HomeMy WebLinkAbout06-0077
F:IFlLESIDAT AF]LE\GeneralICurrent\11750, 1,com]/nlm
Created 1],I]5105002PM
Revised: 1/4/06 1022AM
11750]
George B. Faller, Jr" Esquire
MARTSON DEARDORFF WILLIAMS & OTTO
I.D. No, 49813
10 East High Street
Carlisle, P A 17013
(717) 243-3341
Attorneys for Plaintiff
CAROLYN J. NEIDIGH, Executrix
ofthe Estate of DAVID D. LAUVER,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
v,
NO. ),00&-- ':77
CIVIL ACTION - LAW
MERIT LIFE INSURANCE CO.,
Defendant
JURY TRIAL DEMANDED
NOTICE
You have been sued in court. If you wish to defend against the claims set forth in the following
pages, you must take action within twenty (20) days after this Complaint and Notice are served, by
entering a written appearance personally or by attorney and filing in writing with the court your defenses
or objections to the claims set forth against you. You are warned that if you fail to do so, the case may
proceed without you and a judgment may be entered against you by the court without further notice for
any money claimed in the Complaint or for any other claim or relief requested by the Plaintiffs. You may
lose money or property or other rights important to you.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO
NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW, THIS
OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER.
IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO
PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL
SERVICES TO ELIGffiLE PERSONS AT A REDUCE FEE OR NO FEE:
Cumberland County Bar Association
32 South Bedford Street
Carlisle, Pennsylvania 17013
Telephone (717) 249-3166
George B. Faller, Jr., Esquire
MARTSON DEARDORFF WILLIAMS & OTTO
I.D. No. 49813
10 East High Street
Carlisle, P A 17013
(717) 243-3341
Attorneys for Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CAROLYN J. NEIDIGH, Executrix
of the Estate ofDA VID D. LAUVER,
Plaintiff
v,
NO. 0'-- - ? 7
CIVIL ACTION - LAW
MERIT LIFE INSURANCE CO.,
Defendant
JURY TRIAL DEMANDED
COMPLAINT
I. PIaintiffCaroIynJ. Neidigh is an adult individual and is the duly appointed Executrix of the
Estate of David D. Lauver, who died on January 31, 2005.
2. The Defendant Merit Life Insurance Co" is an insurance company authorized to write
insurance in Pennsylvania with an address of601 N,W. Second Street, P,O. Box 39, Evansville, Indiana
47701-0039.
3. On or about September 17,2004, David D. Lauver completed an Application for Group
Monthly Outstanding Balance Credit Life and Total and PerrnanentDisability Insurance with the Defendant.
A copy of that application is hereby attached as Exhibit "A."
4, All of the premiums for that insurance were paid from September 17,2004 up through the
time of David D, Lauver's death on January 31,2005,
5, The Plaintiff decedent had met all conditions precedent under the policy by completing the
application and paying all the premiums.
6. The Defendant originally denied PlaintiW s claim by letter dated April 8, 2005, claiming that
the death was as a result ofa "pre-existing condition." A copyofthe AprilS, 2005 letter to the Plaintiff
from Monica I. Hape is hereby attached as Exhibit "B,"
7. On May25, 2005, the Defendant then tried to claim that the claim was being denied for
a material misrepresentation by Mr, Lauver when he completed the application. A copy of the May 25,
2005 letter to Carolyn Neidigh from Monica I. Hape afMerit Life Insurance Co. 's claim department is
hereby attached as Exhibit "c,"
8. When asked to clarify her position, the Defendant sent another letter to the Plaintiff s
representative dated June 6, 2005. A copy of that letter is hereby attached as Exhibit "D."
9. In that letter, Dana L. Harris, Claims Supervisor of the Defendant, claimed that Mr.
Lauver's medical records verify treatment for "fairly severe coronary artery disease,"
10. The medical record which the Defendant was referring was incorrectly quoted in the
June 6, 2005 letter. The entire assessment to which the Defendant referred states, "Fairly severe coronary
artery disease in the past with angioplastyand stint, history of MI hypertension and GERD."
I I, The medical records from September 17,200 I through September 17, 2004, do not show
any treatment, medical advice or evidence that Plaintiff s decedent had heart or circulatory disorder; cancer
or tumors; diabetes; stroke; disease of the liver or kidney; alcoholism; drug addiction; any brain, nervous
system or mental/neurological disorder.
12. The policy requires payment of the outstanding balance of the credit account on Mr,
Lauver's date of death.
13. As of the date of death, the account was in excess of $40,000.
WHEREFORE, Plaintiff demands judgment against the Defendant for an amount in excess
compulsory arbitration limits, plus interest and delay damages.
COUNT II
14. The averments of paragraphs I through 13 are hereby incorporated by reference,
15. In evaluating Plaintiff s claim, the Defendant obtained certain medical records from the
Graham Medical Clinic.
16. The Graham Medical Clinic records clearly do not support a basis for the denial of
Plaintiffs claim.
WHEREFORE, denial of Plaintiffs claim was done in bad faith and subjects the Defendant to
punitive damages.
MARTSON DEARDORFF WILLIAMS & OTTO
Date: January 4,2006
I
By It
George B. F-aIler, Jr., Esquire
I.D, Number 49813
10 East High Street
Carlisle, PAl 7013
(717) 243-3341
Attorneys for Plaintiff
I; I~ ")
/1 . 4~-,
VERIFICATION
The foregoing Complaint is based upon information which has been gathered by my counsel
in the preparation ofthe lawsuit. The language ofthe document is that of counsel and not my own.
I have read the document and to the extent that it is based upon information which I have given to
my counsel, it is true and correct to the best of my knowledge, information and belief. To the extent
that the content of the document is that of counsel, I have relied upon counsel in making this
verification.
This statement and verification are made subject to the penalties of I 8 Pa, C.S. Section 4904
relating to unsworn falsification to authorities, which provides that if I make knowingly false
averments, I may be subject to criminal penalties.
/1 ' !
l:. f1)~-V- CG {" r-
Carolyn J. Neidigh, Execu 'x ofthe
Estate of David D. Lauver
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02:41pm
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~CCOUNT NUMSEFt
13498728
Frcm~Am.rlcan a.neral
,.......+'''' '-C ''j ( \
TIT 243 5545
T-145 ~ DOl/DOl F-424
A1erit Life~
In.'UI'~ Co..
A Slocle CamP<lnv Ol:tmldled In Indian..
150' N.W. S.-co!'\d st,...t, P.O. Box 39.
Evan.....ill.. IN 4770'-0030
1 ~aOO-3.2::5-2' 47
I
SCHEDULE
Group Master Policy Number: AG-38-200
FIRST 6ENEFIC/ARY (CREOITOR'
Name and Address of BOR~OW~R (rtrst pt .Qn n.rne.1
belcw) and CO-BORROWER
DAVID n LAUVER
207 FRYTOWN ROAD
CARLISLE. PA 17013
Eff~tiv.
Date
09/17/04
AXERICAN GENERAL CONSUKEll DISCOUNT COMPANY
6 S I!:ANOVER ST
CARLISLE, PA 17013-0417
BOrrdWf!
A....
49
Second e.".r1c;.ry (BoO'~);
E
Second Beneticlary (CG-Bo~):
( 17,- /- '}/". /J~~0t,. 11 ,
v
Co-B.;lrrower's
Ag.
Type of Insuranoe
Single Life. rn Joint Uf." [::J
Q[] S,,(rr;wo/.,.
o Co--Sorrcwer
APPUCA TI4 N FOR GROUP MONTHLY OUTSTANDING BALANCE
CREDIT LIFE NO TOTAL AND PERMANENT DISABILITY INSURANCE
FRAUD WARNING: ANY PERSO~ WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY
OR OTHER PERSON FILES AN /APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CO,NTAINING ANY
MATERIALLY FALSE INFORMA ION OR CONCEALS FOR THE PURPOSE OF MISLEADING" INFORMATION
CONCERNING ANY FACT MATERI~L THERETO COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME AND
SUB..IECTS SUCH PERSON TO CF MINAL AND CIVIL PENAL TIES.
I am applying for the Insur..nce n ark-eel above. I authorize the Creditor to add the monthly premlum(s) f'O~ the Insurance to
my loan each month as the~ becom due. It the requested Insurance becomes effective, the c.o-verage Will be in effect tor the
amount and term for which premiurr has be-en paid. I understand this Insurance pays any claim benefrt to the Creditor on my
behalf to r.educe or extInguIsh my d bt, I declare that the answers on this Application are true and complete ~o the best of my
knowledge and belfef. My answers nay be relied upon by the Insurance compan)' and are the basis on Which the insurance
may be issued.
Borrower
10 -S'"-:5?
cfir
0(2("
2.. Our1n the past 3 years have you received medical advice, been treated
for,_~ been told you had, Acquired Immune Deficiency Syndrome
(AID< or AIDS Related Complex (ARC)?
3. Durin the pOlst 3 years have you received medical advice, been treated
for. 0 been 10Jd you had. any or the following conditions: Hean or
Circul tory Disorder. Cancer or Tumor; Diabetes; Stroke; Disease of the
LIver r Kidney; Alcoholism; Drug Addiction; any Braln, Nervous System
or Me tal/Neurological Disorder?
I
YOU ARE NOT ELIGIBLE FOR L1F~ AND TOTAL AND PERMANENT DISABILITY COVERAQE IF YOUR AGE EXCEEDS
65 ON THE DATE OF APPLlCATIPN, YOU ARE NOT ELIGIBLE FOR LIFE AND TOTAL AND PERMANENT DISABILITY
COVERAGE IF YOU ANSWERED "!woES.' TO QUESTION #2 OR #3. '
EFFECTIVE DATE: Upon accept nce a"d approval of this application by the insurance company. the insurance
becomes effective as of the date y ~u applied for t". Insurance. Th. Errectlve Date is shawn above. I
TERMINATION AGE: Your insur nee coverage will end on the closing date of the bifllng c:;ycle (statement date)
Immediately following the date yo attain age 66 .
PRE-EXIST1NQ CONDITION: If. ass results directlY' or indirectly from... pre:...aisting condition, nol benefit will be
palda A pr....xlstlng condition i$;; condition for which you received medical advice, diagnosis or treatment within the
six months befo,.. the e1fecdve da e of coverage or the date of an advance and which caused a loss within shc months
following the eft'ectlve date of co.v rage or the date of such advance. '
f represent that the information i: Q ansvvers given on this applicClItlon are true and complete to the best of my knowledge
and belief. I understand that satrsfa tory evidenc.e of insurability means that I have truthfully answered "No" to the applicable
questions above. Untruthful answer"! may result In denial of claims. I understand that jf any answers to the qu:estlons are false
and untrue, the Insurance Compan 's liability is limited to the return of the premiums paId for coverage (subject to the
ncontestability provision). Upon a ceptance and approval of this Application by the Insurance company. the insurance
:)ecomes effective as of the EffecUv Date shown above. , understand that the insurance applied for Is OPtional, not required,
lor a condition to obtain any loan c credit transaction. I further declare that I have read or had read to me this statement
lefore signing below.
)0 no't s19n this application ;r an~
leeted have not pe~n completed.
'8 questions applicable to the c
pplicatJon.
'ate9
/""
~4
af.
EV-APP~PA
"tailco In.u....ncc Include::. cOl{cl'1lg_
rar Tal..I & Por IlInIlllCllOl_piUty.
MAXIMUM
ISSUE AGe.
65
TelitMINATION
AGE
66
Mon\hIy Prwnlum Rate for e..cn
51000 af Av.rag. Ody a..nC8
Joint wr. Single ute
.NONE . .844
I
"..,.
Years
I
C~~Borrower
I
l
1. What s your date of birth?
Ves
C
CJ
j
No
[]
[]
spaces applicabre to the borrower(s) electing cov....g. and to the cov~rage being
The ClIpplication will not b. used in a cantllBt If the borrower(s) h.ils not answen!ld
verage being appUed for and/or if the borrower(s) has not .igned,' and dated the
Signature of 8
"Ow., I,) -.. -.1} ;/).t.-..
~..v:;-
Wltr'les:s
-"
~ ~ ....
Sign8tur~ of C Borrower
X721 (OAa31..(3) PAOpMl-End Applic.llon r.,..'.... (,"nDe
Exr'lihit" "AJI
Jun-06-05
04:52pm
From-Insur.nce CI.,ms/Pol,cies
+
T-094
P 002/007
I
F-946
F,,"Oi-OS
01 ~~r"l
ov:l4I2OOS 13:13:07 PM Server: AGFRF~U16 JIO; 1090613 Plgoa::lJ
Frgro....r!cill ~n"ar TIT Z'] SS4S
I
HOI P,OOS/Oll HiZ
r
I
I
Merit Life.
lnswance Co.
ASII:lClk~~"'~
6(11 ~1,-W.set!Ond~ p.o, EJQx~.
EWM'II'h. IN ""'01-Q080
,~:;.e'.7
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ACI:o'LlNT NuMe11l( I I :SCHEDUL.! Group Master florlCY Nlombet': AC-311 200
13498728
~_~oIDORROVIIER~~ /limed IllIRST !ENfAC:LARY ICRECrrOA)
~ J" CO~gRft.O\MOR. AJII!J,ICAN GUJ!IlAL CON9tJHEJ\ DISCOllllT C:OMP AN'!
'.,IUD '(....o.JJ9D. 8 S ilAlfO'sr. n
207 r~rfOWN ROAD CARL!SLE, ~. 17013-0017
CAlU.ISLE, ,.. 17013
....c1N4 _. Criomowol" _._...,Ie=,
- ... Ago 8nIoYll nIDI SIS1'!Il
09/17/0' 49 Sl!CCI'lCI BmtfiGiIty (T:cl ~;
......,,'"""""'" MAAlMW TiiRMlNATlON MoNIllII--.......
_w.. [XI ""..utr c::l 1S8Ui AGe: A~ $100ll"^_",,,,,,_
IXJ- I 85 lS4l '....Ufo .1OgIt~
'1JllI_~--"" ~.. Yon .NC~ . .844
c::J e.._ .-,... C/I;IIIky.
CERTIFICATE OF INSURANCE
NOTICE: THIS IN!iUItANCE IS UMITED TO A MAXIMUM OF $ 100000 I
AND MAY NOT BE !ENOUGH TO COMPLETelY PAY OFF YOUR ACCOUNT I
THIS CERTIFICA T CONTAINS A PRE-EXISTING CONDmON EXCLUSION :
I
I:
I
I
Tho EtfoctlW DlIle of insUrlll~j ~ thl dabI you apply for ..V_1. You wlY not ,roc."'" . ~eath .r total and'
POJl1llUlem dfonoblrdy benetll wllh ~.o:tto any lIC<Qunt ._CIl_n within 8ilC montlll priorto your dlalb ortall/II
and ""nnanent _nily if your deolt/l 0' dl=blllly is c.- by a p........t1ng condition. A p_i&tiIIg """dillDn i.
a CO)lICIlIlon for WI\iCft you -r"dl"'" am.., a""no... Dr _tilt WIIIIln IIx 010...... pllo,1O III. ~
DaM or c_o, or.... dlIl8 of an vance, and whl.h _11I10"" within six RIOnttw followlng IllCll _ Rmr to
you, eertlll.... fo,fit""", Iletlils. I i
oaly tI181 InsunInco marked unci<< 'TVP8 of Inswanca' II offlClivo under IIIis COllificat.. In !his Clrlificott. tho worij!
"lIDr_ ",f./lIto tJ1e B..-r incUr:' C..8_ named ollovo. !'< mllXimum of toNG - I!I8y be insurea .naor l' ,
Cerlif/Clllle. Tho WOrcll "you" .r 'y..... refer 10 bal1'DWOCS w!Io on: _ unci... this c.rtmeate. Thl wQJda ....., 'IJI" or ".u ,
..I.r '" Merit Lif. Ino."._ Co. ,
This o.mnaate fa 5I1bj10l'o tIlet or 11\1 Graup Poucy Ioeued 10 tn. ~.ar ...mod - eM '" I~ldl""" or :D
inSuta_ under tIlo Group P.Iiey. I
fliGHT TO RESCIND: You may resdnll thiS COI1ilIClIle by QIVInA us I s;gnod and d_ "",'lien nCllOl wifIIln 30 d.ys
lIle <We you _ it. If jalrrt iMu~ce Is In _. IlOI/I ba_ must Sign the wrttten nalice. The In.....nce is "'"n v.1li
from ;15 !!lr8Clivc C.... I I :
EUOIIIIUTY. VO. Iuwl beon round "'ogIlIo .... ....u_ undOl' tne Group Maaer PaUcy by meeting the followirG
~"i1Iml!fllS: ('1) )aU have nat _itutll agl 64 on the ute of IIpPr.caIlaIlI (2) YO' h.v. provided $IIlisfoA:l.O,., "",den.. of
irWlIrabiity; and (3) you ......G11D4 tn. r-u,.n~ GIld agreed to pay me moltthly int:uraI'!W premilnns iO 11'I. OfMUtOf'. '
TERMINA110N AGE: Your ~urvJCC coverage Win end on the closing date of 1he billing eye':'
(statement date) immedilltely r'lIDWing rhe date you ;dtaIn age 48. '
UFI! ANI? TOTAL AND PERMANeNT DIeAllIU'IY INsUIUW~ IJ
DEFINITION OF TOTAL AND Pi:RMA/lIENT DISAElIUTY: T.tal Ind permanlnl dlS8blllly m.... that you 1IIB t018I1~
ptfYl111Mnl1Y .nd COntin.OllOly lAl'IaIll. t. engag. ill .ny occupstfon. emplOyment or ICliyity for campensauo" or plllfrt f.r wIllCll
YOU .,.. ~Ad by eduC3tlaR. ninino Or apMIH'IC., :ac:cDn:tlng to th. I::aI1JJicauon of a ~elan or poc:ti2tria.. W. may waiVe
11I1 pny_n or padl3lrtol'5 certi~ If Joo ,",vt sufFen:d the ptlTll8llenl'OSO or Ifg/lt at bath ayes or l/l. SCNCtllllCQ of Doth
h't1ds. both feet Of at OI1e hand and O?e 'oot 81: Dr abOve the WIi$t or ."kIa. I
UFE AND TOTAL AND PERMANENT DI5AllIUTY BENEFIT: II you d1t or bee"",. tatllly and perm.nently dls'bl~
wnlfe IMuted under uus centnCSl8, . wm pay tne amaum. Of ln5ul'1Inca In fon::e at the time at deltl1 or totIJ and permanent
alsllbility. SUCh ll'lymlnt will be ~. when we ~ive proof of 10" ana INill b. paid .. stated in tII. BENeF1CIAR'.!
proollSiOn, If singl. I"""",n... is in el!l!c:t. lIle dllll1 .r tOtal and ponnanem d_1ity ., lIIe bo_ wlU JermiMle thl insuran...
1JIlC'" this c:ertifiCBM.. If jainllllSUllII1!:e is ill errlllll MIl only .ne _ _ or becomes Ullll/ly lna o"""onentb' dlSOO~
oingJe lnsutMC8 wiD _.... In fordo on the relT18lnlng bcrrowtlr 8M . singl. insur.nce certifiCltll will Oa is!ued. Ir b"'l
l>ar__ suffer a lass Blll>l ...... ulnO. only ONE _111 will b. 1lSie!. This benefit wlll be paid as Sl:lted In It>e Ben.nCiS/y
pravisian fot Joint cove~ge whet'B bo' bom).wrs ",,"er ~ lOSS ~uttanaov.sty. . i
UMtTAnoNQ DP LIFe ANI) TO'1"-'I. AND PERMANENT D~AB'L.IT"'l'" IN3UftANce: DENI!,.rr; #'
SUIcide: Ir you comm~ .ulOide lll/uing tho fkst ,'2 """"ecoWe m.ntlls enar Ina etfec:t!ve Date CIf ..,verage. no In""ran
oerlefit wID be P81d. All inSurance p~uma pad Wl8 ba l'8fUnded to you ar. at. the Ctedttors gption. credited ta your ac~unt I
If you tomm~ suicide during 1IIe ~ 12 consecutive months .nar 1lle dll!ll or an IIdVllllDe. n. Insul'llnce beneflt will be paid
far auch IIdWJncc. Alllnaurwncc PRrYUum, paid forthal iildwncz will be ~ to YDU or. at me Cn!dTtors OJ'tfon cmditsd to
yo~r account. Ths 12 m~ ajcjdef"'Sian tuns ~y tgr eaCh advanoc; hCJWevet, a l3ter acI'VInce dOM' not rewsl,rl.
trte 1 Z marrlh stllaae ~CJn pet"iDG fOr IiIny priM adVanc&$. I '
ML~7'C-l!OI"'A I
...aoaa, P.u:an (Io'o/C) Hlb.OC 0eIIlIica. 'if I :
Jun-06-05
04:52.m
From-In.uran,. Clalm./Pall'ie. +
02l11f2006 12:01:15 PM S!Nef: AGfflFAM17 .lID; 796191 Plgee; S
I
Froa--AlIlerican '~.nl 717,43 SS.s
7-094
P.003/007
F-946
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Fob.IHIS
1 H.",
1-005
P.003/005
HIO
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I
, 'I
P",.Existlnll Condition: A ~n9 ocndition ill a condition for wI1ich yDIl received medical a<lVl"". dlllllr.osis CU' I t
lre3lJl11lllt wl\llin the six months plio, to the ew.c:ive Oat. of .a...rag.. Of the dst. of an ll<Iv"""". end which cavset:l your :.1"
oe.}ln Of tatal II'IG perrrla,uh'lt Oi&3DtIltJ witttin lIUr. momns fOllowing' 'uCft &te. ",';
If)1)Ur de8t/1 Of _ .nd pannanslll d....b1111y res!Jlt!l di",dly or indin>c:lly ~'" a pr&-ellisting cond;dan, no D.nelit will be I'
p,"d 'or 111. a=ndlng bBlaI1ce on i118 elTec:tiv1l OIte of coverage and far any ""fHl""lifying IIdvenDes. 'Th. "",.oxIstfno ,I
exduslan Will "" 'PI!ied sgparsl.ely..to .aell 3Cv.Inoe and """nOS only If _ to ;ne btent Ihal the total amount of aU 'I
i_llInce th:ot wuvl<\ OClIClWIsa be 5U'l'8= to tn," exdvs;gn e_ $1 ,OIl..
A ""n-qvalif1il'1I atlv..C11 Is SIl aChls""" ltlOt Is mll<l. an "jfllft account'within six menw after medical advice, disgnosi.
0' t/1!dImenl ~as 0"" ",..lVed for l/1I conoldon wlIlch oAuseG yovr daal/la,tatAl 'nd p8mla'''l/lt OlSablllly. Such advanc.
mllst also De made ",jthin six mO/1lflSbefote tile oat. of your dnth ot latlIl .nd pennon'nlO1Oabirrll/. Ovtr",Dillty, ..10 any
"an-quafrfl/ing aovanco.1s Imilld I. I ,.funa oflhe amo.unl Of pn:rnlum thlll.... pale lar1llat advance.
AMOUNT Of INSUIU\NCI: Tll~ emount of inSlltll1eO to th.. sam. wlItUl., single "' joint Insunnca to aII.Clivl. Tho
"mount .r '''''uranee """II be equit ~~, (1) t~. o~ai"g DII.n.. .n yolft eccount an the date 01 aeem or total .na
permanent alsalll11ty, 'us any ftOl1'<l'J""'YtftQ OlIvan<:a; Of (Z) '~GOOOO , whl_.er IS ,...... '
In nD e'YlUIt shall tna amount of inSW'8t!ce on the Itte of any bOlfQW9f' Insu~ under tha Grouj:) poUey exceed
S 100000 , MY ;tIIUl:Inee pI1!nmIm pail! (or InSu,,"":" in -.. OTtrliS Umn wflI "" ","",Oed to you Of, cllhe c"'alUlrs
.ption, <NdftRd to y.ur aCCOunt. 11\~ CllQ!S5 Insuranca is 111"" void, pravldCd 3ucn ~und is maaa whne you ot1l ally. and
fUlve not wcomc total!)' and pem18l1""" diS::lbtecs.
IIEtfEFteIARY, lleMlIlS pay.bIe und... till. cenifiellle WI" b. palO to lite e_. all 1J'reyoeable beneflClll/Y. Suell I
.mount will b. .pplied by III. Crldltol'to redv,,", Or _ngul.n yoU, .....1Int baIan... AJTy ""''''in"", lltIn8fi1l..11 be paid '0
you. It IMIllJ, oIhetwiSl ttJ your S""'lnd BenerlClalY. II none it nlmll<l or tllen l!.ing. SIICl1 bll.1I<8 sholl be OliO to yoUI'
0SUIIe. II two ineureG bamIwel1 sulIer a ,_ mullllneullllY, .ne be"efIt will b. pokllna any excess will be pald SQU.lly to
tho ~, W living, othlllWfse to. lba Second Ilenellcillry of eaell tnsUTlld bo~. If no Second Beneftcillry is named
or I/Ien living. lAY """_ tamalnillo llIter p.ym.nt of tne ICCllunt will be paid equally to tho estate of each Insu~
borrower. Such rnymn Dy U5 .hall (' ~JotQty dl.ch.wge oW' liability wlt/'l rasp_at to the amount au paId.
GeNeRAL PROVIlIIONlI
PREMIUMS: T"" ",onil1ly pIllmlU ...nl b. delemllned by multiply;ng Ill. monthly p"'mi>Jm I'llIO 1Ilnes trle everage lIatly
bGlanco of your ICCOl.l1t during Ih Pt'e-Ing month, but nOl Ul _COd the .mauntlO WIl\CIl Ill.. i_ran"" 1$ Tlmn04. T1'Ie
monthly p",,,,,um ",teo a.... "lI.",n .. tne ScIllldul.. Wo m.y eIIango 111. psemlum I'IIlu; h.....or. any pI1lmlum rate
, chltlled will not _SO lIle prillHi loci' tIIIe.o "n_ prior appftlVoI is o.bbolnocl fltlm the P,nnsylvlmil 1Il......nce
O",,_nt. 1. .
1EW OF MUllANe&: Tha ~ 0IIls of insUl'Ill<C is the lIate you eo1lIY far ~Q" No IlRlmi"", will o.
chatged and the1e Is. no ",,"8I1l fOt "'IY manlll WIt"" lIlItI! IS f\Q CIUl5t3I1C11n9 belenoe.
Tho in""",n.. will ,,""'i"lIo an 1M 11m bin;ng ~ (statement dole) after 10II11Il afth. foIIowiftll: (1) yout account with
, th.. CttdKot is tennl"_ (2) YOUt a,baount IS II'IIIlSfernId to anathlt CteClI\o~ (3) yOu teqUU tenninotion of th. insutenc.:
, (~) ll>a cl",up ~nl\Y is tonnl..-: ~ 00 dllY" _ you d_1t In ,_nl en "jflut __Ill ""1_ tho CnxllIor CClDtinu..
, pill/men! at tile pramlum I.' lIIlllllS....nCB III connecllOn wilh your eCCllun~ (S) the _1ft IS cIlotg8cIootf; (7) the ClllClilOr
'1lanniMtell ClI\IOI8IIll Clft ttuIt -:1b.lf- U"dtrwl\iCh "jflU were e1lgillle for the ine..,."ce: (11) 'tIl. dellll1 at In inoutlO
_ (II) you _. tolaIly p8lIllonently dilllbllld. n 8 benelll is pay_: or (10) the aile yOu 81I8i" eg. 65. I"
j th.. .vent of (I) or (iii) 1tKWe:. when J InlIMUrlftC8 Ls in effect. . ainQIe iMunlnCII C:ertlftcate'MlI be isIueCI fa cotftInuc the
, ;_01 on 1/1. nomailling eIlGiIlIe ~ unlil SllCII ~_ allalnS 1I01 66 ot tho Ift.IlJratl...19 othen1ri5e tenninattd.
I TERMINATION OF GROUP POWIlY: The Group PaUll)' mey be CIIlolll1011 by _tIIo CtolIitOto.r by UL You wnl be
gl~on :\lI lI1ly.o _ ~ 1111 Ctec:t~ thlll youf insUrance wi. tennrtllle If ..ther we or tile Cflldl!llr Iennlnale 111. Gnlvp
I Pofrey.lftholnSUr.mce1l imml!lfilll8lY replaced by U5 ora"otl1Crl_ret. youWW not be nvtifIed.
IIIISSTA TlMENT OF AliI: " not etIQOIII. lor 1nlN_ if l/l>lI ..,. older than lIIe M8lliInum _ ADe SIOIOcI in
I tII. S."edule on the _ at oppl~. SUbjeCl to "'. 1n~1ll1I\)' pItlIIision, il you Illi$SIlIlecl y...... ago :lIlCI...... nat
. aUg'. fOr j~ no welt luunU.c. ;. .tfadiWO Yn4OC" mI. CMifiIl8EL If rou miUtated JOUr. :and you .rw. e6gtble
but _. 1lI1h. _ent 111. _ra_ tlIm8ins in _ aflM ft would otIl_ have tetminllled, y... Will be
ncltlf.... lhol you '111 "ot eligible 8ft4 Ullll 1M lnsu""'.. MIl tenninala a. or the nelCl bilrong .ycIe (SlIlI.8ment dlll') provided
you an alive and nat _I)' """ per/nanenuy!11sabled. 11\ e1lJ\. cUe, if single Inounmce Is in etfecl, out .allllllY Is limIled
fa . cwrund' of' the premium pIid. If joiftt insuranca la in otrad, ~ IiIDUllY ~ limJtc:d to iI .......nd of ihC' ""nC8 DlrtW88f1
the ilIIur8/Ice """"ium pald for i""li and Singl. IIIIU",""'. A sinOle Noranco Caniflc:ate will be _!;l COJllinIle \ha
i"!IIIran.. on !/Ie erl!lillle balTOWlr. I .
AGE REQUIREMIiNT1I: If InSU...... MIS iSSUlld in emir whllD yau corredly _a your lllI. and you WIr8 nat ef>gible
Illr II\S\IratIC1I. you wtlI be noIified \hat you .f1l not eligible ancI tblllhe insunonce will terminate as rtt tho next bNling <yCJe
: (.1"""'01 dlle) pravlded yau "'" oj... ..., not UlIalY and pennen.l1lIY c&salllod. In 1l1. """" III joint _GO. a Sing'.
In!lllr..... Cert.TlOlIle will be;ssued td _"" the inSllrllloe CII\ l/Ie .tlgible _.
INCONTESTABIUlV: 11\iO ee1uIoeIe shall be Incontestable _ D nos been in fa"" fIlt two """'" during yaw
UflllJm.. AU _emenlS mad. oy )bv shall b. deemed ,.,OJ_,Illli<>... and nO! _rdieo. No _ n::lllling to
In_Uil1she1 be """" to conte=! jllis CettifiOOlI un'- it .. <:DIllaJnaa In a _ aJlllIl- signed by ,au. A COPY af I
lne App/I_ mlllllle IIImi!lled, nm _ I/lal1 wilen COY8t3IlC is Olltrtesled. to you. yOUr se<:OllIWy bllMlld"'" ... athOf '
~~- -, I
11 1/1 m8 aase of joint Insurance, if,.\, C:OIll8Sl UIC i/lSUranca, OUt liability is imitecl tll a reNncr 01111.. diFl'enlnCll belWe8n!he ,
insuran... Pfllrrwm paid Illr jolrt ana SIngle inSUtII"C8. A single inSUlMlle Certifioste wiU 08 \ssulll to oanlinu8 1l1~ '
in.v"",.. an !he erlQible _$ ".. I
AnIGNM~ YllUl' lIIterest In !Ius Cert/llCalJ! ,. IlOl llSSTgnao.la. We'" not 08 llOuna llY any ...kJIUllBtl! or _f '
. ~1D\c-, I i
I 1lI0DIFICAlJONS: All ell..;... or mudili""tions mad. by lbe company llte SIgned bv ;IS Presklent, Vi... Presldento.r i
al!crMtry~ No ather pAf50n l\a$ authol'R1 to aJt8I' Of' WINe any oflhe condffians of I:hls ecrtmcat. Of mka ant aorcetl"lMt I
whien "'"II b. bin..,., upan!h" Comp.ny. ;
CONFORMl1Y WIn! STATE I'M nlTe.s. Al'PJ provision of tllio cenl\lcat.. and/or 11\8 Group Master PoIlC)/ WIll"" Is in I
I etlnfliCt with \he SUllutllS Of tile SlaI8In .."Ion l/le Group Masl., paffC)/ is dellwted Is emended 10 comply with such JtIM... I
tt 1& t,,"denrtood that af'f'l/ ~.. en j&tlilt8 tlgUIIItIOn3 Dr lawo wfll apply if thaH: dJallQOS "ffi:c::;t IInJ aaverage ccntalnec& 1R r
'"-C&. Ct.ft:ries-t:... ~al'ttle Gf'Ot4) 1 pcmcy. I
, '
I '
ML3-21'4CEo1-PA
~ ~~K1.oe~C1~I"-"
I ,
Jun-06-05
04:52pm
From-Insuran,e Claims/Poi ,.,es
+
F!lt-OS-Q! 01 :'5Spm
~oos 13:13:07 ,,~ $et'Yer: AGFRFRlotl6 ,,110; 1090613 Plges: 33
Fr~Anril;an ~n.r3' TIT 243 5S..; T-"09 P.Ol&ItIU ;....'Z
.'
Merit Life.
InlSYI'anI;;e Cct.
"'S!l:Jd(eOf1'l~DomIc:lIIGlnrl"ldiena
S01 "'.W.Secona~ P.Q.Ball:3~.
5.\I~. ''''-47'70, .oaQO
, -6Ofto4eD-a'''''
,
AC':OU~ NlIM'\iR I I SCHSDULE GIlIUp 'kslerPOIiey Number. AC-38-200 ,
1~1.98 IS ,
,
NOr.............. .,'ORROW&R in"'l- '1IIST BiNEFICWiY (CREOlreR)
beftlWJanaCo..ltO""OWIfc AtlUICAN GUAB.AL CONS1lIlll1l CISCoon COHl'ANY
jIiA;.Ill D UUVtt 5 S liANova S!
2.0" PIIYTOW AD,AD CAl\l.ISLl>, Y/" 11013-:~\
CAIlLIS~Ji. PA 17013 - - oe~ ,
. ~~ .
.s~8~(8111'rOt1lWt. /' . , I
EfJ-.eta'W 8cl'fP'8l'II Co.BorI'!MII"lli
0"'" Ago Ago ~""""'S_t~ u
09/17/0~ IIg I
T~e of Insl.Jl'8ND I I
MAXlIIIIJM T1!RIiIlNATION __""'_/!O'...~
Shglo ",r 00 JQioturr ~ 1$$I.11AGIii A.~ S10C1Cl or AVIl1QeOoilr 9aI1S1Cl
rn........ 6' 66 Jo6l'\lLJfc ~Uf.
""'I~_ e_,. '~ONE S .8114
C::J c,._ tlr~6~~. ~- ......
,
Ai'PUCATlON FOR GROUP MONTHLY OUTSTANDING BALANCE
CREtlIT UFE AND TOTAL ANtI PERMANENT DISABILITY INSURANCE
fIlAUD WARNING; Art'( I'ER.llON WHO KNClWlNIIl-Y ANCl WITH INTENT To ClIiFAAlJD AIN _URANlle "aM"~ I
OR OllilR PERSON FILlS AN APPUCATION FOR INSImANCI OR STATIlMENT OF CLAIM CONTAINING '
MA'l'IiRIALLY FALSE INFOIlMAnilN OR CONCEALS 'all ntI! PURP08E 01' MISLEADING. II\IFOlMAnO~
CONCIiRI\IING AN'( I'M:r MA1'ERIAI! TliIERITO COMMITS A I'RAUDULINT INI5UMNI:e ACT, WHICH IS A CRIME ANi I
elJll.le""'" au.... PE!RllON TO CRl:f.:AL ANO CML P.....AL nElI.
I am applying for 1I\e Il19lIrance m ICI ollOll'. I aulhotiZ8 the Clecrrlor iI> 14d tno monthly pnomiUlft(s) fOe tile in""..n"" b
rny 108ft ~acn mDnth IS the)' become ue. If the rwquesred l~"ca became~ effecttve, the covetlge wilt bfl In effect fOr th
ame'un! Ind lerm fOr wnicn premium hils aoon JlGid. I undemal1d this Insurance Pllysuny c:laim bonoftt to tn. Credlta. on m
1leI\I.1f 10 ...duoe or. .;dlngu/lh my dellIf I de~ tnot Ill. ..-.'" on t'" ApjlI_on .... w. and C~p1ota 10 thl ~ at m:
knOlOlledgo and beltef. My a_r.! mllY lie relied upon Il)I the IlllIursnc:e Cllmpany and are tn. ..... on wI1Icn th. mau""'C8 :
ma)' De ,....ed. 1
: IIonoww eo-eomwer i
[t, -s--s-S I 1. Whatis ourdatllafl>irth? I ~ :
Ye"" ~ 2_ Ouring c put , Y.:UW hOve you nleOlvod modioal advice, b..n - '2i ~
IE'J fOr, orfeen told you noo. Acquire<l unmuno CeroCiIClC)' Synd",me ~
(AIOS) AIDS ROlIJted Comploa (ARC)?
o 13'" 3. Durino 0 pall 3 ye.... have you _ medical advice, Men tl9at/l1l C D
. fer, or bOon told yeu hR, ~ Of the fOllOWing conditione; HMrt Dr
Ci"",1aIOly O;s.l1Ier; Cancer arTumot; DIlIIlOl..: SIIcllli!\~Ioe..s. ot_
Uver o~Kidnoy: AIconaJiIm; Dacl AOliCliOn; iIIlJ !ll81n. """"""" System
or M_eURllogical 0_11I'I ,
YOU ARE NOT EUdl8Ll! 'FOII UFE IANo TOTAL AND PERMANJ:NT DI8I\8IUTY COVEllMtlIl'"TQU1I AGE EXCEED
6S ON mE DATE Of' APPUCATlON. yOU AIU! NOT EUGleLl! FOR UFE AND TOTAL AND PERMANENT DIBABI
COVERAGE IF YOU ANliWEJlEI) "YEll" Tll QUESllON IZ OR #3.
EFI'ECTlVE DAlE: LIp................. and QlpnM! or thIS 1IlJl6C11tillll Dy lilt iMutMCO campany. 1M Jnw""nC8
a"eoomes 81IeCII... ... Of.ne _ JGO applied lOr tile Insurance. TIle BIlIc:dllll Dm ;s shown ""..e. I '
TERMINAnoN AGE; Your insuraftco """""'ge wUl end on IIle clOlltnllllallt '" ,,,. bIDing cyet. I_mant _
inlmediately folloWing the cIa,o you _in"!ItI 64, I
PRE-DlSTING CONlJtnON: It il lOss .....ul1!; dIreCtlY or ind_w IJDm " D~no t""dltlon. no bOl1l1fit win 'bl ,
Pli<!o A""'--II cancflliaft III . ~ondi'I"" fo, ....id1 you ",ee_....aic:al aclYiCl!, diallnllSlS or 118_m within thtj
.. montM befont the effective d~ of eoveage or the dm. of an adVitnce and which ~11!:d D loss within 1:11 mol'ltht:
followillg the __ date 0' c........gc 0' tho _ of s'"'" ocluan... I '
I moruent'thll the infOrrn.-tion .nd 8ns'M!B giVAn an tnit .ppllcatfoft .,.. true :.and compt.te to tho boct 0( thy lo1owlecl. I
.no 1KI11ef, I undefSt811ll thot _tlDIy evidence Of il\$U",,"I'!Y m&:lns tlllI I haue tMnIIJlIy .......rod "t<o. 10 d>e .ppllClblO '
qu..~o"" above, UntnAllful atIIW9fll may I'OS\Illn <MMI of cJailNl. IlII1IIelSWld tnal f any ..........10 tne questions are false
"no untrue, II1e Insu""'08 company's IiIDlllty Is IimilBd jQ lIle rel1lm of lite jl1emi""", Paid lor Cll"""'ge (subJIlCl '0 In.'
trlcontel5blb;Jity pr'DWsion). tJQOII .acc'ePl:mGe and aPJU'W81 Of II'lCt Applic;ul;Of1 by th. inc.&I~ee company, tne ineunlne8'
bee am... .....cfiv. a& or t/la EfrwctJve F"'own oJxm:, I un<lor&lllndl/lat 1ft. inou,ance appl'oed fa, is OpUOIltll, not r1IqulrcGl :
"or. cofldjuon to obloin llIIY lOan or tIllnsaclion, I runl1ef dl!clar1l tnOl I nave ...ad or haa read 10 ms UliS $ltIloment
~~~~~~ /'
Do nat scan this- appJiC3'tlon if M\y SDace!ll Glplleabhl tD tb. bOlT'DWOrtC) olDGti"9 C:DVQr.lgo ....,d to ,"I: ~vera9e: beins .
e)e,*d ~ nof been ~pll!!tad. Tne applicBon WIll not be UG:~d ift a ~nf8St "1:h.e bOCTOWllr(S) has nat answere.~ .
1:t1. qu~ons ~plicab" to Ule: ea~ge bQlng ~pphd ror ,;and/or if tna bOrrDWI!r(s) hu not $igned and chded th
apl,Rc.atiGn. I
0".9 " c". S;!l'1.........:r.:..~- -!'JJ) ,~...., .~h,;) ~
-....
Dala $rQnatur!:: af C orrc...v=t
::::: ..~~-~-~-~
T-094 P 004/007 F-946
~
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f~h lblJt 73
--- --
MERIT LIFE INSURANCE CO.
601 N.W. Second Street * P.O. Box 39
Evansville, IN 47701-0039
Phone 800.325.2147 . Fax 800.350.9582
A Member of American International Group, Inc.
April 8, 2005
Evelyn Neidigh
148 North East st
Carlisle PA 17013
RE: Insured:
Account No.:
Claim No.:
Date of Loss:
Type of Coverage:
David D. Lauver
0000000013498728
C05253447
01131/05
Credit Life
Dear Evelyn Neidigh:
According to the information we have received regarding the above
claim, the condition causing the insured's death was present and
medical care was received for this condition within six months
prior to the effective date Df the Certificate of Insurance. as
well as advances on the account. The insured died within six
months of this effective date. Therefore, the condition is
considered to be a "pre-existing condition" and is not covered
under the terms of the certificate.
Please refer to the Certificate of Insurance for additional
information.
We will be happy to reevaluate this claim upon receipt of any
additional information yOU wish to submit.
If yOU have any questions. please contact me at the above address
or 1-800-325-2147 ext 3292.
Sincerely,
Monica r. Hape
Claims Department
Exhibit "BH
...
\.I';"~ ~~ I,'~,:,',"'"
[?<~ibj+ L
MERIT LIFE INSURANCE CO.
601 N.W. Second Street * P.O. Box 39
Evansville, IN 47701-0039
Phone 800.325.2147 * Fax 800.350.9582
A Member of American International Group, Inc.
May 25, 2005
Carolyn Neidigh
148 North East St
Carlisle PA 17013
RE: Insured:
Account No.:
Claim No.:
Date of Loss:
Type of Coverage:
David D. Lauver
0000000013499195
COS253448
01/31/05
Credit Life
Dear Carolyn Neidigh:
We offer our sympathy an the death of David D. Lauver. Due to an
error, the letter you received dated April 8, 2005 was warded
incorrectly. we apologize for any inconvenience this may have
caused you.
However, we have reviewed your claim for life insurance benefits,
and again must deny your claim. There were material
misrepresentations contained on the insurance application that
pertain to preexisting conditions.
We will be happy to reevaluate your claim upon receipt of any
additional information you wish to submit.
If you have any questions, please contact me at the above address
or 1-800-325-2147 ext 3292.
Sincerely,
Monica I. Hape
Claims Department
cc: Amr Gen Fin Serv 8380-101
Exhibit lie"
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E, Ralph Godrey. Esquil
9S Alexander Spring Ro.\d Suite 3
CarJislePA 17013 I
I
Insured: David D, Lauver, deceased
Account No.: ~3498728
Effective Date ~ 09-17-04
Claim No,; C05253447
Dare of Loss: O~/311OS
Type of Covcra/gc: Credit Life Insurance
I
I
Dear Mr. Gomey: I ,
This is in response to yor- Ictter dated June 2,2005. i
Please be advised that t~ Jetter dated April 8, 2005, was iDcolTCct indicating the elairn was denied ie to a
pre - existing oandition! I apologizc for this error, A com:cted lener was sent on May S. 2~ in 'cating that the
reason for denial was dJo 10 material misreprescucation, I
I
I am eoclosing a copy of the following document!110 support our denial of MJ-, Lauver's c:redit life nsurancc c:lailD:
Application for Insuranc!e with all questions answered yes. Certificatc of Insurancc .
and medical records verifyiDJ: treatmcnt for ''fairly severe coronary diseue", '
If you have any further ~UeStioDS or need any funher information, please feci free to concaCt me at ,b above address or
1-800-325-2147 ext5967,
I
I
I
I
:e~:I~, X~'
Selina L. Harris
Claims Supervisor
Jun-06-05
04: 52pm
From-Insuran.e Claims/Policies
+
MERIT UFE INSURANCE CO.
601 N,W, Second Slteeto P,O, Box 39
Evansville, IN 47701-0039.800.325.2147
A Member of American lntemational Group. Inc,
June 6. 2005
RE:
Exhibit liD"
T-094 POOl /007 H46
I;
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F\FILESIDA T AF1LE\GeJ1eral\Current\11750.1atTl lmas
Created 11/15/05002PM
Revised: 1119/06 3:33PM
11750]
George B. Faller, Jr., Esquire
MARTSON DEARDORFF WILLIAMS & OTTO
LD, No, 49813
10 East High Street
Carlisle, PA 17013
(717) 243-3341
Attorneys for Plaintiff
CAROLYN J, NEIDIGH, Executrix
of the Estate ofDA VID D, LAUVER,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
v,
NO, 2006-77
CNIL ACTION - LAW
MERIT LIFE INSURANCE CO.,
Defendant
JURY TRIAL DEMANDED
AFFIDAVIT OF SERVICE
COMMONWEALTH OF PENNSYLVANIA )
: SS,
COUNTY OF CUMBERLAND )
I hereby certifY that a copy ofthe Complaint was mailed to Defendant Merit Life Insurance Co" at
601 N,W, Second Street, Evansville, Indiana 4770 1 on January 5,2006, by certified mail, return receipt
requested,
Attached is the Post Office return receipt signed "Rodney Schmitt" and dated January 10, 2006,
4
,/ ~f5/
George B, aller, Jr., Esquire
Sworn to and subscribed before me
this J3..I;1.L day of January, 2006,
~yt( ct..w
No Public
c
NWEALTH OF PENNSYLVANIA
Notarial Seal
Mary M, Price, Notary Public
Ca~lsl. Bore, Cumberland County
My Commission ExpifeoAug, 18,2007
Member. l'et'lM!llvll,1I AtlClRtlanof NoI8rtII
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U,S. Postal Service",
CERTIFIED MAIL" RECEIPT
(Domestic Mail Only; No Insurance Coverage Providf d)
, O'iJl3 '_
I'l.f~l '. '\
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Total Postage & Fees $ $5.11 . O~~~_6'
g S~ffl~/d___k~__u____->'-:02!4~Jt\~:u---~(J-~f-~~~Y-
r- s;ro.t,ApI.No';r_A ,\1.\ LD/O uJ ~'f
0' PO SoxNo, \Qt) L_!\J_'_~u..:.<l.k~L!O--D _._u____________.._____
ci~----i9;------u;.0 Ill' :;; N7 10 /
Postage $
Certified Fee
Return Reciept Fee
(EndOrsement Required)
o Restricted Delivery Fee
....=t (Endorsement Required)
CJ
....
'2.30
'1.75
'0.00
"
SENDER: COMPLETE THIS SECTiON
. Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
. Print your name and address on the reverse
so that we can return the card to you.
. Attach this card to the back of the mail piece,
or on the front if space permits.
;nArt;l+d"'G~ :1ra-.(C\J1C.2 CO,
(PO I N .lD. StL'orv1 stlf'€+
-\),0. bo'l- 3S
(.0l'\(1SJ d Ie I:LN Lj 11 () I
2. Article Number
rr- from _1sbeI)
PS Form 3811, February 2004
\, I Cu.M!
.
A. Signature
x
o Agent
o Addressee
D. v address different from Item 1?
I~ 1 enter deliver;.' :~dress below:
\ I' j'
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DYes
o No
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3. Servic -',
t!J Certified Mail" '
6'Registerecl
o Insured Mail
o Express Mail
[ . Return Receipt for Merchandise
OC,Q,D,
4. Restricted Delivery? (Extra Fee) 0 Yes
7003 1010 0001 1188 7408
1 02595-02-M.1540
Domestic Return Receipt
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REED SMITH LLP
By: Wayne C. Stansfield
Identification No, 81339
By: Joseph J, Tuso
Identification No, 88044
2500 One Liberty Place
1650 Market Street
Philadelphia, PA 19103
(215) 851-8100
Attorneys for Defendant
Merit Life Insurance Company
CAROLYN NEIDIGH, EXECUTRIX OF
THE ESTATE OF DAVID D. LAUVER,
COURT OF COMMON PLEAS
CUMBERLAND COUNTY
Plaintiff,
v,
No, 2006-77
MERIT LIFE INSURANCE COMPANY,
Defendant.
PRAECIPE TO FILE NOTIFICATION
OF AND COPY OF NOTICE OF REMOVAL
TO: THE PROTHONOTARY
COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PA
As provided under 28 U,S,C, S 1446(d), please file the attached Notice of Filing
and copy of Notice of Removal filed by Defendant Merit Life Insurance Company in the United
States District Court for the Middle District of Pennsylvania on February I, 2006,
Dated: February 2,2006
Attorneys for Defendant
Merit Life Insurance Company,
.,
~
CERTIFICATE OF SERVICE
I hereby certify that I caused to be served a true and correct copy of the foregoing
Defendant Merit Life Insurance Company's Praecipe to File Notification of and Copy of Notice
of Removal via first-class mail, postage prepaid, this 2nd day of February 2006, upon the
following counsel of record:
George B. Faller, Esquire
Martson, Deardorff, Williams & Otto
10 East High Street
Carlisle, PA 17013
Counsel for Plaintiff
~
t"
REED SMITH LLP
By: Wayne C. Stansfield
Identification No, 81339
By: Joseph J, Tuso
Identification No, 88044
2500 One Liberty Place
1650 Market Street
Philadelphia, PA 19103
(215) 851-8100
Attorneys for Defendant
Merit Life Insurance Company
CAROLYN NEIDIGH, EXECUTRIX OF
THE ESTATE OF DAVID D. LAUVER,
COURT OF COMMON PLEAS
CUMBERLAND COUNTY
Plaintiff,
v,
No, 2006-77
MERIT LIFE INSURANCE COMPANY,
Defendant.
NOTICE OF FILING NOTICE OF REMOVAL
TO: THE PROTHONOTARY
COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PA
Please take notice that on February I, 2006, Defendant Merit Life Insurance
Company filed a Notice of Removal, a copy of which is attached hereto, in the United States
District Court for the Middle District of Pennsylvania, The filing with the Court of Common
Pleas, Cumberland County, Pennsylvania, ofthe Notice of Removal attached hereto has
effectuated the removal of this action in accordance with 28 U,S,c. SI446(d),
t s leld
Jos J, 0
ED SMITH LLP
2500 One Liberty Place
1650 Market Street
Philadelphia, PA 19103
(215) 851-8100
Dated: February 2,2006
Attorneys for Defendant
Merit Life Insurance Company
,#0
,
CERTIFICATE OF SERVICE
I hereby certify that I caused to be served a true and correct copy of the foregoing
Defendant Merit Life Insurance Company's Notice of Filing of Notice of Removal via first-class
mail, postage prepaid, this 2nd day of February 2006, upon the following counsel ofrecord:
George B. Faller, Esquire
Martson, Deardorff, Williams & Otto
10 East High Street
Carlisle, PA 17013
Counsel for Plaintiff
IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF PENNSYL V AN
[PQ[S~[Q) t
FE8 0 1 2006 t
l
A
,PER Dv=\
i ~!\f;RISBURG, PA. DEPUTY CLERK
CAROLYN NEIDIGH, EXECUTRIX OF
THE EST ATE OF DAVID D. LAUVER,
CNIL ACTION
Plaintiff.
v,
1 ~o,C V
06-0242
MERIT LIFE INSURANCE COMPANY,
Defendant.
NOTICE OF REMOVAL
Defendant Merit Life Insurance Company ("Merit Life"), through its undersigned
counsel, Reed Smith LLP, hereby removes this action from the Court of Common Pleas of
Cumberland County, Pennsylvania, to the United States District Court for the Middle District of
Pennsylvania, and in support thereof states as follows:
L On or about January 4,2006, Plaintiff Carolyn Neidigh, Executrix of the
Estate of David D, Lauver ("Plaintiff') commenced this action by filing a Complaint in the Court
of Common Pleas of Cumberland County, Pennsylvania, docketed at No, 2006-77, against Merit
Life, A true and correct copy of Plaintiff's Complaint is attached hereto as Exhibit "A."
2, Rather than properly serving Merit Life through its authorized agent for
service of process in Pennsylvania, Plaintiff sent the Complaint to Merit Life by certified mail,
which was received on or about June 10,2005,
3, Removal of this action is proper under 28 U,S,c, S 1441 (a), which allows
for the removal of any civil action over which the district courts of the United States would have
original jurisdiction,
, '
4, The Notice of Removal is timely under 28 U,S,C, S I 446(b) because it is
being filed within thirty (30) days of receipt "through service or otherwise, of a copy of the
initial pleading setting forth the claim for relief upon which such action or proceeding is based,"
5, This Court has original jurisdiction over this action since the parties are
citizens of different states and the matter in controversy exceeds $75,000, exclusive of interest
and costs, See 28 U,S,C, S 1332(a), More specifically, original jurisdiction is present in this
action because:
a, Decedent is an adult individual residing at 207 Frytown Road,
Carlisle, Pennsylvania 17013. See Ex, A.
b, Merit Life is an Indiana corporation with a place of business
located at 601 N,W, Second Street, Evansville, Indiana 47701.
c, The relief Plaintiff is seeking, which is in the amount "in excess of
$40,000," "plus interest and delay damages" and "punitive damages" (see Ex. A), is relief in
excess of $75,000.
6. Accordingly, had this action been brought in the United States District
Court for the Middle District of Pennsylvania, this Court would have had original jurisdiction
over the subject matter under the provisions of28 U,S,c, S 1332. As a result, this action is
properly removable to this Court pursuant to the provisions of 28 U.S.C, S 1441.
.2.
"
WHEREFORE, Defendant Merit Life Insurance Company respectfully requests
that the civil action commenced against it be removed to this Court for all future proceedings,
Respectfully submitted,
/s Wayne C. Stansfield
Wayne C. Stansfield
Joseph J. Tuso
REED SMITH LLP
2500 One Liberty Place
1650 Market Street
Philadelphia, PA 19103
(215) 851-8100
Attorneys for Defendant
Merit Life Insurance Company
Dated: January 31, 2006
-3-
JS44 CIVIL COVER SHEET (Rev 3/99)
The JS-44 civil cover sheet and the information contained herein neither replace nor supplement the filing and service of pleadings or other papers as required
by law, exc:ept as provided by local rules of court, This form, approved by the Judicial Conference of the United States in September 1974, is required for the
use ofthe Clerk of Court for the purpose of initiating the civil docket sheet. (SEE INSTRUCTIONS ON THE REVERSE OF THE FORM,)
I.(e) PLAINTIFFS
Carolyn Neidigh, Executrix of the Estate of
David D. Lanver
(b) COUNTV Of RESIDENCE Of fiRST LISTED PLAINTIFF Cumberland
(EXCEPT IN U.S. PLAINTIFF CASES)
(e) ATTORNEYS (FIRM NAME, ADDRESS, AND TELEPHONE
NUMBER)
George B, Faller, Esquire
Marlson, Deardorff, Williams & Otto
10 East High Street
Carlisle, PA 17013
DEFENDANTS
Merit Life Insurance Company
COUNTY OF RESIDENCE OF FIRST LISTED DEFENDANT Vanderbur1!h Countv.,
Indiana
(IN u.s. PLAINTIFF CASES QNL VI
ATTORNEYS (IF KNOWN)
Wayne C. Stansfield
Joseph J, Tuso
REED SMITH LLP
2500 One Liberty Place
1650 Market Street
Philadelphia, PA 19103
(215) 851-8100
II, BASIS OF JURISDICTION
(PlACE AN X IN ONE BOX Ot.L v)
CONTRACT TORTS FORFEITURE/PENALTV BANKRUPTCY OTHER STATUTES
181110 Insurance PERSONAL //IJUR'I PERSON4lIHJURY o 610AgTicullufB o 422 Appeal 28 use 158 [] 400 Stale Reapportionment
0120 Manne o 310Alrplane o 362 Personal Injury- o 620 Other Food & Drug [] 423 Withdrawal []410 Antitrust
0130 MaUer Act o 315 Airplane product MedMalpractice o 625 Orug RelaledSeiZIJreof 2SUSC157 o 430 Banks and Banking
0140 Negotiable instrument Liabl~1y o 365 Personal InjIJry- Property 21 USC6a1 o 450 CommerceflCC Rates/etc.
0150 Reoovery of Overpayment o 320 Assault, Libel & Product Liablllly o 630LiquorUiws PROPERTY RIGHTS 0460 0ep0mIti0n
& Enforcement of Slander o 36a Asbestos PefSonal o 640 RR & Truck 0470~cketeerlnnuencedand
-~'" o 330 Federal Employer Injury Product o 650 Airline Regs o 820 Copyright CorruplOrganiUltlons
0151 Medicare Act liability Uabdity 0660 OccupaliooaJ 083DPatern o 810 Selective SeNlce
0152 Recovery of Defautted o 340 Marine PERSONAL PROPERTY Salety/Health o 840 Trademar1l o 850 Seauille&lCommCldmesl
Student Loans o 345 Milrine Product o 370 OlherFraud o 6900lher exchangE!
(ExcLVeterans) Liabiffly o 875 Customer Challenge
0153 Reoovery of Overpaymerlt o 35OMOIorVehicle 0371 Truth In lending SOCIAL SECURITY 12USC3410
of Veterans Benefits o 355 MotorVehit:le o 300 OIherPersooat LABOR 0891 Agl1culturalActs
0160 Stockholders Suits PltldlJctUablllly Property Damage u 710FaiTLaborStandan:ls o 861 HIA(1395ff) o 892 Economic Slabilizatlor1 Act
0190 Other Conlract o 360 O\herPersooal o 3&5 Property Darnage o 662 Black lung (923) o 893 Enlrtronrnen!al MaIterS
Property Liability Act
0195 Conlract Product Liability Injury o 720 LatloflMgmt Relations o 863 DIWC/OIWW (405{g)) 0894 Energy Allocation Ad.
o B64 SSID Tille XVI o 895 Freedom 01 Information Act
REAl PROPERTY CIVIL RIGHTS PRISONER PETITIONS o 730 LaborlMgml. Reporting & o 865RSJ(405(g}) 0900 Appeal 01 Fee Detennlnalion
o 210 Land Condemnation o 441 Voting o 510 MollonslO Disclosure Act Under Equal Access 10 Justice
o 740 Railway Labor Act FEDERAL TAX SUITS 0950 Consttlutionalityof
o 220 Foreclasure a 442 Employment Vacate Sentenre State Statutes
o 230 Reot L&ase & EJectmeot o 443 Housingl HABEAS CORPUS: o 790 O\herLabor Utigation o 870 Taxes (U.S. Plaintlfl m 890 Other Statutory Actions
o 240 TortS 10 Land Accommodations 0530 General or Defendant)
o 245 ToctProductliabil/fy 0444 Wf:JIlare o 535 Death Penalty o 791 EmpJ. ReI. Inc. o 871 IRS - Thln:l Party
o 2Q() All Oltler Real Property o 440 Other Civil RIghts 0540 Mand<lmus & Other Security Act 26 USC 7009
o ssoCivil R1ghls
o 550 Prison CondillOns
Transferred from
01 Original 181 2 Removed from 0 3 Remanded from 0 4 Reinst<Ned or 0 5 another district 0 6 Multidistrict
Processing Stale Court Appellate Court Reopened (specify) litigation
VI. CAUSE OF ACTION (CITE THE U.S. CIVlL STATUTE UNDER WHICH YOU ARE FILING ANO WRITE A BRIEF STATEMENT OF CAUSE.
DO NOT CITE JURISDICTIONAL STATUTES UNLESS DIVERSITY.)
Claim based on alleged life insnrance policy
VII. REQUESTED IN CHECK IF THIS IS A CLASS ACTION
COMPLAINT 0 UNOERF.R.C,P,23
o 1 u.s. Government
Plaintiff
o 3 Federal Question
(U.S. Government Not a Party)
181 4 Diversity
(Indicate Citizenship of Parties
in Item 1II)
o 2 U.S. Government
Defendant
IV. NATURE OF SUIT (PLACEANXINONEBOXONLY)
V, ORIGIN
(PLACE AN x IN ONE BOX ONLY
III. CITIZENSHIP OF PRINCIPAL PARTIES (PtACE AN X IN ONEBOX FOR
(For Diversity Cases Only) PLAlNTlFF AND DNE BOX FOR DEFENDANT)
PTF OfF PTF OfF
Citizen of This State 1811 01 Incorporated or Principal Place 04 04
of Business in This State
Incorporated and Principal Place 05 1815
of Business in Another State
Foreign Nation
Citizen of Another State 02
02
Citizen or Subject of a 03
Foreian Countrv
03
06
06
Appeal to District Judge
o 7 from Magistrate
Judgment
DEMAND $
Check YES only if derrendecl in corrplaint
JURY DEMAND:
18I YES
[J NO
VIII. RELATED eASElS) (See 1"lrudion'I'
IF ANY
JUDGE
DOCKET NUMBER
DATE IIJI/ora
FOR OFFICE USE ONLY
RECE1PT# AMOUNT
SIGNATURE OF ATTORNEY OF RECORD
v)
APPlYING IfP
c
~
./
-~
JUDGE
MAG. JUDGE
,/ j It-- \ \, It ~
~
F .flLi::$\DATAFILE'.(ic'"","I'Cullem 11'<'1 I ,,,,,,I:,,lm
n"'lltd 1,1~,li:; O')2P~1
Q.~\1,cd . '~'i111 10 ~~A\I
. ,~~.) ,
George B. Faller, Jr., Esquire
MARTS ON DEARDORFF WILLIAMS & OTTO
I.D, No, 49813
10 East High Street
Carlisle, PAl 70 I 3
(717) 243-3341
Attorneys for Plaintiff
CAROLYN 1. NEIDIGH, Executrix
of the Estate ofDA VID 0, LAUVER,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL V ANlA
v,
NO, ~oo(" - ? 7-
CIVIL ACTION - LAW
MERIT LIFE INSURANCE CO"
Defendant
JURY TRIAL DEMANDED
NOTICE
You have been sued in court, If you wish to defend against the claims set forth in the following
pages, you must take action within twenty (20) days after this Complaint and Notice are served, by
entering a written appearance personally or by attorney and filing in writing with the court your defenses
or objections to the claims set forth against you, You are warned that if you fai I to do so, the case may
proceed without you and a judgment may be entered against you by the court without further notice for
any money claimed in the Complaint or for any other claim or relief requested by the Plaintiffs, You may
lose money or property or other rights important to you,
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE, IF YOU DO
NOT HAVE A LA WYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW, THIS
OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER,
IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAYBE ABLE TO
PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL
SERVICES TO ELIGIBLE PERSONS AT A REDUCE FEE OR NO FEE:
Cumberland County Bar Association
32 South Bedford Street
Carlisle, Pennsylvania 17013
Telephone (717)249-3166nt ''" '
I ',uc. C;(.Ji-~ ;" F Cj
II TastlliJonv "'/18,':'" ','9M P,:::e:OF""-i
"rJt1 trill "",/ " . ,I "'Ii' "m" f,,,
r """" u' ""; v"" <.r.( ~ >_
J . f--~' ")<Cl~,~,' (:(lVI1 .:~t (~ 0 'To I, -' JNi"tJ
'v - ~I~SJ,@ n...
1 vt...!. ,,~
~Clt1"1f4t::
George R Faller, Jr., Esquire
MARTSON DEARDORFF WILLIAMS & OTTO
LD, No, 49813
] 0 East High Street
Carlisle, PA 17013
(717) 243-3341
Attorneys for Plainti ff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CAROLYN J, NEIDIGH, Executrix
of the Estate ofDA VID D, LAUVER,
Plaintiff
v,
NO,
CIVIL ACTION - LAW
MERIT LIFE INSURANCE CO"
Defendant
JURY TRIAL DEMANDED
COMPLAINT
1, Plaintiff Carolyn J, Neidigh is an adult individual and is the duly appointed Executrix of the
Estate of David D, Lauver, who died on January 31,2005,
2, The Defendant Merit Life Insurance Co" is an insurance company authorized to write
insurance in Pennsylvania with an address of601 N,W, Second Street, P,O, Box 39, Evansville, Indiana
47701-0039,
3, On or about September 17, 2004,DavidD, Lauver completed an Application for Group
Monthly Outstanding Balance Credit Life and Total and Permanent Disability Insurance with the Defendant.
A copy of that application is hereby attached as Exhibit "A"
4, All of the premiums far that insurance were paid from September 1 7, 2004 up through the
time of David D, Lauver's death on January 31, 2005,
5, The Plaintiff decedent had met all conditions precedent under the policy by completing the
application and paying all the premiums,
6, TheDefelJdal1t originally denied Plaintiff s claim by letter dated April 8, 2005, claiming that
the death was as a resultofa"pre-existing condition," A copyofthe April 8, 20051etterto the Plaintiff
trom Monica 1. Hape is hereby attached as Exhibit "R"
7, On May 25,2005, the Defendant then tried to claim that the claim was being denied for
a material misrepresentation by Mr, Lauver when he compleled the application, A copy ofthe May 25,
2005 letter to Carolyn Neidigh from Monica L HapeofMerit Life Insurance Co, 's claim department is
hereby attached as Exhibit "c."
8, When asked to clarify her position, the Defendant sent another letterto the Plaintiff s
representative dated June 6, 2005, A copy of that letter is hereby attached as Exhibit "D,"
9, In that letter, Dana L. Harris, Claims Supervisor of the Defendant, claimed that Mr.
Lauver's medical records verify treatment for "fairly severe coronary artery disease,"
10, The medical record which the Defendant was referring was incorrectly quoted in the
June 6, 2005 letter, The entire assessment to which the Defendant referred states, "Fairly severe coronary
artery disease in the past with angioplasty and stint, history ofMI hypertension and GERD,"
11, The medical records from September 17,2001 through September 17, 2004, do not show
any treatment, medical advice or evidence that Plaintiffs decedent had heart or circulatory disorder; cancer
or tumors; diabetes; stroke; disease ofthe liver or kidney; alcoholism; drug addiction; any brain, nervous
system or mental/neurological disorder.
12, The policy requires payment of the outstanding balance of the credit account on Mr,
Lauver's date of death,
13, As of the date of death, the account was in excess of $40,000,
WHEREFORE, Plaintiff demands j udgment against the Defendant for an amount in excess
compulsory arbitration limits, plus interest and delay damages,
COUNT II
14, The averments of paragraphs I through 13 are hereby incorporated by reference,
15, In evaluating Plaintiff s claim, the Defendant obtained certain medical records from the
Graham Medical Clinic,
16, The Graham Medical Clinic records clearly do not support a basis for the denial of
Plaintiffs claim,
WHEREFORE, denial of Plaintiff s claim was dorrein bad faith and subjects the Defendant to
punitive damages,
MARTS ON DEARDORFF WILLIAMS & OTTO
Date: January 4, 2006
,
By ",
George B, Faller, Jr,: Esquire
LD, Number 49813
10 East High Street
Carlisle, PA 17013
(717) 243-3341
Attorneys for Plaintiff
VERIFICATION
The foregoing Complaint is based upon information which has been gathered by my counsel
in the preparation of the lawsuit. The language of the document is that of counsel and not my own,
I have read the document and to the extent that it is based upon information which I have given to
my counsel, it is true and correct to the best of my knowledge, information and belief. To the extent
that the content of the document is that of counsel, I have relied upon counsel in making this
verification,
This statement and verification are made subject to the penalties of 18 Pa, C.S, Section 4904
relating to unsworn falsification to authorities, which provides that if I make knowingly false
averments, I may be subject to criminal penalties,
/, ,', , I ( ',)
\_ :e' ",''i. i', '- "
Carolyn], Neidigh, Executrix of the
Estate of David D, Lauver
\.tar-2S-05
J2..\ I om
~-Jm-A~I~,can GI"I"d
~\~'-C"~\( \
I~
I
I
717 243 5546
T~146 P 001/001 F-424
rr-~~,
.A-1erit Life.
,,,...._ Co..
A Sleet.: Campany DDmlC"i~d In indiana
801 N.W. S..:,.,,,d St....t, P.O. Elo:- 39,
E'iv.".v,lI_, IN 47701 0030
'.800-3.2:3.2147
: Ii "'CCOUNT NUMBER I SCHEDULE Group Master Policy Number: AG-38-2QO
: 13498728
, Name end Address of BORRowER i"''''l pt ."n niilm..,1 FIRST li1ENEF1CIAFlY (CReOITOR)
I belelw) and CO-BORROWER AJ'I"'RIC""", GENEIl.AL cON'SUMEll DISCOUNT COMPANY
DAVID D LAUVElt 6 5 fiANOVER ST
I 207 f'~"tTOWN ROAD cA.RLrSLE. Ph 11013-0417
CARLISLE, PA 17013
BelrrCINe C0-6.:>r(0.....,... 5.-cal'\d Ihtn.rleiary (SoIT_I'); (/:; mol,-, J?; /1. ''-'''';J!._~
Etr-.::tiv. E
Date Ago A.. Second S,,"etleiary (Co-BD~): r
09/17/04 49
Type elf InSl.lra"c:. MAXfMUM TERMINATION Monthly Prwrnlum RaIe for Each
Sing'. Lir.. [Xl Joint Uf.. [ ::::J ISSUE AGE AG~ S1000 or Av.l'lIge C."y a...~
Jolntu.. SlngJe LIfe
[KJ Berro......,. 65 66 >NONE _844
-l..ile In,..,,.."cc InclLld.::II co..v.g_ .
CJ Co-Born)wer lor Tenll &. Por ."lImlor_billty. ~~ Yea... I
APPLICATU NFOIilGROIJP MO/IfTHLYOIJT.TAJ!iIp.tIIG .,A!;ANC~ ,
CREDIT LIFE No TOTAL AND PERMANENT DISA81L1TYINSURANCE
FRAUD WARNING: ANY PERS,?!, WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY
OR OTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CO,NTAINING ANY
MATERIALLY FALSE INFORMA ION OR CONCEALS FOR THE PURPOSE OF MISLEAOING., INFORMATION
CONCERNING ANY FACT MATE~ I I. THERETO COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME AND
SUB.JECTS SUCH PERSON TO C MINAI. ANO CIVIL PENALTIES,
I am applyIng for the Insura.nce r arked above, I authorize the Creditor to add the monthJy premlum(s) for; the Insurance to
my loan eaGh month as they becom due. It the requested InsuranGe becomes effectfve, the coverage will be in effect for the
amount and term for which premJun has been paid. I understand this Insurance pays any claim benerrt to th~ Creditor on my
behalf to reduce or extinguish my dE bt. I declare that the answers on this Application are true and comp~ to the best of my
knowledge and belief. My answers may be relied upon by the Insurance company and are the basts on WhiCh the Insurance
may be issued.
Borrower C,o-BolTDWer
I (/J - S- -s:> I 1. What 5 your date of birth? I I
Yes (!f' Durtn the past 3 years have you received mectlcal advice, been treated Yes No
C 2" C C
for,)~ been told you had. Acquired Immune Deficiency Syndrome
f2(" (AID or AICS Related Complex (ARC)?
0 3, Durin the past 3 years have you received medical advice. been treated ,0 D
for. 0 been told you had, any of the following conditions: He..n or I
C'lrcul tory Disorder. Cancel' or Tumor; Diabetes: Stroke: Disease af the
LIver r Kidney; Alcoholism; Drug A.ddlction; any Brain. Nervous System
arM. taIlNeu.-ologlcal DIsorder?
AND TOTAL AND PERMANENT DISABILITY COVERAGE IF YOUR ,
YOU ARE NOT ELIGIBLE FOR LlF AGE EXCEEDS
65 ON THE DATE OF APPLlCATI ';',YOUARIi,lI!IOTeU~.UU'OR LIFE AND TOTAL AND PE;RM"ANEIIlT OlaAIIILlTY
COVERAGE IF YOUANSWIiRl5D . S" TO_1!!$1'IGIlhU:GIlIl,#3. '
EFFECTIVE DATE: Upon accep nee and approval of this application by the insurance company. the insurance
becomes effective as of the data y u applied for the Insurance. The effective Date is shown above. I
TERMINATION AGE; Your insur nee cOV8tc1ge will end an the closing data of the billing cycle (statement date)
Immediately fallowing the date yo attain age 66_
PRE.elJIIS/f"JN<;l CONDITION:!f II OS8 results directlY O:f' ind'...c:tfyfrom a"pre.ai.stin:$lCQndftfon..nO'~wfILI:J,e
paid.. A:,pr.....~d.tI,f19'col1cfltlonis:...:i C~tiot1..td.r which. yOll, .r:ece1v..,m.cffCaJ'acIvICIJ. -diagnosis',or treatll'fem withiri'the
sfxmonfhS"befO....'the.ft'iH:tfvedill ,eat cDve1"8.~e:or th.d~.,";:.n.ctvanf:e.nd which cau:sect _ toss within she. months
following: the .ffectlve date of eOV' tag. Or' th*dato afsUt:h advance. .
f represent that the informatlon_ <; d answers given on this application are true and complete to the best of my knowledge
and belief. I understand that satisfa tory evidence of insurability means that I have truthfully ..nswerod "No" ta the applicable
questions above. Untruthful answer. may resuh: In denial of claims. I understand that if any answers to the qu'estlons are false
and untrue, the Insurance Compan ~~ liability Is limited to the r:lum o! the premiums paid for coverage (subject to the
ncontestability provision). Upon a eptance and approval of thiS Appltcation by the Insurance company, the insurance
Jecomes effective as of the EtfectJv Date Shown above" I understand that the insurance applied for Is optional nct required
lor a condition to obtain any loan c credit transaction, , further declare that I have read or had read to me this statement
)efore signing below.
10 not sign this application if a~:!i spaces applicable to the borrowel'(s) electing coverage ilnd to the coverage being
I@cted have not been completed. The apptic::ation will not b. used .In a contest" the borrower(s) ha.s not answel"l!d
18 questions applicable to th@ c verage being applied for ancf/or if the borrower(s) hilS not Signed: and dated the
ppllc.atlon_ ~h#~
ate '7' ", 014' Signature 01 8 rrowvr 'J ~ . ,./) .J) ,;{.-..- ,....
Witness
... Signllture of C Borro.......er
'=V-APP-PA
.>:721 (01-31..03) PA O~nd Applic'lIIlon lco" Inoo , ,-
Exhihir- "A"
,_..-
J"-)6-0\
04. Slom
From-in,uranci Cla.m,/Poll(,ei
+
r-a94 P 0D21DJ1 HH
oz.1l4l2OO51)'n07 Pro.1 Sel"wer .1GFRF;:1M1G .10: 109061) "'gill: 3J
FI~..~IHjS a'-(~g, Ffor.v.,rICi~ .1tolol l:i loll 55~S T...."go P.005/033 I=.(BZ
I
Merit Lite.
,~Co.
A__-"~
S01 N.W. S.eoncl9ll'e<<. P.o. ~,
EVOI'l3Yh.IN 4""01.oos::l
,~l;C'f..7
"
AC:l:o\JJrfT'NUM8Ift I :sCHEOU~ GIlIUO Malct parlOy Numbr. AC-JO-ZiIo
U498708 I
,...,._~oIDOA..tMltR (1ir.;t~ IlIlN!'11 Il:,RST SeNEPlelAJtY tC:REOrTOA)
~'''''' eo.sCRROWIOR ! AIOlUCJIQ GIJItRA1. CONSllIlU DISCOtm'r COl1PAN'!
-'IO D 'L&II'n1 I l5 S B.\NO'9'SJ, s't
107 FAitO~ ROAD I CARL~$LEI r~ 17013-0417
CARLISLE, .~ 17013
....- _s c..-, ~..~~.~.
8 nr n~l
- ... ... fCIINt '1 :
09/17/04 49
"...,........ - mlAlliATlON MoIIIlrt__rsr_
_"'s. (JJ ......... Cl ISIUE AGE AGl! $1OC1QafAWSllgII:_~
Jon uro _UIO
ro- I 6$ 6<l .110_ . ,B44
~~-.. '" .....
DC:I>8clfTDtoC lao'T"" ~
CERTIFICATE OF INSURANCE :
NOTIC!!: THIS INSURANCE IS UMIT!D TO A MAXIMUM OF $ 10000a I
AND MAY NOT BE ENOUGH TO COMPl.ETeI. Y PAY OFF YOU'" ACCOUNT ,
THIS CEli11l'lCAT ' CONTAINS A .....I!-I!XI8TINC CONtllTIDll EXCLUSION
Th. at_ lIlltII of ifdU""!! ~ the _ you appl~ fo' ..,,_.. You wl6 not 'r.ce.... a ~_ .t lOW"""!
_.... dr.llili'iIJ _._ ~1Illl.anll_untl_.._n_1IIX 11I"_ ~ri....tal/Our_b ..ts
and ",,_nt_1IlIy IrYourdelUh Ot_I1lIy"''- bY" ...._ng.._n. Il~_....
" CO_ hI< _lIOY:.t:.r' .ltlla8Il_ __ .. b_ _n "'" __ prIOr", Ill. - '
_..,--..,. .tIM _III... _..... whim GI_"" wIIhln * 1IIO_'on__ _ ..- _t ,
YhtC1lrtlll_fot__ II
OnlY 1IIllI """""00 _ under 'T_ of I""""""" Is lIflectiva under IIlls Cerlifiat.. In IIlls ce_ th. wont
"OOr_ _10 llleS."""""!' c_ ...mOd -, A.mllllfmum 01_ -m.y'" iMlJ"'" D/lClaf 1"'
C8rUrtaare. The waRls "YOU- or '"yoll"" ntfer to bDtI"DWeIS whO ftlnsl.nd under this C.rtiftCltI. The IMam "'-II, -UI'" or"ou I
"';'rl<tMetfl L/Ia I_Co. '
_ r Thts o.runoet. r. .-abj_d to ttle t at tn8 Ql1tUp PoliCY h:cued ta the CroCIllor named &bow V4 III evJd."~ OfJ'"
_tl"" _erllle GtodJl Policy, I
lUGtIT TO RESCIND; YOu may 'nil _ C;'- by OMI\o ... allg<ltd and d__ _ within 30 dO,.
the dMe you rICIIVe iL If joint inIu~ee is In 1ft'8CI. bOth bof'1'tM8t8 must aisrn the wrttten natir.. ,.,.. IftBUf'8nce is then void
hrn jts I2faGtivs O. I I :
EUClIIIIUTY, Y.. .... ....n f.....d arlQlll. 1ll<........... III1d...... GIlIun _ P.... by meeting tho f_1ii
""l""0llIS: (1) )<>II have nal _ 0111 61 ..,1he _ 01 oppr_, C2l )'00 blve ptDVidld _ry evidence of
rnm.nbiIty; &ncI (:I) you ..-q&IA&UNI 1:1\8 Fnt>> GIld ....1D ~ me monthly lMucwnc. prwmivrnc f4 fIht Onlcfitol". '
TERMlNA1lON AGe: YDUr L"!:urancc cov...ge win end ..n Ihe cloSing date Qf !he billing cyel~
(statemenl date) immedlataly r'llowing !he date you lIfIafn age 66. ;
UFI! ^NJ? TClTAL ANO P!!lIMANI!NT ClleABIU1'Y 'NSLlItANee I!
DEFINITION OF TOTAL AND PERMANENT DISAIIIUtY, Talal..~ POnn8n1nl d_liIy m.a... lIlot YO. lUo tolOl~
ptI\'I1l1t1t1lll\1 and cantlnuouoly UI1abI. to enguo. in all)/ aocuplltian. smpl<lymett or atliYity for COnlpentaUan a, pmflt for Whl'"
yau 8n!- suit8d by ~c:llla". 'b'Ginino Dr 1bP1lk'fMtc:a, IICCSnifftg to .... cattltic::;Uon aI :a ph)sId.U or podbtti:st. W. m8Y wai..,o
tIIs pny>iCian 0' podIatt1ot's celllllOalto/l If you '"'V8............lhe ............,... or IIg/It of bolh .,., .rl/lo severo... af bOrh
h."dlr, J)Otf) fttlt. Dr Df ODe hend and oqe taot lit Dr abOve me wrtst or ."'Ida. : I
UI'E AND TOTAl. AND PERMANENT DISADIUlY BENEFIT; If yau d1s Dr be<Ome tDl3lly Br1d pormanent1y disabled
wnlle In5urecI undw' UUS Certlftalh, ,. wnJ pay VIe .mmun. of lnSulW1C8 In fcm:a allhlt time at Cfe8th or tot!l and pesm:m&itt
.lsabillly, Such """""nt will be Mljde wilen ww _ rxaof of 10.. aM Will be paid .. __ in tlw !IENB'lCIARlr
IMVlIiSiOn. IfsinOIe Ins&nnce is in street. the death <<total and,oennanem dis;Dlfty OflJ'l8 DamlWel'wtUtemriMtll theinSurand8
_t/Jis~ Ifjoinl'............isill_ _.nl~ Dftt __ or_eslDlaIIv 8l1ll0....anOflllY <119I."",1
single ImIutance wII _.. in fora. .n tho tWlI1lIlnlng borrower I/llI . 0;1191. inlNtlln.., oortiIICSID will .. issued, If .eel
bo,_ suffer a loSS Bllllo ..... ...., anly ONE _tit wi! be lIOid, This benefit ,,"Ill<! paid as Slated In the Benelld.",
""'.....n 'or /OIn' CllVtlt100 wII.... bo'" _ _.... ,... ....1liWII.usIy, : '
.........,.Ano,. OP UF1: ANO TO"M.&. AND PERMAH&NT DfIlIADILl'I'V IN8llKANce I5EN~ I i
SUIcide: "~camm.l SUICidl dJPing 1M ~ .12 consecutiVe month5 an,r tn. Elfedfvl Done r1I alverage. no Jn~n~
Der.em wiD be ptlid. AIllMUf3tlc: p~ paid WID be,.fu1ded to JOu or. .. the Ciedl:ars option. mdted tEl your account, I
tt you commit Nlckte during the ~ 12 CO/\Secutfve rnonthlllner U"e data ar an adVMe.e, no Insurance benefit will be pUid
for such edV'8"cc:' ,AII1ft3W'W1Ce pt'1:fnIum, paid fof'thar: advanlZ Will be If!RnIe:J ro you or. .at me 01!dft0r'!l "~n amitMI to
yoUor aceaunt. Ths 12 mont;h sWcide!l.ISton .runs ~,. for each .advanoe; nowev<<. a bter SCIVlInce doe,l\Q\ re--st..rt.
UtB 1 Z tnonlh 5VJaae ~l,)n pet100 tor &n1" Pflor .acvaltl;;8S. I
ML3-274e-.l:!Ot""A I
"'~1~AJOInr"~HELOe~'" . J;
J",-06-05
0452,m
From-Insurance Cla''lls/Pollcirn
.
T-a94 p OOl/oor H.,
OUJ1-'1OO6 12.il:1.'S PM Se~ .a.GFRFAll.l,7 JIQ: 196197 Psgn:S
Fib-II-OS 12-SdOl' F'o.-A....,iCil.1l '!flInt I 111 243 5S.t' r.006 P. 003/0~S F.OIQ
I. P...ExlsII"1 con4i1ion; A ptIHloIisling ""ndiUon ill 8 condition for which l"'" rocaived medical allYlce, dlJlQ"osi. or "
tre:nmttll wiUlin 1he sIX mom/1$ ptfart. the lilfec<i..... DIlle of cowrage, or 11I& dol. 01 an edvance. ElMd wIli<:h ""vsed your .."
I Cle.!\ft Ottot.1llna permanlMtGhlWlttfwithin e mtmmI tollCNlifll $uCt'I dale. _ _ :.;'
lf)'Oolr _,#I loIaIlIdtj p_an.flt diI;IIllllly resllltS d,twelly or, iI1clill!diY fi'OIlI I p"'~in~ condilla.. "0 ~enelil will ~e
1Ilald, for1he "'--lUntI~l- onlfllllillftlMl oate of_nlga .... far any ",,__Ut'yfng 1Id_, 'rho pre.ext5t1og
exduslon Will Il< _QI!Iiod sOllOlllelY III lac!l ad\'llnoe "nd SIllln8ll only W i11d 10 ;)1& extant that the IO~ amount of aU ;
, irWHimce1turtwoulfl ocncr'Wfse be su~to t:fti5 excIusicn exceedS S'f,OC9. . '.
I A llCIn--qu8Uf;fitlg adVanCB Isllll ad'vance tMt Is made on yaur aceou"t WI\hin sDc.l'11<lmhS after madlaj advice. diagnosis
or trNIment kas bien recetved for tnI con~ldon which dllJ.Sed yDur death ortctaJ and permanllW1t (I_bUllY. $udlldvane. ;
. must aIIo bI made within six mornras b.fOtl the elat. of your dbtft ot total Incf pt!tmMatte lftIItbiRtv. Our ~;rny. 81 to ""'Y
I non-quarrfyin9 aO.llnClI. Is .mitll~ to . "'funa o1l1tl ","cnlnt Or DRml"", __ ~IO forlhlll.."""", , '
AMOUNT Of INlURANC8: T"l!I'lltmount af inscuatrCC' tI the- Am, wftetn., single Of JDrnt If'\51.Ir"Bnca '$ 9ff.cti~_ "'f'11<l ,
smO\lnt of In;urance shill be equal ~o: (1) ttt. Duls1InQlng Dllenee on yout accol.lJ1t on 11'1. date of deltn or total .nd I !
permanem dl3ltll.1Jty, IllS any nlm"CJUdfylag adVl1nces; elf" ~ ~ 100000 , wtllctrl!:vlft IS IQ!Z.
In no eVDnt shall the amount af inSUftlnce on thl IJfg of any bClT'OWQf' lnsumd l.Iffder tlte Grou~ Policy nCl!led
S 100000 . Any insut:lncaprtll'niJm Pi1id for Jf'lS&InIF1C1! iI\ ~ armis 6mi'twfll be l'II'Unded to you or," the Cn'lQltClIrs
olltion, avcHttd to your account. Tn~ ~ '~nce is tl1en void, pravtdld :nJd'lI'!fUnd is made wnne yOt.I are aJive and
n~vlS nOl: .tHIcome igt=a11t and ptft'nliln.",ur cliiGDlecI.
fJer..eFlClAAY'. aene:ms payabltt !.Ind., 11I18 Cetdtic:tlte Will b. peld 10 VIe Ct&dttar. dltrevoClble beneflClalY'. Sueh I
Inteunt will b, IppUecI by \he C,_'* to rach.lcc elr extInguiSll yewr ~1Ift( balance. Any n!lmaininSl' NMtJtI w;1I be psid to
yO" W IMl1!I __ la your s~ Blltllllctary. It .one ;. nlm.. '" lhen IMng, ,.en h'"ncs ""all "" oela 10 .au'
estiu" II twO i_ ~ ovfllt a lOSS alrmllllnOlnll\Y. on, Dene/ll wDl bl pllkl ancl any ....... will bot _ equally to
Ill. banawer.I W rNlng, aIlllIlWIst to lb. hc:and Benllldllry of ndt i",UBd ba""-, tf na Saa:ma lena1lclary ill n_"'eeI
or tIl.. lIvinIl: IJIY _ .......tniIla _ poym.rn of lIle ICCOtInI will be pai4 equally to Iha ISm8 01 .e"" 1_"" ,
botrOWWr. Such payment D'/ ua 8lt.III' plotQ.ly dlscharv- Ol.ll" KUnb with I'Kp8ct to the .tInounl_ plaid.
QE\mAAL PRCMS\OlIIlI
1'Rl!MIUM81 TIle "orAhl) prem will be de_ br mulllpfJ/lll/ UlelllDlllh/y p"""""" nlta tJlnullle ."""'. ~_"y
_.. of your __ ~urIng 1ft. Iln-a month. but notla ..- tile ImOlll1lla I>ften 1ha insulMcs IS dm.sa, The
monthly p,.mlum "a .,. shOlNft ., tne Schw:f\IJe. W. fIllY change th. pnwnIunI nrtu.; howey.... any prernivrn "'8
"""'1100 wilt not ....... I/1e ptlmi t.~ __ "nlets ptfar ap""",.. .. o_nod tram !he PennayMml. lJtlllllll'lce
Departrnent_ i.. _ _ I
l't':RM OJIINSUIlANCI!: The ~ o.te of inI'llWftCO IS tn. dati you 8PGIY fOr CO'WtaQ.. Nit """'i"", will be
char1Ied and _;"110 1IIIt0llll1l1' IllY manlll_ __IS tIO _ClIng ""'"n_
T11a ........n.. WIilllnni.... an 1Iit _ b;Dlng <)ClIo (ItIItmltll dato) IftIrIWlIul aflhe fadowlftG: (1J your "_ with
, tIte CnditGr Iatonnln_ (2) ~ ","",vnllI_to _It _~ (,S) you mquaotllrminlltian ofth. iIlslllllnce;
, (<I-) I/la a....p __!lI~ ~ till ~_ya. ._~tn _n1 on lIOllt __Ill ...1_.... CnlcIlIar _nu""
i pumem eI tI\o pnmItIm far'" _..Ill CIII1I1_ wilh YOU!' ....unl; \11).... _MIS ~ (7) 1/1. Cl8dilOr
, tlnninlllll8 __ an III. _$_ unaerl>ftOll you WIllI II1gIb/I far 1he i....,..,..: (8) 1Ile 11811I1 af.n i...."'"
I _ (II) you -. taIdy .......onently aiablad. lfI bendlS ~: or (10) 1he.... you S1II1I1 eao 6/1. tn
i tit. ~'* 01 (I) or (I) IIJOWt. ""en J,."."ee b 1ft .".., .. aillOle iIdvnIm:. c.ntIk:nt wm be i....s to eentIIue the
, ~ ..th............ .lgtIe ~IlftUl......__1G1 6& arthll...........I9C111l.........termmlttd.
I TEllNlINATJQtII OF GIIOIlP I'OIbcv: Thor Group PaUey mor" -_ br eltherth. "-'" or by us. Vou wnl be
ut.on 3tI alyll _ >>y Ill' C/OdiIqr lIlat yuur _ w111e1llWl11e I( e11fler we or 111. ~ __ 1he Gnlvp
I P"flC1.lflllllllsvr.lm:e IS _I81D1YIllpII.... by us oranClll'1er_. yOu wII nat be_.
III/ll$TATIMINT 0/1 AlII: lilt not <l/lglII/e fill' __ iI_ _ older IIIIn IIJIIII_ ,.". Ago _ in
, tho 8"'""ule ..1110 _ Of appIr:t..::. su~..to tho In_1III\r JlIIl"\Sian, if..." -... your ago and ..... not
. .Ugi......t iMutllnca, no .... .......... fa ....~ und8r till. ~ If you ~ JOIff':Ip ..d YDU .,. .Iigt"bkt
buI_lIAlIlo.,' .'_t(I___,,__.,,"u/d08l___,yOuwmbt!
nCllllitll that you ... nat eIigIbIo lIftI,_lM In..nn..lII01lll1min&!l u of u.. _Ilil/ln, craIa ~ _I pravIIIlCI
you.......ve ..., not ~ n""""lIIIIIy _led. I. _ _.If sIngJe PltlnnCll Is in ~ aur .leQy Is IImlIed
tD . tefund oI'thc preftlNin plIId. Ifjoll'll ~ Ie in cf'Iac!. fNlli.auay b limJtc:d to. Nt\fnd of..".. ""ftCII DlftMIt'l
the 'nuance ......ilIm paid fOl'i' and lingll Insu......, A. single .Ill... CllIlllICllte will be illuod 14 eol1liltue tile
in..,.".. an tile efQllft be......r, '
AGI! RaQlJIREMINTS: If UlSU_ .... _10 in om>r wttIM yuu POllKIty _ your 1111 .n~ yG\I w.... nO! el'lQible
....,-. you... De _ thlll YOu e", not otigilll. and 1b1l1lle inaurtnea will tcnninala II of tho nOlrt bJling cyde
I' l-Ifttm dole) pra\llded YOu "'" 'l"'. am IlOltallly and permenolllfy lIIIbIed. In thl .... 01 joint in5urIn... . 1Ii"91e '
InMI_ cortJt"_.., be_la _.oll1e ~ on1l1e ellgiblellornJwer, .
, INCONTESTASlU1V, 1lli8 CI\tfreaIo ..oil bot !IIcllnlastabll -- I nas -. .. "'.... .......... '"'"'* dutlng yoUr' I
I uroUm.: All _OllIS _" by )bu 111III be d_ ...._,..IiG.1S and nlll wana-. No sIItIment rclali"ll 10 I ,
'""""1liII1 _Ill used la co_ jnia CertIficOla _ ij io _nod In _ _ appII_ siGr*.by )OIl. A copy of I
Inl Ajlpl- "'""' be llIm-, not_Ulan wflon eoveraae is canleslod. to you. yOur socolldaly _d- or ol/ler '
~~' -I I
!, In lIII ClI$ll of joirlt _, iI-ir ""most l/lC itIaJran<:e. lJtI{ 1IallIIi!y ;" imitelllll. refuIIrJ 0/ lb. dilrnltlB IJeIweero lilt> ,
I'n_at ptanwm ..... fill' lord IJId s/l19te inSIJrqnca. A slngll _ CertifiCllle wl1l at iSSUed 10 continul tllt '
In........ on !he .rogjlll__ ... I
AnIGNMeNT: YbUr UIl8ml1n lhIs ClIllIICots ,_ noI _, W..... nO! bO DaIll1ll by 0Jl'j "'lgnmllltlo'_r '
of '"lcn:ot, I I'
I" MOOlF1C'A1lONS: All chang_ c?r TTJQditications mlde by the ComPllny l11e SIgned .by Its PrBSfaent. Vice Preskrent or I'
8l!eret8ry. No other person hSS sutj;otrt1 to altar or WINe 8ny of the conditions af dtl!l eertificat. at n't1IJc8 aft)' 4Qh:.et'l"lMt
~jtn snail be tlindq upon the Com~ny. I'
CtlNFORMllYWllH STATES1lATUTEs: Any IlFOVlS"," 011/1" ce~llIcate ."dJormo Group -PoIlCYWl1lo11ls in I
I "tollflICl..;u,IhUIOIl4Il1 orthe sure 1ft ""'lOll"'. Gmup Mastorponcy is ~.Ilvon!d IS llllendod III eomPlywilluucb SllIM.. 'I
!hit l~ ..,nd~r'CttIod that ."'Y ~.. .... j&tata ~Qn3 or 18W3 wnl ~ if thOX' t:h1l'lgeS ;::lffecf: any CQWP!&IUI e:cntalneQ I~
I:M:::/:.'I.e~IP."~ ,-- ,
CI!B<<lCDf l'UOl5aI~l<I.oCCucbro<:l'~
, ,
--
MERIT LIFE INSURANCE CO.
601 N.W. Second Street * P.O. Box 39
Evansville, IN 47701-0039
Phone 800.325.2147 * Fax 800.350.9582
A Member of American International Group. Inc.
April 8, 2005
Evelyn Neidigh
148 North East St
Carlisle PA 17013
RE:
Insured:
AccClunt No.:
Claim No.:
Date of Lass:
Type at Coverage:
David D. Lauver
0000000013498728
C05253447
01/31/05
Credit Lite
Dear Evelyn Neidigh:
According to the information we have received regarding the above
claim, the condition causing the insured's death was present and
medical care was received for this cClnditian within six months
prior to the effective date of the Certificate of Insurance, as
well as advances an the account. The insured died within six
months of this effective date. TherefClre, the condition is
considered to be a "pre-eXisting condition" and is not covered
under the terms of the certificate.
Please refer to the Certificate of Insurance for additional
information.
We will be happy to reevaluate this claim uPon receipt of any
additional information yoU wish tCl submit.
If you have any questions, please contact me at the above address
or 1-800-325-2147 ext 3292.
Sincerely,
Manica I. Hape
Claims Department
Exhibit IIBIl
MERIT LIFE INSURANCE CO.
601 N.W. Second Street * P.O. Box 39
Evansville, IN 47701-0039
Phone 800.325.2147 * Fax 800.350.9582
A Member of American International Group, Inc.
May 25, 2005
Carolyn Neidigh
148 North East St
Carlisle PA 17013
RE:
Insured:
Account No.:
Claim No.:
Date of Loss:
Type of Coverage:
David D. Lauver
0000000013499195
C05;>53448
01/31/05
Credit Life
Dear Carolyn Neidigh:
We offer our sympathy an the death of David D. Lauver. Due to an
error, the letter you received dated April 8, 2005 was worded
incorrectly. we apologize far any inconvenience this may have
caused you.
However, we have reviewed your claim far life insurance benefits,
and again must deny your claim. There were material
misrepresentations contained on the insurance application that
pertain to preexisting conditions.
We will be happy to reevaluate your claim upon receipt of any
additional informatiCln you wish to submit.
If you have any questions, please contact me at the above address
or 1-800-325-2147 ext 3292.
Sincerely,
Monica I. Hape
Claims Department
cc: Amr Gen Fin Serv B380-101
Exhibit "C"
'.'"Tf'.'.'-'-
Jun-06-0\
04,S/pm
F rom"l nSur an'e CI alms/Poll C 195
,
T-094 P 001/007 H46
MERIT UFE INSuRANCE CO.
601 N,W, Second SIT""t. P,O, Box 39
Evansville. IN 47701-0039.800,325.2147
A Member of AmeriCan International Group, Ine,
i
,
I,
,
June 6. 2005
I
, I
E, Ralph Godrey. Esquire
95 Alexander Sprins Ro'" Suile 3
Carlisle PA 17013 I
I
RE: Insured: DavJ D, Lauver, dec:c:aS<Od
Aeeount No,: ~3498728
Effective Date lO9-17-04
Claim No.; COS2S3447
Dale of Loss: 0~/3l1OS
Type of Coveral&e; Credit Life Insurance
I
i
Dear Mr. Gadrcy; I
This is in response to yor lcner dated June 2. 2005,
Please be advised that tile lener dated April 8, 2005. was inCOlTect illclicatiJtg the claim..... denied to a
pre -wslins conditioal I apologize for this error, A corn:c:led lener was sent on May S. 2005 In 'calioS that the
reason for dellial WlI5 d.J. 10 _lallDiucpreaenwion, I
I
I am e~loslng 0 copy of the following docwnenll\ to support our deniill of Mr, Lauver's cledit life nsurance claim:
Application for Insuranc!e with all qllOstions lIDSW..ed yes. Certificate of Insurance
and medical reconb verifying treatmenl for ''fairly severe coronary disea.....,
If you have any furtha Les'ions or need any further information, please feel free (0 cOntacl me at labove address or
1-SQO.32S-2147 ext 5967,
I
I
I
Sincerely,
Ii
Ii
i
Selina L Harris
Claims Supervisor
,
~X~,
,
I
I
:1
F:xhihit
"nil
CERTIFICATE OF SERVICE
I hereby certify that I caused to be served a true and correct copy of the foregoing
Defendant Merit Life Insurance Company's Notice of Removal via first-class mail, postage
prepaid, this 31st day of January 2006, upon the following counsel of record:
George B. Faller, Esquire
Martson, Deardorff, Williams & Otto
10 East High Street
Carlisle, P A 17013
Counsellor Plaintiff
Is Wayne C. Stansfield
Wayne C. Stansfield
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