An insurance company that doesnt want to to pay up

super_dad

ok, now I can see why they don't want to pay up... but bear with me!

a friend of mine has an insurance policy which covers for accidental damage. basically what's happened is one of their lovely little kids has spilt some paint on their sofas whilst they are out of the room. They have basically chucked a tin of paint, it has hit the wall and the lid has fallen off ... the tin has then landed on the sofa. The little kid has then started "splashing".... wonderful.

This is a true story, it is a new (ish) sofa and is/was in v.good condition.

Insurance company have come back with "pull the other one sonny jim, it's got bells on".... where does my mate stand?

He has spoken to a solicitor and solicitor has said to make a video of his lad throwing a can of paint (what!?) and then to threaten legal action... anyone else any ideas?

dmg24

Insurance companies have some pretty sophisticated systems in place to detect what they believe to be fraudulent claims, so some doubts or inconsistencies may have been picked up during the claims process.

Could I ask how old the child was, and how big was the tub of paint?

There is a duty on the policyholder to take due care, and it could be argued that in leaving an open tin of paint in a room with an unsupervised child, they have not taken due care.

You could put in a complaint with the insurance company, but as this is one of the most common scams (not saying that your friends is) I'm not sure how far he will get.

super_dad

the darling child is almost 3.. and it was a small tin of gloss type paint. the paint was not open. We are all trying to work out how he actually managed to open it up but we can't actually work it out. We've put it down to "just one of those things" and the impact of it hitting the wall.

It was a new can of paint and they're assuming that someone may have opened it in the store before it was purchased by our friends and then not closed it properly (that's their argument anyway)

olly300

Do you have photographic evidence of the damage? And do you still have the damaged items plus the receipts for them?

dmg24

Looking at it from the view of the insurance company you can see that it doesn't look good?

super_dad

hi... i can see it from the insurance companies view. We all made a video of the little scamp picking up a can of paint and "launching it" (was quite funny actually as the little lad was a bit hesitant thinking he was going to get another smacked leg!!)

Yes we got photo's of the sofas (insurances company have them too)

I suppose the next step is to complain to the ombudsman and then make a claim via https://www.monenclaim.gov.uk and let a court decide. Was just wondering whether anyone had anyother ideas...

thanks anyway.

dmg24

No, you need to follow the insurer's complaints procedure first.

sarahg1969

dmg24 wrote: »

No, you need to follow the insurer's complaints procedure first.

That's right. And if their internal complaints procedure does not produce a result, get the Ombudsman to look into it. If the insurers have no evidence (they need real evidence, not just their opinion that it's a scam - that's not enough), then the Ombudsman will rule in favour of the policyholder.

super_dad

oh right... from the conversation that i overheard the guy from the insurance company was saying "we're not satisfied that a child of that age can throw a can"... my friend then said "we made a video of him throwing a can"... insurance guy said "in similar test cases we have rejected the claim as we are not satisfied with what has happened"..." we are not satisfied with you account that you left the room and the lad has thrown this can of paint in the minutes that you're out of the room"..."do you often leave youre child unattended" kind of attitude.

He then went on to say "how did the child open the can of paint?"... my friend replied "I don't know, I wasn't there"...insurance guy says "so you can offer no explanation?? at all, except that it came loose when he threw it?.. thats not great"... what are you "supposed" to say if that's what happened???!!!!

so what kind of questions should we be asking? any idea?

dmg24

The questions that your friend was asked are all reflective of how the insurance company are cracking down against fraud.

The difficulty that you will have is if they have had tests carried out (and it is quite possible that they have) and they have found that on the balance of probabilities a child would not be able to throw the pot and/ or open it, it will be your word against that of a professional.

It is a difficult one, but I fear that your friend will be a victim of the massive increase in fraudulent claimants who are making things more difficult for the rest of us.

Brooker_Dave

super_dad wrote: »

so what kind of questions should we be asking? any idea?

Just buy another sofa.