Fill and Sign the Price V State of Illinois Complaint Against States Attorney Form

IN THE CIRCUIT COURT OF COUNTY, MISSISSIPPI PLAINTIFF VS. DOCKET NO. DEFENDANT COMPLAINT COMES NOW Plaintiff, , with this his/her Complaint against the Defendants,   agent of and agent, servant or employee of and for , agent of and agent, servant or employee of and for agent of and agent, servant or employee of and for of , and would show unto this Court the following: 1. Plaintiff is an adult resident citizens of County, Mississippi. 2. Defendant is a non-resident corporation of the State of Mississippi, but is authorized and doing business in the State of Mississippi and has appointed as its agent for service of process at Defendant is a non-resident corporation of the State of Mississippi, but is authorized and doing business in the State of Mississippi at its offices located , , County, Mississippi, and is a predecessor to may be served with the process of this Court by service upon its appointed agent at County, Mississippi. 4. Defendant is a non-resident corporation of the State of Mississippi, but is authorized and doing business in the State of Mississippi and has appointed as its agent for service of process the Insurance Commissioner of the State of Mississippi. 5. Defendant is an adult resident citizen of County, Mississippi, an agent of , an agent, servant, or. Employee of and its predecessor, and may be served with the process of this Court at his/her place of employment located at , Mississippi. 6. Defendant is an adult resident citizen of County, Mississippi, an agent of , an agent, servant, or employee of and its predecessor , and may be served with the process of this Court at his/her place of employment located at , Mississippi. 7. Defendant is a duly licensed and acting corporation formed under the laws of the State of Mississippi and may be served by process upon its appointed agent for service of process, , Mississippi. 8. Defendant is an adult resident citizen of County, Mississippi, an agent of an agent, servant, or employee of and may be served with the process of this Court at his/her place of employment located at , Mississippi. 9. The action complained of herein accrued in County, Mississippi; this Court has jurisdiction over the parties and the subject matter hereto pursuant to the Constitution of the State of Mississippi, Miss. Code Ann. § 9-7-I81 (1972) and related statutes. 10. and his/her husband/wife, at all times pertinent to this action, jointly owned and resided upon a parcel of land located at , County, , Mississippi. 11. On , 20 , and his/her husband/wife, , plaintiff herein, entered into a loan agreement with secured by the above property, in the amount of $ which sum included closing costs, recording fees, finance charges and credit life insurance on the life of . 12. On , 20 , and his/her husband/wife, plaintiff herein, renewed the , 20 mortgage loan at for the sum of $ , which sum included closing costs, recording fees, finance charges and credit life insurance,   policy no. , on the life of . 13. The mortgage loan dated , 20 and the renewal of , 20 were executed by and plaintiffs herein, for the benefit of and secured by deeds of trust on property located at County, , Mississippi. 14. At all times pertinent to the cause of action stated herein, Defendant was agent, servant and employee acting within the scope of his/her employment, for and on- behalf of . In 20 , and his/her husband/wife, , were solicited by, and made an application to, for a loan for the purpose of paying off the outstanding mortgage and deed of trust at . 16. On , 20 , and his/her husband/wife, , plaintiff herein, signed and executed all necessary documents for a mortgage loan at at their office at , Mississippi, for the sum of $ , which sum included closing costs, recording fees, finance charges, and credit life insurance in the amount of $ , policy no. , on the life of 17. At all times pertinent to this action, Defendants and were agents, servants and employees, acting within the scope of their employment, of . 18. Defendants , and at all times pertinent to this action were soliciting agents of and for ; the proper persons to solicit and procure applications for credit life insurance, and the proper persons to contact for the filing of claims. 19. At all times pertinent to this action, , born , 20 , properly disclosed to defendants herein that he/she was disabled and his/her monthly income was derived from Social Security Disability benefits. 20. On , 20 , died in County, Mississippi. 21. Within the time specified on the policy of insurance, plaintiff caused to be served upon defendants due proof of the death of , which proof was duly received by defendants. 22. On , 20 , denied credit life insurance benefits under Policy No. issued on the life of , deceased. 23. On or about , 20 , and agents, servant or employees of     and agents of and for denied credit life benefits payable under Policy No.   issued , on the life of , deceased. 24. Defendant has refused and continues to refuse to pay benefits under Policy Nos. or issued on the life of , deceased. COUNT I. 25. Plaintiff realleges each and every allegation contained in Paragraphs 1 through 24. 26. On or about , 20 and , 20 , , deceased, made full and truthful disclosures of all information requested of him/her, including any physical or mental impairment and medical conditions, to , soliciting agent, servant and employee acting within the scope of his/her employment, of and for and . 27. On or about , 20 , , soliciting agent of and for advised    and his/her husband/wife, plaintiff herein, and knowingly and fraudulently misrepresented unto plaintiffs what constituted sufficient answer and responses to said application for credit life insurance benefits. 28. On or about , 20 , soliciting agent of and for knowingly and fraudulently completed the application for credit life insurance benefits on the life of , and misrepresented facts and matters within his/her knowledge, for purposes of securing payment or the obligation for the payment of a premium of insurance for the benefit of ,     and . 29. Plaintiff, , alleges upon his/her information and belief that the aforesaid action of defendant was prompted by willful and conscious wrong and by actual malice or by conduct so grossly negligent, wrong, and inexcusable as to amount to a complete disregard for the rights of creditor, and plaintiff herein, and was attended by intentional wrong, insult, and abuse. Such conduct on the part of the defendant entities plaintiff to an award of punitive damages of and from said defendant.30. As a direct and proximate result of the conduct of the defendant as aforesaid, plaintiff has sustained compensable losses in addition to the loss of benefits withheld in excess of $ constituting the remaining gross unpaid balance at at the date of death of , attorney fees, and severe mental distress, which plaintiff is entitled to recover. COUNT II. 31. Plaintiff realleges each and every allegation contained in Paragraphs 1 through 24. 32. On or about , 20 , issued to deceased, credit life insurance Policy No. which policy1 effective , 20 , provided credit life insurance benefits on the loan made that date at . A copy of said contract of insurance is attached as Exhibit “A” and made a part hereof by reference. 33. Said policy was in full force and effect at the time died in County, Mississippi on , 20 . 34. Within the time specified on the policy of insurance, plaintiff caused to be served upon defendant due proof of the death of which was duly received and retained by defendants. 35. Plaintiff duly demanded from defendants payment of the outstanding balance of the mortgage loan at in accordance with the terms of the policy. 36. full and complete knowledge of the facts hereinabove stated, defendants totally failed, refused, and neglected to pay the balance of the outstanding mortgage upon proof of the death of , deceased, causing plaintiff to suffer extreme humiliation and embarrassment and mental distress. 37. Notwithstanding demand for payment of benefits law-fully due and owing under said contract of insurance, defendant has, without an arguable reason, refused and continues to refuse to pay any benefits therefore, defendants are indebted to plaintiff in a sum exceeding $   constituting the remaining gross unpaid balance at at the date of death of , payable under the policy of insurance no. together with interest thereon by reason of the facts hereinabove stated. 38. At all times relevant hereto, defendants, knowing that plaintiff's claim was and is wholly valid and should be paid, have refused to pay to the benefits under the policy of insurance as aforesaid at a time when they had no logical or arguable reason to deny the payment of benefits, and have wrongfully breached their contract of insurance with plaintiff, and have wrongfully and in breach of the implied covenant of good faith and fair dealing withheld and denied benefits due. 39. Plaintiff alleges upon his/her information and belief that the aforesaid actions of defendant were prompted by willful and conscious wrong or by actual malice or by conduct so grossly negligent, wrong, and inexcusable as to amount to a complete disregard for the rights of plaintiff and was attending by intentional wrong, insult, and abuse. Such conduct on the part of the defendant entitles plaintiff to an award of punitive damages of and from said defendant. 40. That as a direct and proximate result of the conduct of the defendant as aforesaid, plaintiff has sustained compensable losses in addition to the loss of benefits withheld, including severe mental distress and attorney fees for which plaintiff is entitled to recover. COUNT III 41. Plaintiff reallege each and every allegation contained in Paragraphs 1 through 24. 42. On , , soliciting agent of and for advised and his/her husband/wife, , plaintiff herein, knowingly and fraudulently misrepresenting unto them what constituted sufficient answer and responses to said application for credit life benefits. 43. On or about , 20 , , soliciting agent of and for knowingly and fraudulently completed the application for credit life insurance benefits on the life of and misrepresented facts and matters within his/her knowledge, for purposes of securing payment or the obligation for the payment of a premium of insurance. 44. Plaintiff, alleges upon his/her information and belief that the aforesaid action of defendant was prompted by willful and conscious wrong or by actual malice or by conduct so grossly negligent, wrong, and inexcusable as to amount to a complete disregard for the rights of the creditor and plaintiff herein and was attended by intentional wrong, insult, and abuse. Such conduct on the part of the defendant entitles plaintiff to an award of punitive damages of and from said defendant. 45. As a direct and proximate result of the conduct of the defendant as aforesaid, plaintiff has sustained compensable losses in addition to. The loss of benefits withheld in excess of $ constituting the remaining gross unpaid balance at at the date of death of , attorney fees, and severe mental distress, which plaintiff is entitled to recover. COUNT IV 46. Plaintiff realleges each and every allegation contained in Paragraphs 1 through 24. 47. On , 20 , issued to , deceased, a credit life insurance policy on the mortgage loan made that date at , which Policy No. , effective      , 20 , provided credit life insurance on the life of . A copy of said contract of insurance is attached as Exhibit “B” and made a part hereof by reference. 48. Said policy was in full force and effect at the time died in County, Mississippi on , 20 . 49. Within the time specified on the policy of insurance, plaintiff caused to be served upon defendants due proof of the death of which was duly received and retained by defendants. 50. Plaintiff duly demanded from defendants’ payment of the outstanding balance of the mortgage loan at in accordance with the terms of the policy. 51. Notwithstanding its contractual obligations to do so and its full and complete knowledge of the facts hereinabove stated, defendants totally failed, refused, and neglected to pay the balance of the outstanding mortgage upon proof of the death of , deceased, causing plaintiff extreme humiliation and embarrassment. 52. Notwithstanding demand for payment of benefits lawfully due and owing under said contract of insurance, defendant has, without an arguable reason, refused and continues to refuse whatsoever; therefore, defendants are indebted to plaintiff in a sum exceeding $   constituting the gross unpaid balance at at the date of death of , payable under the policy of insurance no. together with lawful interest thereon by reason of the facts hereinabove stated. 53. At all times relevant hereto, defendants, knowing that plaintiff's claim was and is wholly valid and should be paid, have refused to pay the benefits under the policy of insurance as aforesaid at a time when they had no logical or arguable reason to deny the payment of benefits, and have wrongfully breached their contract of insurance, and have wrongfully and in breach of the implied covenant of good faith and fair dealing withheld and denied benefits due. 54. Plaintiff alleges upon his/her information and belief that the aforesaid actions of defendant were prompted by willful and conscious wrong or by actual malice or by conduct so grossly negligent, wrong, and inexcusable as to amount to a complete disregard for the rights of plaintiff and was attended by intentional wrong, insult, and abuse. Such conduct on the part of the defendants entitles plaintiff to an award of punitive damages of and from said defendants. 55. That as a direct and proximate result of the conduct of the defendant as aforesaid, plaintiff has sustained compensable losses in addition to the loss of benefits withheld, including attorney fees and severe mental distress which plaintiff is entitled to recover. COUNT V 56. Plaintiff realleges each and every allegation contained in Paragraphs 1 through 24. 57. and , agents, servants, and employees acting within the scope of their employment of and for the benefit of were at all times pertinent hereto, the proper persons to contact for filing claims under credit life insurance policies, more particularly, credit life insurance policy no. issued , 20 on the life of . 58. Said policy was in full force and effect at the time died in County, Mississippi on , 20 . 59. Within the time specified on the policy of insurance, plaintiff caused to be served upon defendants due proof of the death of which was duly received and retained by defendants. 60. Plaintiff duly demanded payment from defendants in accordance with the terms of the policy. 61. Defendants and as agents, servants, and employees acting within their scope of employment at and notwithstanding complete knowledge of the facts hereinabove stated, totally neglected, failed and refused to file a claim for credit life benefit s under Insurance Policy No. issued on the life of effective , 20     , causing plaintiff extreme humiliation and embarrassment. 62. Defendants and as agents, servants, and employees acting within their scope of employment of and for the benefit of and , denied and continue to deny plaintiffs claim for insurance benefits; therefore, defendants are indebted to plaintiff in a sum exceeding $     constituting the gross unpaid balance at at the date of death of , payable under the policy of insurance no. together with lawful interest thereon by reason of the facts hereinabove. 63. That as a direct and proximate result of the conduct the defendants and individually and in concert, and as agents, servants, and employees acting within their scope of employment with , as aforesaid, plaintiff has sustained compensable losses in addition to the loss of benefits withheld, including attorney fees and severe mental distress which plaintiff is entitled to recover. 64. Defendants and agents, servants and employees acting within their scope of employment of and for and denied said credit life insurance benefits unto plaintiff herein which denial was prompted by willful and conscious wrong or by actual malice or by conduct so gross as to amount to a complete disregard for the rights of plaintiff and conduct attended by intentional wrong, insult and abuse. Such conduct on the part of the defendants entitles plaintiff to an award of punitive damages of and from said defendants. 65. Defendant agent, servant and employee acting within his/her scope of employment for and on behalf of accompanied said denial of benefits unto plaintiff herein with words of such abuse and contempt intended to insult and abuse plaintiff and in complete disregard for the rights of plaintiff, and such conduct on the part of the defendant and entitles plaintiff to an award of punitive damages of and from said defendants. WHEREFORE, PREMISES CONSIDERED, plaintiff sues and demands judgment against the defendants in a sum exceeding $ plus legal prejudgment interest thereon in actual damages, compensatory damages, including attorney fees and emotional distress, in an amount this Court shall find reasonable, and punitive damages in such an amount as would reasonably deter defendants' conduct from occurring in the future. Respectfully submitted, _______________________________________ Attorney for Of Counsel: Telephone: MSB # Attorney for