House Insurance Claim - Fraud Team called out

samantha241

Hi

I have a house insurance claim and a friend pretended to be my ex-husband and signed a cheque so that I would get the insurance money for food and accommodation in my name only.
The flood from a tank in the attic, was genuine, and they questioned where all the contents were on a previous occassion(as most had been taken out by my ex-husband)but I lived there most of the time (single bed and all my study things were there).Policy states it can't be empty for more than 42 days.
Would they void the entire claim, even though my ex-husband knew I was going to get money for food and accomodation?
Am worried, never been involved in an insurance claim, clean record, full time job for a large company for 11 years and never been involved with the police.
Please help, I can't sleep at night.
Thanks
Sam

dacouch

I don't understand your situation, as its not very clear.

Is your name not on the policy as a policy holder?

Why would they think the house is empty

samantha241

Hi Dacouch

Thanks for replying.

Yes, my name is the second policy holder, my ex-husband was the first.

As he took most of this things, the house was quite bare, plus I removed the rest as it took the insurers over a week to send someone out.

I lived there and sometimes at my boyfriends.

dacouch

Was the house Unoccupied / Unfurnished (Not sufficient furnishings for a human to live there) for more than 42 CONSECUTIVE days (I assume your Insurer specifies 42 days as you mention this figure).

samantha241

Hi Dacouch

There was a table and chairs and a sofa, bed, wardrobe and study furniture. However, I took out the table and chairs and sofa before the loss adjuster came to prevent further damage as there was some water on the floor. The bed and study rooms were undamaged.
As a result, I haven't made a claim for contents at all. Just the buildings.
I can't afford to pay back what they have already done, about 15k worth of work has already been done.
Thanks
Sam

dacouch

Send me a personal message to tell me which Insurer it is and I'll have a read of the exact wording in relation to this from their policy.

Do not type which Insurer it is in on the main thread

cogito

You only need to read the gas and electricity meters to determine whether a house has been occupied or not.

woody01

I have a house insurance claim and a friend pretended to be my ex-husband and signed a cheque so that I would get the insurance money for food and accommodation in my name only

Fraud is fraud.
I would get a good lawyer.

dacouch

Depending on the circumstances of the fraud (Generally if the policyholder would not be able to claim for anything they were not entitled to by producing forged documents) the Ombudsman will advise the Insurer to pay the claim.

LadyIndecisive

I don't fully understand the original post but perhaps there is fairly relevant case law here. The case of Axa v Gottlieb in 2005 relates to a fraudulent claim for alternative accomodation following an escape of water claim and is outlined here

http://www.onlinedmc.co.uk/axa_general_insurance_v__gottlieb.htm

There is a common law principle, over and above utmost good faith and contract terms. Quoting from the Star Sea 2001 case: "The law will not allow an insured who has made a fraudulent claim to recover. The logic is simple. The fraudulent insured must not be allowed to think: if the fraud is successful, then I will gain; if it is unsuccessful, I will lose nothing".

Also relevant is DL v Khan 2002, a claim for lost rent where the Insured blamed the co-insured. The co-insured was found to be agent of the Insured. Under the common law rule, where all or part of a claim is fraudulent (or where fraudulent devices are used to promote what started out as a genuine claim), the insured cannot recover in respect of any part of the claim. After there has been a fraudulent act, all sums paid out in ignorance of the fraud are recoverable, including sums relating to the genuine part of the claim.

I am not a lawyer myself but these are useful reference points.

samantha241

Hi

My insurance company has voided my claim from the date of my flood, saying it was not in utmost good faith.

Should I appeal to them directly or get a solicitor involved (any recommendations most welcome) or should I go to the insurance ombudsman, just I have read in your replies that even if you go the insurance ombudsman, solicitors can still be involved to prove your case.

The flood was genuine and I think they are just trying to get out of not paying as someone else signed so that my food/accommodation cheque could be put into my sole name. I was still entitled to that money.

Also sometimes, I had two rooms in the hotel(budget hotels), but I gave all the bills as they were and they still paid out, I had an allowance and the remainder of the time, I paid for everything.

They are now also saying I shouldn't have had two rooms but I did not cover anything up and gave the bills as they were. Could this be considered as fraud?

Please help, I have lost all my savings, am in huge debt (50k approx) and living with friends now.

Am living a nightmare and just want my house back.
Sam