Original Complaint - 97 CH 4324

8/9/2019 Original Complaint - 97 CH 4324

1/25

2120 - Served2220 - Not Sewed '2121 - Served2221 - Not Served~ ~~- ~~~2320 - Served By Mail 2321 - Sewed By Mail2420 - Served By Publication 2421 - Served by PublicationSUMMONS ALIAS - SUMMONS (Rev. 3/21/95) CCG-1 A

IN THE CIRCUIT COURT O F COOK COUNTY, ILLINOISCOUNTY DEPARTMENT, CHANCERY DIVISION

(Name all parties)SUSAN MILLE R

Plaintiff

NSURNACE COMPANY

b p e dp ~ l l f l sNO. 9'7CH0432a

SUMMONSTo each defendant:

YOU ARE SUMMONED and required to file an answer to the complaint in this case, a copy of whichhereto attached, or otherwise file appearance, in the office of the Clerkof this Court (located in the RichardDaley Center, Room* 802 ,Chicago, Illinois 60602) within 30 days after service of this summons, not countithe day of service. IF YOU FAIL TO DO SO, A JUDGMENT BY DEFAULT MAY BE ENTERED AGAINSYOU FOR THE RELIEF ASKED IN THE COMPLAINT.To the officer:

This summons must be returned by the officer o r other person to whom it was given for service, witendorsement of service and fees, if any, immediately after service. If service cannot be made, this summons shall bereturned so endorsed. This summons may not be served later than 30 days after its date.

or yo u may present an Application to Sue or Defend asa Poor Person (form #CCG-19). If approved by th ePresiding Judge, th e fee will be waived.

A P R 08-WITNESS, ,T ......................~ , 1 9 . . . . .. . .

........................................Clerk of CourtName Christopher V. LangoneAttorney for Plaintiff(s) Date of service: ....................... 19. ..Address One Eas t Wacker Drive (To be inserted by officer on copy left withCity Chicago defendant o r other personjTelephone (312) 464-7200Atty. No. 34257**Service by Facsimile Transmission will be accepted at: (3121464-0077

(Area Code) (Facsimile Telephone Number)AURELIA PUCINSKI, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, IL1,IWOIS

*Law Division Room 801Chancery-Divorce Room 802County Division Room 801Probate Division Room 1202


2/25

IN THE CIRCUIT COURT O F COOK COUNTYCOUNTY DEPARTMENT, CHANCERY DIVISIONSUSAN M ILLER and all others ) I ,similarly situated , )

)Plaintiff, ) 97CH04324CLASS ACTION1v. )

)ROYAL M ACCABEES LIFE ) JURY TRIAL REQUESTEDINSURANCE COMPANY, 1)Defendant. )

CLASS ACTION COM PLAINTIntroduction

1. This action seeks redress for breach of contract in connection with the saleof insurance.Parties

2. Plaintiff, SUSAN M ILLER, is an individual who is a citizen of Illinois.3 . Defendant. ROYAL MACCABEES LIFE INSURANCE COMPANY

("MACCABEES"), is an insurance company, licensed to sell insurance in the State ofIllinois.Alle~ ation s ar t icular to Miller

4. On approximately September 15, 1987, Defendant sold a policy of insuranceto Plaintiff ("the Policy"). A true and correct copy of this policy is attached here andincorporated as Exhibit A.

5 . The Policy, w hich is a form document sent to numerous personsstates, on the page designated on the lower left hand corner "L-5 (FPAL-6)", under theheading "Cost of Insurance Benefits," that: "Monthly Cost of Insurance Rates will be


3/25

determined by the Company from time to time based on its expectations as to futuremortality experience."

6 . On September 15, 1991,Defendant, in its "Annual StatementPolicy Year Ending September 14, 1991," attached as Exhibit B, which is a computergenerated form document sent to numerous pe rsons, stated in relevant part that: "startingSep 15, 1991, current monthly insurance charges on this policy w ill be adjusted . . . Theadjustments reflect the increasing number of A IDS -related deaths and , fo r policies whichare not part of a pension plan, new federal corporate insurance taxes."Class Allegations

7 . Plaintiff bring this action on behalf a class.8. The class consists of all persons nationwide, w ho:

(a) within the last ten years brough t a policy of insurance similar to theone attached as Exhibit A and which indicated that the premiumincreases would be related solely to expectations of "futu re mortalityexperience;" and(b ) had their premiums increased for reasons other thanexpectations of "future mortality experience".

9. Joinder of all Plaintiffs is impracticable because, on informationand belief, Exhibit A is a standard, form insurance contract, which has been entered intoby hundreds or thousands of individuals.

10. Questions of fact and law common to all members of the class predom inateover those peculiar to individual class mem bers. These comm on questions include:


4/25

(a) whether the statement, in E x h i b i t , that "Monthly Cost ofInsurance Rates will be determined by the Company from time totime based on its expectations as to future mortality experience."amoun ts to a representation that rates will not be increased unlessmortality rates change ;(b) whether M accabees breached their contract with the consumers ofinsurance by increasing rates, as stated in Exhibit B, because of"new federal corporate insurance taxes."

11. The Plaintiff will fairly and adequately protect the interests of the classbecause the Pla in tiff s claims are typical of the claims of all of the members of the classand because all claims are based on the same factual and legal theories.

12. Plaintiff and Plaintiff's counsel will fairly and adequately represent theinterests of the class mem bers and will vigorously pursue this matter.

13. Certification of the class is appropriate. A class action is the onlyappropriate means of resolving this controversy because of the relative ly small am ount ofmoney in controversy and the fact that class members are not aware of their rights. In theabsence of a class action, a failure of justice will result. Prosecution of separate actionsby individual members of the class would create the risk of inconsistent or varyingadjudications resulting in the establishm ent of inconsistent or varying standards for theparties.

14. By its conduct described above, Defendant Maccabees breached its contractby increasing its insurance rates for reasons other than those provided for in the contrac twith the Plaintiff.


5/25

WHEREFORE, Plaintiff, SUSAN MILLER, requests that the Court grant thefollowing relief in her favor and on behalf of the class members and against ROYALMACCABEES L IFE INSURAN CE COMPANY such that:

a. all money collected by ROYAL MACCABEES LIFE INSURANCECOMPANY as a result of increases in insurance payments that arenot authorized by its contract with consumers be repaid to the class; andb. Any such other relief that the Court deems approp riate and just under thecircumstances.

Respectfully subm itted,

Christopher V . Langone, Esq.Brian K. Hodes, Esq.Langone & HodesOne East Wacker, Suite 2420Chicago, IL 60601(3 12)464-7200

One of Her Attorneys

Dated: April 8, 1997\\Chris\lawd~e~\CASESV\CTIVE\Milier\mill. rnaeabeeseamp.wpd


6/25

S C H E D U L E O F a E N F F I T S A h u I N I T I A L M O N T H LY E X P E N S E C nA R GE SI N I T I A L D A T E T O W HI C H I F I I T I A LS P E C I F I E D C O V E R AG E I S H O N T HL YB E N E F I T P R O V I D E D E XP EN SEA MO UNT CHA RG E

E X I a L F P RF M IU M S 2 5 0 r P t 3 + S EP TE MR ER 15, 2 0 4 2 s 4 9 . 9 iJ IJ ST AB LF L I F E V I- 1 5 '3 * T H I S AM OU VT D OE S I N C L U D E T H E A C C U M U L A T I O N V A LX I MUM A D M I h I I S T R A T I V E C HA RG E: S 5.3 0 M A X I M U M P R E M I U M L O AD : 6 . 5 3%INU M S URRE NDE R CHARG E: $ 3 ,9 8 7 .5 0 WITHD RA WA L CHA RGE : $25.00V ER AG E C O N T I N U A T I O N C OM P ON E NT : $72.91TE: T H E T E R M I N A T I J N DA TE I S T H A T E L E C T E D B Y TH E OWNER. I T I SP O S S I B L E T H A T CO VE RA GE M I L L C E A S E P R I O R T O T H E M A T U R I T YSHOWN I F S U RS EO U EN T P R E M IU M S A ND I N T E R E S T C R F D I T E D A R EI Y S U F F T C I E N T TO C O N T I N U E C O VE RA G E T O S U C t i A D AT E.

-~D A T E O F 1 S S U E :S E P T E HB E K 159 1987

C M I L L E R t 4 A T U R ITY D A T E : S E P T E M B E R 15 r 2349

X: F E M A L E I S S U E AG E: 46

I U M C L A S S : S T A N D A R D -N O N S M O K E R

PREMIUM: ~ ~ 7 5 .c

M O N T HL Y D E D U C T I O N D A Y I S : T HE 1 5D A Y O F E A C H M O NT HP L A N N E D P E R I O D I C P R E MI UM :5875.80 ( A N N U A L )

N OT S IJ RR EN DE R Y OU R P O L I C Y OR A LL OW I T T O L A P S E F O R A N Y R E AS O N N I T H O U TS U L T I N G T H E C OY PA NY . I?$A SE D F A N Y Q U E S T I O N A BO UT T H I S P O L I C Y I C O N TA C TUR L O C A L MA CCA B E E S A G E NCY OR W R I T E T HE C O MP AN Y A T I T S HOME O F F I C E .3 "


7/25

INSURANCE PROCEEDSPROCEEDS PAYABLEThis Policy shall terminate upon the death of theInsured. The Company will pay the lnsuranceProceeds subject to the provisions of this Policy to theBeneficiary upon receipt of due proof of the lnsured'sdeath. The Company will require surrender of thisPolicy as a condition of payment.The lnsurance Proceeds payable depend on theSpecified Benefit Amount Option i n effect at the dateof death.Two Specified Benefit Amount Op tions are availableunder this Policy:LEVEL OPTION-The Specified Benefit Amount asshown on the Schedule Page Includes theAccum ulation Value. Under this option, the lnsuranceProceeds at the lnsured's date of death shall equalthe greater of:1) the Specified Benefit Amount on the date ofdeath; or2) the Accumu lation Value on the date of deathmultiplied by the pe rcentage shown i n the Tableof Minimum Death Benefit Percentages for theInsured's attained age.INCREA SING OPTION-The Specified BenefitAmount as shown on the Schedule Page s in additionto the Accumulation Value. Under this option, thelnsurance Proceeds at the lnsured's date of deathshall equal the greater of:1) The Spec ified Benefit Amount on the date ofdeath, plus the Accum ulation Value on the dateof death; or2) the Accumulation Value on the date of deathmultiplied by the percentage shown in the Tableof Minimum Death Benefit Percentages for theInsured's attained age.Any increases or decreases made to the SpecifiedBenefit Amount may change the lnsurance Proceedspayable. Any loan, Withdrawal, or Partial Surrenderof this Policy will be subtracted from the lnsuranceProceeds.If the Insured is living on the Maturity Date and thisPolicy is i n force, this Policy shall terminate and theCom pany shall pay the Surrender Value to the Owner.The Maturity Dafe is shown on the Schedule Page.It is poss ible that coverage will term inate prior to theMaturity Date if premiums paid following paym ent ofthe Initial Premium are insufficient to continuecoverage to such date. It is also possible thatcoverage will terminate prior to the Maturity Dateshown if the Company changes the interest rate orthe Monthly Cost of lnsurance Rates.CHANGES IN SPECIFIED BENEFIT AMOUNT OPTIONThe Schedule Page shows the option elected In theoriginal application. The option may be changed by

the Owner as allowed by the Com pany.If the lncreasing Option is in effect and the Ownerchanges to the Level Option, the Specified BenefitAmount subsequent to this change will equal the totalof the Specifled Benefit Amount prior to the changeplus the Accumulation Value. Thereafter, theSpecif led Benefl t Amount wi l l inc lude theAccumulation Value. If the Level Option is i n effectand the Owner changes to the lncreasing Option, theSpecified Benefit Amount subsequent to this changewill equal the Specified Benefit Amount prior to thechange less the Accum ulation Value. Thereafter, theSpecified Benefit Amount will not include theAccumulation Value.CHANGES I N SPECIFIED BENEFIT AMOUNTThe Specified Benefit Amount of this Policy may beincreased or decreased upon written request by theOwner Subject to the following conditions:1) Any decrease will become effective on theMonthly Deduction Day that falls on or nextfollows the date the request is received by theCompany. Such decrease will reduce theSpecified Benefit Amount in the follow ing order:

a) It will decrease the insurance provided by themost recent increases successively; thenb) it will decrease the Initial Specified BenefitAmount.

2) The Specified Benefit Amount may not bedecreased to an amount less than $25.000.3) The Specified Benefit Amount may not bechanged by an amount less than $10,000.4) Any requ est for an increase must be applied foron a supplemental application. Such increase willbe subject to evidence of insurability satisfactoryto the Com pany. Any increase will be subject tothe sufficiency of the Accumulation Value, lessany indebtedness, to cover the next MonthlyExpense Charge. Any increase will becomeeffective on the effective date shown on theSpecification Endorsement.5) The Specified Benefit Amount may not beincreased if there has been a prior decrease.APPLICATION FOR ADDITIONAL INSURANCEAdditional insurance on the life of the lnsured'sspouse or child may be applied for by supplementalapplication. Approval of the additional nsurance shallbe subject to evidence of insurability satisfactory tothe Company. Additional insurance shall also besubject to the sufficiency of the Accum ulation Value,less any indebtedness, to cover the next MonthlyExpense Charge. Such new insurance will beprovided by rider and will become effective on theeffect ive date shown on the Specif icat ionEndorsement.


8/25

DEFINITIONS1 I Whenever used in the Policy, thefollowing words MATURITY DATE I Imean:

ACCUMULATION VALUEThe amount of money that is credited with interest tothe Policy on a monthly basis.BENEFICIARYThe person nam ed in writing by the Owner to receivethe Insurance Proceeds in the event of the Insured'sdeath.CASH VALUEThe amount of Accumulation Value of this Policy lessany Surrender Charges.COMPANYThe Maccabees Mutual Life Insurance Company.DATE OF ISSUEThe date shown on the Schedule Page from whichpolicy years, months and anniversaries shall bedetermined.HOME OFFICE OF THE COMPANY25800 Northwestern Highway, P.O. Box 2165,Southfield, Michigan 48037-2165INDEBTEDNESSThe sum of any unpa id policy loans and any unpa idpolicy loan interest.INITIAL PREMIUMThe amount due at the Date of lssue shown on theSchedule Page and payable in advance.INSURANCE PROCEEDSThe total amount the Company will pay upon thedeath of the lnsured.INSUREDThe person named on the Sche dule Page whose lifethis Policy insures.LOAN VALUEThe amount that can b e borrowed under the Policy.

The date specified as such on the Schedule Page,upon which the Surrender Value will become payableif the lnsured is living.MONTHLY DEDUCTION DAYThe day of each month shown on the Schedule Pagewhen the Accumulation Value of the Policy iscalculated and the Monthly Expense Charge isdeducted. The first M onthly Deductior Day shall bethe Date of lssue.MONTHLYEXPENSE CHARGEThe total amount deducted each month for thecoverage provided under the Policy and any additiona lbenefits provided by rider.OWNERThe person to whom this Policy belongsPART IAL SURRENDERAn amount available in cash at any time upon requestequal to 50% or more of the Surrender value.PLANNED PERIODIC PREMIUM PAYMENTThe amount of regular premium payment elected bythe lnsured. This amount and the frequency ofpayment are shown on the Schedule Page. TheOwner may change the amount and frequency of thePlanned Periodic Premium Payment at any timesubject to the policy provisions. Any change infrequency and amount will be reflected in the AnnualReport provided by the Company.SPECIFIED BENEFIT AMOUNTThe init ial amount of coverage shown on the SchedulePage. This Amount may be changed by the Ownerat any time subject to the policy provisions. Anychange in the Specified Benefit Amount will bereflected in a Specification Endorsement.SURRENDERCHARGEThe amount deducted by the Company from theAccumulation Value if the Policy is surrendered.SURRENDERVALUEThe amount of Cash Value, plus the cash value Of anypaid up dividend additions, less any indebtedness,available in cash or an Optional Method of Settlementupon the termination or maturity of this Policy.WITHDRAWALAn amount available in cash at any time upon requestwhich is less than 50% of the Surrender Value.


9/25


10/25

CONTROL OF POLICY I IBENEFICIARY CHANGE OF OWNERSHIPThe Insurance Proceeds will be paid o the Beneficiarylast named in writing by the Owner. Two or moreBeneficiaries will receive equal shares of the proceedsunless a differen t allocation is specified. A Beneficiarymust survive the lnsured. Otherwise, his share will bepaid to the surviving Ben eficiary or Beneficiaries inequal shares. If no Beneficiary has been named orthere a re n o surviving Be neficiaries, the InsuranceProceeds will be pa id to the Owner, if living; otherwiseto the Owner's estate.CHANGE OF BENEFICIARYThe Owner may change any Beneficiary at any timewhile the Insured is living. A written notice of chang emust be sent to the Company at its Home Office. Th echange will take effect on the day it was signed,subject to any action taken by the Company prior tothe recording of the change at the Home Office.

The Ow ner may name a new Owner by written noticemailed to the Company. The change w ill take effecton the day it was signed, subject to any action takenby the Company prior to the recording of the changeat the Home Office.ASSIGNMENTThis Policy may be assigned by the Owner ascollateral. Any assignment must be in writing an d asigned copy sent to the C ompany at its Home Office.The rights of the Owner and the interest of anyBeneficiary will be subject to the rights of anyassignee of record as specified n the assignment. TheCompany is no t subject to the rights of any assigneeof record. The Co mpany is not responsible for thevalidity or effect of any assignment.

OWNERSHIPThis Policy belongs to the Owner. If the Owner dies,this P olicy belongs to the Owner's designee, or theOwner's estate if no Owner's designee has beennamed.

DIVIDEND PROVISIONThis Policy, while in force, may participate in any AUTOMATIC OPTIONdivisible surplus of the Company. The amount of anysuch dividend shall be determined by the Board of If no option i s selected, dividends will be adde d to theDirectors. Accumulation Value of the Policy and treated asadditional premium.DIVIDENDSEach annual dividend when payable may be app liedunder one of the following options:1) Paid i n cash;2) Added to the Accumulation Value of the Policyand treated as an additional premium; or3) Left to accumulate with the Company at interestof not less than 3% per year. These dividendsmay b e withdrawn in cash at any time.


11/25

PREMIUMSPAYMENTThe Initial Premium is due on the Date of lssue andis payable in advance. Subsequent premiums arepayab le in advance of the period to which they a pply.No benefit will be provided on the basis of anypremium until that premium has been paid. Theamounts and frequency of P lanned Periodic PremiumPayments are shown on the Schedule Page.Premiums must be paid to the Company at its HomeOffice. Upon request, a receipt signed by thePresident or Secretary of the Company will befurnished for anv oremium oavment.

As of each Monthly Deduction Day during the first ninepolicy years, the Coverage Con tinuationRequirem entshall be the sum of the Coveraae ContinuationComponents applicable to each polit$month from theDate of lssue.The Coverage Continuation Component in e ffect onthe Date of lssue is shown on the Schedule page. TheCoverage Continuation Component will change as ofthe effective date of any increase in the SpecifiedBenefit Amount, or any addition of, or increase in, anyrider. The Coveraae Continuation Cornoonent in effect, . , as of any ~ o n t h h eduction Day will apply to theChanges n frequency and increases or decreases in policy month next fol,owing. The Company will notifythe am ount of Planned Periodic Premium Payments the Owner of any change in the Coveragemay be m ade by the Owner. The P lanned Periodic Continuation Component.Premium cannot be changed to an amount less than$50.00. Prem ium payment notices will be sent to the A Grace Period of sixty-one days will be allowed forOwner upon written request. The notices may be sent the payment ofpremiumsufficient to cover any pastannually, semi-annually, or quarterly. due M onthly Expense Charges and applicable loan

Under the special payment facility, Planned Periodic interest. Written notice of such premium will b e mailedPrem ium Payments of $25.00 or more may be made to the last known address of the Owner and anyon a mon thlv basis. assianee of record at least thirtv davs before therace Period ends. If such pr em iim is ;lot paid withinAdditional payments may be made at any the Grace Period, all coverage will terminate withouttime during the continuance of this Policy. value at the end of the Grace Period. If a claim byThe Com pany reserves the right to refuse to accept death during the Grace Period becomes payableany premiums which would disqualify this Policy from under the Policy, any overdue Monthly Expensefavorable tax treatment as life insurance under federal Charge will be ded ucte d from the Insu ranc elaw. If premiums pa id during any policy year exceed Proceeds.the federal life insurance premium guidelines, theCompany will return the excess premiums withinterest of at least 4% within sixty days after the end REINSTATEMENTof the policy year. I f this Policy terminates as provided in the GraceGRACE PERIOD Period provision, the Owner may apply forreinstatement. The application m ust be received byExcept as provided below, this Policy will enter the the companyt its Home office five years ofGrace if the Surrender On the Monthly the date of termination, bu t before the M aturity Date,Deduction Day is insufficient to cover the Monthly and must include:Expense Charge. (The Accumulation Value,Surrender Value, and Expense Charge are 1) evidence of insurab ility of the Insured satisfactorydescribed in the Nonforfeiture Provisions.) to the Comoanv:..The above notwithstanding, prior to the ninth policyanniversary, this Policy will enter the Grace Period if: 2) payment of a premium sufficient to prevent thisPolicy from entering a Grace Period for at leastThe Accumulation Value less indebtedness on the three months after the date of reinstatement;Monthly Deduction Day is less than the MonthlyExpense Charge; 3) payment or reinstatem ent of any policy loan; andor ifThe Surrender Value on the Monthly Deduction 4) payment of interest on the reinstated loan from theDay is less than the Monthly Expense Charge; date of reinstatement to the end of the policy year.and Reinstatement will not b e effective until the date theThe sum of the premiums paid since the Date of application is approved by the Company.Issue, less any loans, Withdrawals or PartialSur rend ers, is les s than the Co vera ge The Incontestability provision with respect to theCon tinuation Requirement as of the Monthly reinstatement application and the Suicide provisionDeduction Day. will apply from the effective date of reinstatement.

11 h


12/25

NONFORFEITURE PROVISIONS( ( ACCUMULATION VALUE COST OF INSURANCE I The Accumu lation Value on the Date of lssue shall The Cost of lnsurance is determined on a monthlybe at least 931/2 percent of prem iums paid on or befo re basis. The Cost of lnsurance is determ ined separatelythe Da te of lssue, less the Monthly Expen se Charge for the Initial Specified Benefit Amount and for ea chfor the first m onth. On each M onthly Deduction Day increase in Sp ecified Ben efit Amount.I I the Accumulation Value shall be calculated as (a), plus(b) plus (c), minus the sum of (d) plus (e) where: The Cost of Insura nce is calculated as (a), multipliedby the result of (b) minus (c), where: /(a) is the Accumulation Value on the precedingMonthly Deduction Day;(b) is one month's interest on (a);(c) is 93112 percent or more of all premiu ms receivedsince the preceding Monthly Deduction Day;I (d) is the amount of any Partial Surre nder, PartialSurrender Charge, Withdrawal and Withdrawal

I fee since the preceding Mo nthly Deduction Day;(e) is the M onthly Expense Charge for the m onthfollowing the Monthly Ded uction Day.On any day other than a Monthly Deduction Day, theAccumu lation Value sha ll be calculated as (f) plus (g)minus (h), where:

(f) is the Accumu lation Value as of the preced ingMonthly Deduction Day;(g) is 93% percent or more of all premiums receivedsince the preceding Monthly Deduction Day;(h) is the amount of any Partial Surrender, PartialSurrender Charge , Withdrawal or Withdrawal feesince the preceding Monthly Deduction Day.MONTHLYEXPENSECHARGEThe Monthly Expense Charge shall be calculated as(i) plus (j),where:(i) is the Cost of lnsurance (as described below) plusthe cost of additional benefits provided by rider:(j) is the Adm inistrative Charge.The Administrative Charge shall not exceed, bu t maybe less than, the Maximum Administrative Chargeshown on the Schedule Page.INTEREST RATE

(a) is the Cost of lnsurance Rate as described in theCost of lnsurance Rates section;(b) is the lnsurance Proceeds at the beginning of thepolicy mon th divided by 1.0032737;(c) is the Accumulation Value at the beginning of thepolicy month.If the Accumulation Value is included in the SpecifiedBenefit Amount and the re have been increases n thelnsurance Proceeds, then the Accumulation Valueshall be first considered a part of the Initial SpecifiedBenefit Amount. If the A ccumulation Value exceedsthe Initial Specified Benefit Amount, it shall then beconsidered a part of additional Specified BenefitAmounts resulting from increases in the order of theincreases.Any dedu ction for the C ost of lnsuran ce during theGrace Period shall not be con sidered a waiver by theCompany of the terms of the Grace Pe riod provision.Any such charge shall be deducted from theAccumulation Value as of the date of the charge.COST OF INSURANCE RATESThe mo nthly Cost of lnsurance Rate is based on thesex, attained age, and rating class of the personinsured. Monthly Cost of lnsurance Rates will bedetermined by the Compa ny from time to time basedon its expectations as to future mortality experience.greater than those shown in the Ta ble of Guaranteed

1owever, the Cost of lnsurance Rates will not beMaximum lnsurance Rates or as the same areamended by the rating factor, if any, shown on theSchedule Page. Any chang e in the Cost of lnsuranceRates will be on a u niform basis for insureds of thesame age, sex and c lassification whose policies havebeen in force for the same lena th of time. The interestrate used to calculate theguaranteed Cost ofThe interest rate used in the calculation of the insurance~t~~ is 4% per year, The Table ofAccumu lation Value is guaranteed to be a minimum Guaranteed Maximu m Insurance Rates is alsoof ,32737 Percent Per month, compo unded monthly, applicable to increase amounts of insurance subjectwhich is equal to 4 Percent Per Year com pounded to anv aoalicable ratina factor shown on the Schedule.~.., ~~rr...--.- ~w/ / annua lly. Interest in excess of the guarantee d Paae.minimum rate may be credited as determined by theCompany's Board of Directors. Interest credited onthe portion of the Accumulation Value that is loan edwill at no time be less than the gu aranteed minimuminterest rate.

-~" -

The guaranteed Cost of Insurance Rates are basedon the 1980 Smoke r or Nonsmoker Commissioner'sStandard Ordinary M ortality Table (CSO), Age LastBirthday.rr


13/25

NONFORFEITURE PROVISIONS (Continued)CASH VALUEThe Cash Value shall be calculated as theAccumulation Value less the Surrender Charge.SURRENDERCHARGEThe Surrender Charge is the lesser of (a) or (b), where:(a) is the Accum ulation Value;(b) is the Maximum Surrender Charge shown on theSchedule Page multiplied by the factor from th eTable of Surrender Charge Factors thatcorresponds to the policy year of surrender.SURRENDER CHARGE FOR INCREASES IN/ I SPECIFIED BENEFIT AMOUNTIf the Specified Benefit Amount is increased, aseparate Surrender Charge will be applied at the timeof the increase. The Specification Endorsementproviding for the increase will include the MaximumAdditional Surrender Charge resulting from theincrease. The Additional Surrender Charge will equa lthe Maxim um Additional Surrender Charge shown onthe Specification Endorsement multiplied by the factorfrom the Table of Surrender Charge Factors thatcorresponds to the number of years since theincrease.The Additional Surrender Charge resulting from anincrease shall be added to the amount specified in(b) above to determine the total Surrender Charge.BASIS OF COMPUTATIONSAccum ulation Values are based on the 1980 Smokeror Nonsmoker CSO Mortality Table, Age LastBirthday, with interest at 4 percent per yearcompounded annually. Accumulation Values are atleast equal to those required on the Da te of Issue bythe state in which this Policy was purchased.Reserves are based on the 1980 Smoker orNonsmoker CSO Mortality Table, Age Last Birthday,with interes t at the Calendar Year Statutory ValuationInterest Rate. Reserves are calculated using aModified Preliminary Term method, but are not lessthan the reserves calculated using theCommissioner's Reserve Valuation method.Where required, a detailed statement of the me thodof com putation of Accum ulation Values and rese rvesunder this Policy has been filed with the insurancedepartment of the state in which this Policy waspurchased.CONTINUATION OF INSURANCEIn the event Planned Periodic Premium paym ents arenot continued, insurance coverage under this Policyand any benefits provided by rider will be continuedin force.

17

Such coverage shall be continued until terminationas provided in the Grace Period provision. Thisprovision shall not continue the Policy beyond theMaturity Date nor continue any rider beyond the datefor its termination, as provided in the rider. If theInsured is living on the Maturity Date and the Policyis still in force, the Company will pay the SurrenderValue to the Owner.WITHDRAWALA Withdrawal from this Policy may be made at anytime prior to termination upon wrinen request by theOwner to the Company at its Home Office. The sumof all Withdrawals cannot equal or exceed 50% of theSurrender Value.When a Withdrawal is made, the amount of theWithdrawal will be deducted from the AccumulationValue. The lnsurance Proceeds shall be reduced bythe amount of the Withdrawal. An additional fee of$25.00 will be deducted from the Accum ulation Valuefor each Withdrawal. Not more than three Withdrawalswill be allowed in any policy year.The Company reserves the right to defer a Withdrawalfor a period permitted by law, but not for more thansix mon ths from the da te of receipt of the request bythe Company at its Home Office, unless such paymentwould be used to pay premiums on policies in forcewith the Company.PARTIAL SURRENDERA Partial Surrender of this Po licy may be made at anytime prior to termination by written request of theOwner to the Company at its Home Office. A PartialSurrender is an amount which when added to allprevious Partial Surrende rs and Withdrawals equalsor exceeds 50% of the Surrender Value. If a PartialSurrender is made, an additional fee will be deductedfrom the Accumulation Value as follows. Theadditional fee will equal the Surrender Chargemultiplied by the ratio that the Partial Surrender bearsto the Surrender Value. After a Partial Surrender, theSurrender Charge for the Policy will be reduced bythe additional fee. The lnsurance Proceeds, theAccumulation Value, and the Cash Value will bereduced by the amount of the P artial Surrender. Notmore than three Partial Surrenders will be allowed inany policy year.The Company reserves the right to defer a PartialSurrender for a period perm itted by law, but not formore than six m onths from the date of rece ipt of therequest by the Company at its Home Office, unlesssuch payment would be used to pay premiums onpolicies in force with the Company.


14/25

The NONFORFEITURE PROVISIONS (Continued)SURRENDER ANDSURRENDERVALUEThis Policy may be surrendered at any time prior totermination upon written request by the Owner to theCompany at its Home Office. The amount payable onsurrender of this Policy shall be the Surrender Value.which is the Cash Value including the cash value ofany paid up dividend additions, less anyindebtedness, on the date of surrender. TheSurrender Value will be paid in cash or under anelected Settlement Option.If surrender is requested under this section within 30

days after a policy anniversary, the Surrender Valueshall not be less than the Surrender Value on thatanniversary, less any Partial Surrenders, Withdrawals.or loans made on or after such anniversary.If his Policy is surrendered, coverage shall terminateas of the next Monthly Deduction Day. The Companyreserves the right to defer the payment of theSurrender Value for the period permitted by law, butnot for more than six months from the date of receiptof the request by the Company at Its Home Office,unless such payment would be used to pay premiumson policies in force with the Company.

POLICY LOAN PRO VISIONSPOLICY LOANSThe Owner can borrow against this Policy as solesecurity for any amount up to the Loan Value plus thecash value of any dividend additions at any time priorto the termination of this Policy. The loan must berequested by the Owner in writing.On a policy anniversary, premium due date, or duringa Grace Period the Loan Value is the Cash Value lessany loan and accrued interest. Otherwise, the LoanValue is the amount with interest which equals theLoan Value on the next policy anniversary.Before advancing the loan amount, the Company maywithhold an amount sufficient to pay interest on totalindebtedness to the end of the policy year and anyMonthly Expense Charges due during the next threemonths, or to the end of the policy year, whicheveroccurs first.The Owner may be required to sign a loan agreementassigning this Policy to the Company as security. TheCompany may delay the payment of the loan.Payment may be delayed up to six months from thedate the request was recieved unless such paymentwould be used to pay premiums on policies in forcewith the Company.LOAN INTEREST RATElnterest is payable in advance on the first interestpayment due aate and on each policy anniversary thatfollows. The first lnterest payment oue date IS the dateof the loan

Loans under this policy will bear interest at a rate thatis subject to adjustment on each policy anniversary.The initial interest rate charged on any loan will bethe Company's Adjustable Loan lnterest Rate in effecton the previous policy anniversary. As of eachsubsequent policy anniversary, the interest ratecharged for the policy year following will be theAdjustable Loan lnterest Rate in effect on that policyanniversary.The Owner will be notified of the initial interest rateat the time the loan request is made. The Companywill also notify the Owner of any change in the interestrate applicable to an outstanding policy loan. NOPolicy will terminate in a policy year as the sole resultof a change in the interest rate during that policy year.Insurance will remain in force until the time it wouldhave otherwise terminated had the interest rate notbeen changed.lnterest not paid when due is added to the loan andbears interest at the same rate as the loan.The Adjustable Loan lnterest Rate will be determinedas of the first day of each January, April. July, andOctober, and will be determined by comparing theAdjustable Loan lnterest Rate in effect for thepreceding three months with a maximum interest ratedefined by law and described below. Any change inthe Adjustable Loan lnterest Rate will be subject tothe following:


15/25

POLICY LOAN PROVISIONS (Continued)a. .The Adjustable Loan lnterest Rate wi llbeloweredto be equal to or less than the legal maxlmuminterest rate if such legal maximum rate Is .5%or more lower than the Adjusted Loan lnterestRate for the preced ing three months.b. The Adjustable Loan lnterest Rate may beincreased by at least .5% but not highe rthan helegal maximum lnterest rate, i f the lega l maximuminterest rate is .5oh or more higher than theAdjustable Loan lnterest Rate for the precedingthree months.The Adjustable Loan lnterest Ratewill not exceed thegreater of:(1) .The Published Monthly Average for the calendarmonth ending two months before the date on

which the rate Is determined; or(2) The interest rate used to compute theAccumulation Value under the Pollcy during theapplicable period plus 1 % per year.The Published Monthly Average is Moody's CorporateBond Yield Average-Monthly Average Corporate as

published by Moody's Investors Service, Inc., or anysuccessor to it. In the event that Moody's CorporateBond Yleld Average-Monthly Average Corporate is nolonger published, the Published Monthly Average wilibe a substantially slmilar average established byregulations Issued by the Insurance Commissioner ofthe state in which thls Policy was purchased.REPAYMENT AND TERMINATIONPolicy loans, including accrued interest, may berepaid in whole or parta. any time prior to terminationof thls Pollcy. A loan outstanding at the end of theGrace Period may not be repaid until this Policy isreinstated. All funds received by the Company underthis Policy will be credited as premium paymentunless clearly marked for loan repayment.Whenever the policy loan plus accrued interest equalsor exceeds the Cash Value of this Policy, writtennotification wili be sent to the last known address ofthe Owner and assignee, if any. This Policy willterminate sixty-one days after the date of mailing thenotification. Any accumulated dividends will be paidIn cash at that time.


16/25

SETTLEMENT OPTIONSAVAILABILITY 5. ANNUITY OPTION. Annuitv oavments will beThe lnsurance P roceeds of this Policy will be p aid inone sum unless a payment option is chosen. All orpart of the lnsurance Proceeds may be applied underone of the following options. However, the amount tobe applied must be at least $3,500.00. The amountmust also provide a periodic payment of at least$20.00 to each payee. If the payee is not a naturalperson, the proceeds may not be placed under aSettlement Option without the consent of ther,,,,,..

, , ,made during the lifetime of a payee; or jointly totwo payees, one of whom must be the lnsured,during their lifetimes; and contiruing to thesurvivor during his remaining lifetime.Payments will be made under any single premiumimmediate life or joint and survivor annuitycontract as may be issued by the Company onthe date proceeds becom e payable. The amountof each annuity payment will be 102% of theDavment which the amount retained bv the"" '""a ' ly . ~ d m ~ a n vould otherwise ourchase.' The1 ) ELECTION com pany 's rates in use on such date will be usedas the basis for payment.The Owner may elect a Settlement Option or change The amount payable under any option shall be thea prior election at any time while the Insured s living. actuarial equivalent of the amount of InsuranceThe election must be recorded by the Company at its procee ds applied under that option,Home Office before it is effective. The Com pany shallnot be liable for any payments it mav have made Under Options and 59 proof the

/ 1 before receiving thai notice. tiompanyI If no option is in effect at the Insured's death, anyBeneficiary may choose a Settlement Option.Unless this election is made irrevocable before theproceeds are placed under a Settlement Option, thepayee may change the election at any time.1 OPTIONS1, INTEREST OPTION. Left on deposit with theCompany with the interest payable at not lessthan 3% per year. The deposit period and

withdrawal rights will be as agreed at the time ofthe election.2. INSTALLMENT OPTION, FIXED PERIOD.Payable in equal installments for the number ofyears elected (not more than 20). The amount ofeach paym ent is shown in the Settlement OptionTables. Rights of commutation of unpaidinstallmentswill be as approved by the Companyat the time of election.3. LIFE INCOME OPTIONS. 10 or 20 YEARSCERTAIN. Payable in installments for certainperiod elected, and con tinuing thereafter for therema ining ifetime of the person on whose life theincome depends. The amount of each installmentis shown in the Settlement Option Tables.4, INSTALLMENT OPTION, FIXED AMOUNT.Payable n installments until the proceeds applied.together with interest on the unpaid balance at theeffective rate of 3% per year, are exhausted.Amounts of installments and withdrawal righ ts willbe as approved by the Company at the time ofelection. ,17

a) of the date of birth and sex of the payees; andb) that the payee is alivemay b e required before payment is made.In the event of the death of a Payee under aSettlement Option containing a period certain, anyremaining proceeds shall be paid to the Beneficiaryor Beneficiaries designated by the Owner. If noBeneficiary has been named or there are no survivingBeneficiaries, the proceeds will be pa id to the Payee'sdesignated Beneficiary or the Payee's estate.PAYMENTThe first payment under Options 2, 3 and 4 will bedue the date the proceeds are applied under theSettlement Option. If the proceeds are payable dueto the Insu red's death, the first payment will be dueon the date of death. The first payment under Options1an d 5 will be due one, three, six, or twelve monthsthereafter, depending on the mode of paymentselected.EXCESS INTERESTThe interest payments under Option 1 and thef!uaranteed payments under Opt~ons , 3, or 4 areased on a guaranteed interest rate of 3% per year.The interesi payments under Option o i theguaranteed payments under Options 2 and 3 may beincreased by excess interest as declared by theCompany. Excess interest will be used to extend theperiod under Option 4.PROTECTION OF PROCEEDSThe proceeds of payments due or to become dueunder any option may not be assigned by theBeneficiary. To the extent permitted by law, theproceeds will not be subject to the c laims of creditorsof the Beneficiary or the lnsured.


17/25

r SETTLEMENT OPTION TABLESMONTHLY P4YMEN TS FOR EACH $1,000 OF PROCEEDS -OPTION 2 O PTI O N 3

FIXED PERIOD LIFE INCOMEPER $1,000 APPLIED PER $1,000 APPLIED

NO. of Annual MonthlyYears Payment Payment1 $1,000.00 $84.472 507.39 42.863 343.23 28.994 261.19 22.065 211.99 17.916 179.22 15.147 155.83 13.168 138.31 11.689 124.69 10.5310 113.82 9.61

11 104.93 8.8612 97.54 8.2413 91.29 7.7114 85.95 7.2615 81.33 6.87

Male Female4546474849

45 5046 5147 5248 5349 5450 5551 5652 5753 5854 59

GuaranteedPeriod10 20Years Years

$3.99 $3.874.05 3.924.11 3.974.17 4.024.24 4.074.31 4.124.38 4.174.45 4.224.53 4.284.61 4.344.70 4.394.79 4.454.88 4.504.97 4.565.07 4.62

OPTION 5LlFE INCOMEPER $1,000 APPLIEDNO GUARANTEEDPERIOD

Age MonthlyMale Female Payment45 $4.0246 4.0947 4.1548 4.2249 4.29

45 50 4.3746 5 1 4.4547 52 4.5348 53 4.6249 54 4.7150 55 4.8151 56 4.9152 57 5.0153 58 5.1254 59 5.24

i1I

80 85 8.62 5.50 80 85 12.37 181 8.74 81 12.93 /82 8.85 82 13.5483 8.96 8384 9.06 8485 ; 15 9.14 15.60-11SETT


18/25

TABLE OF MINIMUM DEATH BENEFIT PERCENTAGES*

Attained AgeThrough 40414243

44454647484950515253545558575859

Attnlned Age60616263646566676869707172737475-90919293949597

Percentage

TABLEOFSURRENDERCHARGEFACTORS

Pollcy Year 01 SurrenderOr Yeara Since lncreaw Factor12345678910 And After

TBLl (FPAL-8)


19/25

TABLE OF GUARANTEED MAXIMUM MALE INSURANCE RATESPER $1,000

I I NON-SMOKER SMOKERMONTHLY MONTHLY MONTHLY MONTHLY 1ATE AGE RATE AGE RATE AGE RATE


20/25

(1 TABLE OF GUARANTEED MAXIMUM FEMALE INSURANCE RATES 7AGE

123456789101 1121314151617181920212223242526272829303132333435363738394041424344454647

-11

NON-SMOKERMONTHLYRATE AGE.07000 48,06667 49,06500 50,0641 51,06250 52.06000 53,05917 54,05834 55,05750 56,05750 57,05834 58,061 7 59,06500 60.06834 61,06667 62.07501 63,081 7 64.08001 65,08251 66,0841 67,08584 68,08667 69,08834 70,09001 71,091 8 72,0941 73.09584 74,09834 7510168 7610418 77,10751 78,11085 79.I1501 80,12001 8112585 82,13418 83,14419 8415502 8516669 8618087 87,19587 88.21088 89,22588 90,24089 91,25757 92,27508 93,29425 94

95969798

PER $1,000MONTHLYRATE AGE MONTHLYRATE AGE MONTHLYRATE


21/25

'30JW SNVOl 8O SM30N3lYnS l V l l 8 V d Ok ONV &33 Vd 3l fl C3 H3 S 3 H l NO NMGHS WflIW

31001H3d 03NN Yld 3 H l N I 33NVH3 ON 6 N011d0 80 1NnOWV lIz l3 N3R 031 zlI 33d S N I 39NVH3 ON I V H l ONV bO IV d SI l S 3 8 3 1 N I SS33X3 UN 1 V H l 'O33YVH3 3YV S3

33N VYn SNI WnWlXVW 0331 NV8Vfl3 3 H l 1 V H l 3WflSSY S3fllVA HSV3 O331NV1Vfl3

3 f l lV ANVOl 8 0

HSV3


22/25

MACCABEES M U TU A L LIFE INSURANCE COMP ANY25800 Northwestern Highway, P.O. ox 2165, Southfield, Michigan 48037-2165

AMENDMENT

Attached to and made part of the Policy as of its effective Date of Issue:

Under the section titled "Policy Loan Provisions," the provision entitled "Loan lnterestRate" is hereby deleted and the following language is substituted:Interest will be charged on all policy loans at a rate of 7.4% per yearcompounded annua lly and payab le in advance. lnterest must also be paidin advance on each policy anniversary thereafter until the loan is repaid.lnterest which is not paid when due w ill be added to the loan. Unpaid interestwill bear interest at the same rate.

Signed for the Company at its Home Office in Southfield. Michigan.

Secretary / President


23/25

A Y Y L l C A T l O N F O R I N S U R A N C E T O P A R T Ia , & r" "* -'"NO. 592199 M A C C P SE E S M U T U A L LIFE IN S U R A N C E C q M P A L ' " 4074420

p w s r o r - , TpPrint Name Age Rela tionshin

. a utomatic Prem. Loan


24/25

2,%+ < z ...;:. ::.,:. :..?..;~., . : - : . . . . . . .;^,.i..i. .. . . D l s A B l L l T y I N C O M E O N L Y . , , ' ? > ~ ) ~ ~ " ~ , " ~ $ ' ' .'". . . . . .' ' . ' : ...........Plan P -- ' Bel. . r t B 'Be ne fit Pe;iod - 7 L i fe t ime Acc ident

. . . . . . . . . .. . . . . . . . . . . .iabi l i t ies) '$ . . . . . .I nsurance ' in fo rce , app l ied f . o ror app!ying?greiriuate.:::;

23. Has the proposed Insured(r ) in Qu e s t i o ~ : .(Cive de tai ls . ' Yes answers in Quest ion a) Ya. a reinstatem. . or an appl icat ion for l i fe'&heal th insurance pending or contemplated inEl im inat io n Period (for add' l pol icy(s1. . . . . . .. . . . c j ~ ; ' : " :........ . , ... ," .,..,D d l ~ j o ~ ~ ~ .EWEFITS, .y~~;i.y~>i:i:ji,;2j.~tjrx~~.:ff;...,?.. ..,+,+.- .....ie"ef i t $ : - - -O COLA;:;j{;lf:,':>~l;::~.:-:. 'D ef e r redAdd ' l Bene f i t $-.,D CashV+I .ue -:,$ :, :.. .

Heal th SS ~vnrlersinorland ~ ~ r p e dha t: (1) the answers reco rded in Part I above and'Part II, bearing the same num ber, and any

~ ~. .t I l l required are, to the best of my'knowledge and bel ief , t rue and com plete and correct ly recorded and wi l l becom ef this ap pl ica t ion and any contra ct for insurance issued upo n it ; f2) Except as provid ed for i n he at tache d ReceipUs).Insurance shall take ef fect un t i l the po l icy i s accepted by the Ow ner and the f i r st p rem ium i s paid to the Company and(3) Acceptance of anvssued shal l const i tute a rat i f ic at io n o f any change, corre ct ion or a ddit io n mad e by the Company, except in stateshere required: any change in am oun t, pla n of insurance, c lassif icat ion, a e a t issue or ben ef i ts shal l require the signature

the Owner : (41That no Agent has the auth ori ty to wa ive the answer to a$ quest ion, to pass on insura bi l i ty, to waive any- . . -the Company's r ights or requirements or to make or al ter any contract.made at State D a t e 1 9 acknowledge receipt of O ut l ine of Coverage

ert i iy that this app l icat ion accu rately records the informa-suppl ied b y the Appl icant. Proposed InsuredSpouse [If to b e Insured)tness Second Proposed InsuredRes~dentAgent ( I f lo int W.L.). I BY

f other than p ropos ed Insured) [Signature & Title o f O ff icer s igning for Firm or Corporat ion)lAoolicant 1s a Firm or Corporation, insert nam eo f Company)


25/25

I 11 conttnuation of Application to MACCABEES MUTUAL LIFE INSW-RANCE COMP AN Y

\Vht .~ i lld I'rol)osr.d Insur(-d ast consult a physician? Date 4-67Dnc lor.A (lclrc~rsP~CUAZSA I ~ I P L F I b U 5 0 ~ 7 ~7 - ,What tr(batrlientwas g1vt.n or reromnicnded? UoNc- 6 FN F a I 63/3\ I' l1txn d ~ d ccon(l I'roposed insured last consult a physician?Do( torAddrt.ssLVh'it trt,atii it~nt vds ~ : ~ v t * r ir rrcommrndcd?t a parent, brothc~r,or ststcsr of arly person propostad fo rt.\,cxr 1.1~1ubcrculosis . diabt*tr.s, canc6.r. high b lo od pressure,. ,art disease,~ . l c ~ t i r ~i~wasc. r mental illness, 0:tj.15 ,+ti\ I)tbr50n~>ru l~c f i t~ ( lor rovc>ragrw~ t h l nhe past ilve years.J H(.r.ri t~ kani inrd y or co ns ul t~ d phvsirlan or otl it~ r ractitioner?1) lb.1.11 unr1t.r ol>\t-r\,at~o~ir trt*a tii lrn l in a ilosliit.il, s;tnitar~~rrlir t~ist~tul ioi i?( ti;~cl in 2-r,ty. c~lrc tro rardtograni. lood, uri nr or othpr laboratory tests?1 1 ~ 1 , ~ i n \ 1(. r>c)r i 11ropos(~(Ior (over~%gt,vcLr..I K(. rt>lvt .d h t~ n c~ f~ t \r ro i i i l ~ r i i sa t~o i ior s ic-knes or injury o r had l ifp or

d ~ \ ~ l l ~ i l t t ynstir~ir i(r.atc,d 1111. i i ~ o d ~ f ~ ( * d ,c~ierIed. anct~Il~.~ Ir r iot rt~ne~.ed?t ? Soi1~111 i d v ~ ~, or trc.atm(3til or or t ~ t ~ . r irrt~slc~cl ~ ~ rr h t . c ~ idtltcted tot h ~ ,i s t , (> Ialcohol or drugs?

1 l i , ~ din\ t l ~ \ t ~ a % ~ ~f thv re l)r od ult ~v c rgans, g rni tal organs, breast>, or.In\ aii illuta tlnn or bodily drfo rni ity, hrrnl' l or ruptu rr, hemorrhoids orvcir1(ow v(~ i r i \ l

. ......< ,DETAILS Or " Y E S " ANSWERS question number. covered pc i r c le app l i cab l e i tc *ms . Idiagnosi

Original Complaint - 97 CH 4324

Documents

Transcript of Original Complaint - 97 CH 4324