance Company time to respond to the complaint filed with the Revdex.com by the Complainant, [redacted].Based upon the Coverage and Premium Contribution Schedule provided with [redacted]'s complaint...

filed with the Bureau, [redacted]'s monthly contributions submitted and applied to his account should be $3.75 per month carrying a face value of $50,000.00. Our records confirm [redacted] Submitted $3.75 per month from the issue date to March 1, 2003. His allotment, as instructed by 5 Star Life Insurance Company, was then decreased to $3.25. He Continued to Submit contributions in the amount of $3.25 until June 1, 2014. Please refer to the accounting chronology at Tab "A."Please refer to the comparison of both insureds 1997 rates and their 2003 rates listed on page 2 of this letter:Member's Monthly Premium Schedule for $50,000.00 ([redacted])(1997) Non-Smoker (2003) Non-Smoker Phase Ages Premium Ages Premium Phase I 18-49 S 3.75 18 - 39 $ 3.25 Phase II 50-59 $ 17.50 40 - 49 $ 3.75 Phase III 60 - 69 S 19.00 50-59 S 17.5060 - 69 S 32.00The Coverage and Premium Contribution Schedule for [redacted] suggests, for long term cost purposes, [redacted] may wish to keep the rate schedule issued with his Better Alternative Certificate in 1997.For the record, [redacted] also has an active Better Alternative Certificate carrying a face value of $100,000.00. A comparison of the 1997 rates and the 2003 rates are also provided below:Spouse's Monthly Premium Schedule for $100,000.00 ([redacted])(1997) Non-Smoker (2003) Non-Smoker Phase Ages Premium Ages Premium Phase 18-49 S 7.50 18 - 34 S 6.00 Phase II 50-59 $ 35.00 35 - 39 $ 6.50 Phase III 60 - 69 S 38.00 40 - 49 $ 9.0050 - 59 $ 35.00 60 - 69 $ 62.00Given the above options, [redacted] may also opt to keep her 1997 rates. An Accounting chronology of [redacted]'s rates is provided at Tab "B."In the complaint letter, [redacted] requested [redacted] be reimbursed for premiums submitted and applied to his account after the 2003 rate change. If you refer to Tab "A," and if the request was honored, [redacted] would owe 5 Star Life Insurance Company $67,00; 5 Star Life Insurance Company would reimburse [redacted] $71.25. The difference would be $4.25.With respect to [redacted]'s account, she would owe 5 Star Life Insurance Company $187.00; 5 Star Life Insurance Company would reimburse her $12.00.Please note, 5 Star Life Insurance Company is willing to write the reimbursement checks in the amounts of $4.25 and $12.00, respectively, to the insureds. 5 Star Life Insurance Company, on the other hand, would be willing to consider this matter an even wash. To do so, 5 Star Life Insurance Company would require [redacted] and [redacted] to complete, date, and return the enclosed Rate Verification Forms, Tab "C," to:5 Star Life Insurance Company Attn: Mildred *. H[redacted], MSLS Director, Compliance [redacted] Alexandria, Virginia [redacted]Upon receipt of the verification forms, one for each certificate number, 5 Star Life Insurance Company will lock in the rates specified.If additional information is required, please do not hesitate to contact me. Our hours of operation are Monday through Friday, 8:30 a.m. to 5:30 p.m., E.D.S.T.Respectfully submitted,Mildred H, MSLS Director, Compliance

The attached payment history information was compiled and faxed to the nursing home as requested. A hard copy was also mailed directly to [redacted]   [redacted] was misinformed when she was told that her request could not be fulfilled. 5 Star Life Insurance Company continually strives to...

provide the best service possible to our members and appreciate the opportunity to address, and rectify this request. We apologize for any inconvenience [redacted] experienced during this process.   Please let me know if you have any questions or additional information is required. Sue W[redacted]
*

Date: Wed, May 11, 2016 at 10:29 AMSubject: [redacted] Complaint ID [redacted]To: [redacted]Mr. [redacted], Below is 5 Star Life's response Ms. [redacted]'s additionalconcerns.'Following is our response to address the additional concerns Ms. [redacted] hadfollowing our 4/21/16 response to Complaint ID [redacted]. It seems that Ms.[redacted] is confusing her and her former husband’s coverage. Ms. [redacted]’scoverage has never included her husband and children. Mr. [redacted]’sindividual Better Alternative coverage, as well as his National Guard stateassociation individual and dependent coverage, have always been separatefrom Ms. [redacted]’s coverage. At no time has Ms. [redacted] been responsible, or paidfor, Mr. [redacted]’s coverage. The credit card update noted would have beenrelative only to Ms. [redacted]’s coverage as Mr. [redacted]’s coverage waseffectively terminated with his death 12 months prior.The policy Ms. [redacted] claims was “removed” by AFBA agents, actually involvedtermination of the spousal portion only of the dependent coverage pursuantto the divorce in 2012. The children’s coverage remained active until Mr.[redacted]’s death.AFBA makes every effort to answer each customer service call promptly andin real time. However, during times of high call volume or when we areexperiencing technical difficulties, calls may be routed to the voicemailsystem and slated for response within 24 hours by a representative. AFBAcontinually strives to provide our members with the best customer serviceexperience possible.Sue W[redacted], Legal Analyst, 5 Star Life Insurance Company'Please let me know if you have any questions or need additionalinformation.Sue W[redacted]Legal Analyst5 Star Life Insurance Company[redacted]Alexandria  VA  22314-1556###-###-####