Great 'How to ensure your insurer pays claims' Hunt: How to assure a payout

Pokka

Hi,

I am new here, so am hoping this is the right place to post my question.

A tree branch fell from a tree in a country road. It fell and ricocheted off another car on the other side of the road and crashed into our bumper and went under the car.

The bumper is cracked and parts fell off, and luckily there wasn't any damage under the car or to the steering. I got out to ensure the other car driver was ok, but as it was pouring with rain we only spoke for a few seconds. She thought a lorry must have knocked the branch and the rain helped it fall - it was a big branch!! I took a couple of pictures of the debris in the road and the lady living on the road opposite where the accident happened gave me her number is case we needed her to confirm the details of the accident.

When we called the insurance company, they said they cannot cover the claim as they cannot recover the money from the tree. They said they could put it down as a fault claim and we would need to pay an excess of £450. This would affect our no-claims so we were wary.

We've checked with a specialist garage and they said they would charge £600 to repair the damage, so we have now cancelled the claim.

But this is a lot of money for an accident that no matter how much good judgement you have cannot be avoided. Can anyone help with this? I feel the insurance companies should cover us for this, but they say they don't.

I thought that maybe the council should be responsible as maybe the tree should have been trimmed back, we had to do this a few years back after receiving a letter from the council for our trees at the front of the house.

Any help will be so appreciated. Thanks.

mattymoo

The insurance company is offering to cover you though aren't they. You appear to have comprehensive cover, subject to a £450 excess. The no claims discount would be affected.

Now, if you could get the excess back from a negligent party the NCD would be reinstated so you would almost be back at square one, although the base premium might increase via a claims loading.

The claim would be against the landowner on whose land the tree stood. Problem is, how do you prove they were negligent. If lightning struck the tree and caused debris to fall, or the tree branch was hit by a very tall vehicle then it would be very hard to prove negligence.

If however the tree was diseased and rotten and should have been felled anyway, you might have a case. Problem is, you need specialist reports from an arborocultural specialist to support your case. If the insurers outlay is £150 (600-450) they are probably saying no to spending a further 500 on reports to possibly recover 150. It doesn't make economic sense.

Had the tree branch caused a fatality or serious pile up, then yes, all the stops would be pulled out.

rudekid48

In a nutshell, there are two types of people after a claim has been made: -

1/ Happy people - they have been paid out.
2/ Unhappy people - they haven't been paid out.

However, in probably 99% of cases, both of these people have one thing in common: -

They put their claim in assuming that they are covered.

This is where the problem lies. We are all guilty of this in most things that we do, there will be exceptions, but can all of us honestly say that we have carefully read and fully understood every single Insurance policy, Loan agreement, Credit Card contract, Mobile Phone contract, Utility contract (gas, electric etc), HP agreement, Hire contract (car etc), Mortgage agreement, Lease, rental, Store Account, Blockbusters membership, Gym membership........ I could go on but you get the picture?

This means really that the happy people have been lucky and the unhappy people unlucky.

Add in to the mix fraudulent claims, dishonest third parties, forgetfulness, hard nosed businesses (which is what all Insurers are at the end of the day), opportunist contractors (mechanics, loss adjusters etc). Is it any wonder that there is such a diverse range of experiences?

It's also too easy to pin the blame on any one part of the chain - do we blame the people who work in Insurance? Remember the long list earlier, all of the Insurance people will also have most of those, how many of them have also fallen foul themselves? Do we blame the public for our apparent 'ignorance' of the things we sign?

The blame lies all round, it is the way of our society. There will always be someone out there that will happily rip you off in every line of work that there is. There are also people that will try and 'pull a fast one' in every transaction that they do.

So where does that leave us?

1/ Try to understand everything that you sign up for.
2/ Don't cut corners.
3/ Beware of doing things DIY if you don't fully understand what you are buying.
4/ Use professional services - you then have some come back if things go wrong.
5/ Honesty pays.

I'm just rambling now so I'll stop.

HappySad

Read ALL the small print after you have joined the company and even better before you join them. Then when you come to claim you know what your are really covered for.

I was offered a new washing machine by British Gas-appliance cover and I had to quote to them that I was entitled to it from the policy document.

With my mobile cover I read completely the small print and noticed that I could add my whole family to the policy document so that if they damaged my phone I would be covered. 6months later my baby son dribbled all over my phone and I got a replacement because he was on the policy document.

FlameCloud

pedro123456 wrote: »

It’s not just a case of reading the small print though, and the constant inference that “if you haven’t read the T&C, or policy wording” then you the policy holder only have yourself to blame if things don’t work out.

The fundamental problem is that the T&C, are bias in favour of the IC, in order for a claim to be successful you have to meet the IC’s definition, and these Insurance definitions (especially medical definitions) will be more stringent than the medical definitions, making them bias in favour of the IC.

I think the IC’s have their own definition of definition

This is because it is the fault of the policy holder. This is because in anything, and I mean anything in life- if you choose to buy something without reading all of the terms and conditions and without any form of professional advice if things come back and bite you on the !!!! then I am sorry, but it is no one elses fault but your own. As Dacouch and other brokers demonstrate, there are people our there able and willing to source the correct cover for anybody. If someone chooses not to use them, that is down to themselves, not the insurance company.

Modern policy's are so much tighter these days than in years gone by. They will almost always be along the lines of "We will cover A, B and C, but not X and Y, and not if Z happens". You seem to want them to cover anything and everything, as not doing so is unfair on the policy holder, despite the insurer making it clear at the point of sale that they do not.

I am in two minds with you- whether you are just a wind up merchant or you caught a loss adjuster in bed with your boyfriend, having killed both of your pet kittens and used all of your favourite shampoos.

pedro123456

Flamecloud,

You ought to lay off the wine gums, they are making you talk daft again.:D

This is because it is the fault of the policy holder. Well it would be our fault !!!!

This is because in anything, and I mean anything in life- if you choose to buy something without reading all of the terms and conditions and without any form of professional advice if things come back and bite you on the !!!! then I am sorry, but it is no one elses fault but your own. Idiotic statement.

As Dacouch and other brokers demonstrate, there are people our there able and willing to source the correct cover for anybody. If someone chooses not to use them, that is down to themselves, not the insurance company. Its not about correct cover, its about the imbalance of the policies, in favour of the IC, you lemon.

Modern policy's are so much tighter these days than in years gone by. Correct to prevent claims and turn profit into greed.

They will almost always be along the lines of "We will cover A, B and C, but not X and Y, and not if Z happens". Yes but the IC’s A,B,C definitions have bells on, and are in reality are their own interpretation, making them unbalanced in their favour.

You seem to want them to cover anything and everything, where did I imply this?,as not doing so is unfair on the policy holder, despite the insurer making it clear at the point of sale that they do not. another idiotic statement.

I am in two minds with you- whether you are just a wind up merchant or you caught a loss adjuster in bed with your boyfriend, having killed both of your pet kittens and used all of your favourite shampoos. Two minds, aint you a clever fella, I don’t actually care much for you thinking you are worthy to have an opinion on myself, but in any case, I have only one thing to say to you dingbat “Ive got plenty of shampoo” :rolleyes:

Now who I am and what I’m about is of no concern to you, if you want to attempt to answer my questions do so, in an appropriate manner, if not sit down and be quiet.

Ps, aint Halifax got shut of you yet?

unionjack81

Well isn't this discussion evoking plenty of passionate responses!

Everyone seems to have an opinion one this one. If you have experienced a bad claims service for a claim you may later have had paid, it is understandable that you may not be the biggest fan of the insurance industry. However, as a someone previously mentioned, insurance companies are businesses not charities. It is their duty to protect the 'common pool' into which every policyholder pays to secure the protection offered by the insurance contract. If they paid out every claim whether it was covered or not insurance premiums would get much higher and everyone would be moaning about that as well. Yes, some claims get wrongly repudiated at first, but after going through complaints process every insurer has, there is the Financial Ombudsman Service to fall back on - bottom line is, if it's covered, it will eventually be paid (albeit after going through the FOS). Panic over?

Another thing, a lot of people seem to be living in the past by using the argument of 'insurance contracts are too confusing':

a) the whole industry has moved towards a plain English approach making the insurance policy more user friendly. Terms are given definitions to avoid confusion by the policyholder and where they do not have their 'every day' meaning.
b) if the policyholder doesn't have any faith in their ability to interpret the policy it might be advisable to get their insurance broker to explain it to them - I understand that is what they receive commission for :rotfl:

I have complete faith that where I have an insurance policy and a legitmate claim covered under the plain english terms of my contract it will be paid.

:A UJ

dacouch

Can we start posting advice on ways to get your claim settled with the minimum of fuss and how to deal with it if their are problems with the claim.

If we continue to argue amongst ourselves then any MSE members who need hints or advice on their claim will read a few posts and then give up. I'm sure MSE did not start this thread for MSE members to argue amongst themselves. Perhaps if we want too argue we could open a seperate thread.

Can we get back to posting helpful advice on the claims process, taking a complaint to the Ombudsman, whether you have to deal with the Insurers own contractors and suppliers etc.

ozskin

how about a submission on which insurance companies have paid out and how long poll, of course there are going to be extremes at both ends but it may suggest which are better companies out there rather than just cheap which has been well discussed here, and lead us to a more informed idea next time we renew. perhaps the insurance insiders would like to provide a top 10 or who they insure with.

lisyloo

how about a submission on which insurance companies have paid out and how long poll, of course there are going to be extremes at both ends but it may suggest which are better companies out there rather than just cheap which has been well discussed here, and lead us to a more informed idea next time we renew. perhaps the insurance insiders would like to provide a top 10 or who they insure with

Just a wild and crazy idea, but what about using a professional with decades of experience who can give you this information.
Often for nothing.
Obviously the best companies may not be the cheapest.