Insurer calling us "fraud" and trusting thie contractor over loyal customer

dacouch

With regard to the food costs, you were lucky the Insurers agreed to pay you a contribution towards food as not all companies will. The reason for this is that you would still have to buy food if you were living at home and had no claim. As you have accepted the food payment when staying with relatives it would be expected your food costs would be similar or not much more than they would be if you had been staying at home.

If you genuinely could not find hotel accomadation I would suggest you obtain written confirmation of this from the hotels you approached (Or at least some of them). This may help prove that you did not deliberately stay at a relatives to make money from the Insurers. This along with a letter explaining how this happened may mean they will agree to pay the valid parts of your claim. As other posters have mentioned once you have got this part sorted out you may then be able to negoiate on getting the poor workmanship corrected.

As has been stated by other posters this is a serious matter and if its not resolved will affect your abilities to obtain any type of Insurance Policy including car for many years to come

jasoo

Thanks. this issue has been going on for 10 mnths now. When my policy was cancelled - I had to go elsewhere (brocker) who charged me 70% more than market rate to insure me.

Re contractors.. should i now approach them personally or should I request insurer to deal with producing an accurate invoice? When i first approached contractor -they said they will do some correction/ammendments upon hearing from my insurer. But as I'm waiting for Ombudsman to review my case I guess they are not prepared to take any actions?
Assuming that the contractor issue is a seperate one, can i ask the inurer to tell contractor to go ahead with unfinished business?

ben500

Let's take a brief look at your claim from an insurers point of view.

jasoo wrote: »

[FONT=&quot]leakage from bath leading to damage to bathroom floor and kitchen ceiling / units.[/FONT]

The of the most common type of fraudulent claims along with paint spillage, mobile tv's and bouncing hammers. As it can be maximised to almost complete free redecoration of property, is easy to create and poses relatively little danger to the policyholder as to other methods such as fire, often redecor is on the policyholders mind anyway and it's just a gamble to see if they can chance it for a freebie.

Given the brief description above as "leakage from bath" I'm getting the impression we are talking of a quite minor escape of water here not some deluge, which should require little more than a little redecor. Unless of course we are talking about a prolonged escape which brings forth it's own questions.


[FONT=&quot]INSURER AT FULT:
[/FONT]
[FONT=&quot]1)[/FONT][FONT=&quot]Bathroom[/FONT]
[FONT=&quot]Insurer said they would only pay for replacement of 1 row of damaged tiles.[/FONT]
All they have any obligation to do as per most if not all policy wordings.

-[FONT=&quot]after disputing this they[/FONT][FONT=&quot] agreed to retile the whole of that wall.

This was a generous gesture on there part which evidently didn't satisfy you.

again we had to disoute - leading to them agreeing [/FONT][FONT=&quot]to retile the rest of the walls but we would have to pay towards it. [/FONT]

[FONT="]which we finally agreed.[/FONT]

Not before trying to get them to stump up full price though.
-
[FONT=&quot]the work carried out was left in poor standards.

Yet you later signed a satisfaction note to the contrary it would appear.

The floor tiles were protruding out causing toes getting caught and footwear being torn.
Again did you not notice this prior to signing the sat note?
Contractor were approached by us who said the tiles we chose were inappropriate but it is not up to them to advise us, however offered to return to re grout the uneven surfaces. (which they have not done untill given go ahead from insurer)[/FONT]

You selected inappropriate materials but somehow feel contractors responsible for this.

[FONT=&quot]We were asked by contractors to sign a form without any figures / description to say that work was completed and satisfactory.
Upon requesting a breakdown of costs we noticed they were exaggerating the figures by charging for a larger surface area of the bath When questioned they admitted that we were right and agreed to change the figures. Furthermore, they charged well over market value for other duties. Eg. To take off light bulb by switching off the main supply and refit the bulb cost over £30.

Normal industry rate for this would be four hours labour plus any materials, the electrician has made a visit to the property carried out work and left I presume, it is unlikely he would get more than two such visits carried out in one morning/afternoon most often just the one, I'd say your insurers have negotiated an extremely competitive rate for this work at that price, you should be grateful that they have bargained so hard on your behalf. Either that or this electrician is one of the worst paid in the country.


Non qualified workers switched off the home security alarm whilst trying to find the correct main supply switch – leading to house being insecure for 2 days. [/FONT]

[FONT=&quot]2)[/FONT][FONT=&quot]Kitchen[/FONT]
[FONT=&quot]When wall units were taken down by what looked like non experience / qualified worker – they advised insurer it was reusable.[/FONT]

As is their obligation under their contract with your insurers not to replace servicable parts or incur unnecessary costs against the claim.

Did he not have a large "Q" on his back for qualified?

[FONT=&quot]-We had to fight our case again by getting independent advice who said they clearly were not reusable. [/FONT]

Not difficult to get some independant traders to say anything you want them to to insurers if they think they have a chance of getting work out of it and quite commonplace. Let's face it you wanted a new kitchen too but were taken aback when finding out there was nothing much wrong with the existing one.

[FONT=&quot]-Insurer finally agreed to pay for wall units.[/FONT]

Goal!

[FONT=&quot]-We said the floor units should also be replaced as it would not look coordinated.[/FONT]
[FONT=&quot]- They finally agreed to go pay 50% towards the cost of floor units.[/FONT]

We tried for full whack but they were having none of it, didn't want to push it though we've been lucky so far.

This is going well let's see how much else we can push for. Time to pull the accomodation card too can't live in a house whilst I'm getting them to rip it apart for me

House is coming along nicely now, wonder if I can get them to retile the kitchen floor now seeing as that scruffy painter bloke spilt his tea on it.


[FONT=&quot]
[/FONT]
[FONT=&quot]WE FEEL THAST THEY ATTEMPTED TO SHORT CHANGE US ALL THE WAY

We struggled but in the end we milked them quite for a while.


Oh !!!!!! they found out we cancelled the hotel!!!!
[/FONT]

[FONT=&quot]OUR FAULT
[/FONT]
[FONT=&quot]Insurer had agreed to pay hotel accomodation ( about £110 per day) whilst work was being carried out PLUS (£25)Food allowance. Bothe children were upset by this and we stayed at relatives after more than one attempt to book /cancell hotel accommodation. We[/FONT][FONT=&quot] didn't inform insurer that we had changed our mind and allowed them to pay us for hotel cost as we thought the cost was simmilar ( infact we saved them money by agreeing to stay in family room and not 2 seperate rooms - which would have cost almost double)
[/FONT]
[FONT=&quot] Insurer is accusing us of FRAUD and exageration of claim and demanding back all hotel cost and costs of work carried out.
[/FONT]
[FONT=&quot]The invoice provided by thier contactor was completely inaccurate and exagerated. when we questioned this - contractors re measure work carried out and admitted that they had charged us for inaccurate measurment of bathroom and that some of the work was incomplete.[/FONT]
[FONT=&quot]
[/FONT]
[FONT=&quot]What do you feel should be the outcome?[/FONT][FONT=&quot] as everyone has tried to short change everyone else and insurer has accused us of fraud but not thier contractors.
[/FONT]
[FONT=&quot]Even if we did pay up - it would mean i am paying insurer for non satisfatory completion of work.
[/FONT]
[FONT=&quot]Thanks for your time in reading such a long note.
[/FONT]

jasoo

ben500 wrote: »

Let's take a brief look at your claim from an insurers point of view.

Thanks for making me see it from insurers prespective. I'd like to make a few clarifications: a) it was the builder that was on site that charged £30 for switching main light switch off. not a qualified electrician
b) our policy speaks about resonable replacements, like for like - surely my bathroom would not have looked resonable with non coordinated tile?
c) we sent insurer picture of the damaged wall units that the builder said was replacble - when challanged the non qualified builders judgment the insurer and senior contractor than agreed that it was all damp from leakage and rotting. - so we were not asking them to throw in a new kitchen.
d) we did not sign document that asked us to confirm the jobs were carried out satisfactoly as it id not contain any breakdown of work/costs. It was on request for the breakdown of what we would be signing for that led us to discover that contractor were trying to over charge / exagerate and in some cases tried to charge us for work not done eg. removal of old units (which still sit in my garage).And at this stage we had to point out all the poor quality / standards of work.

Have they not tried to fraud the system knowing that most people wouln't ask for breakdown of costs particularly when it is an insurance calim and the insurer is paying for it?

Do u think its worth me putting this petty argument to the contractors who have admited over charging and agreed to regroat the floor tiles? also they have charged us for replacing floor boards in the bathroom which we know for a fact has not happened. We are prepared to undo the floor tiles to show this. but does all this make insurer case a little more weaker? we are prepared to pay out the cost of hotel accomodation already paid to us even though we incurred cost by staying at family. Is it reasonabe to requet them to carryout all the jobs agreed (as they have been put on stand still due to our disagreement)

jasoo

thaks. this was usefull. but if insurer are asking for repayment of cost of work carried out by contractors, then the insurer must review the amount it is asking me to repay as they are reclaimin from me what the contractors are charging them. They have assumed that the contractors figure is correct without looking into it forthemselves and trying to gt me to pay what i don't owe.
Is this getting a bit confusing now?

I'm trying to get the insurer to acknowledge that we have both been in the wrong at some point " so lets just compromise".

dacouch

I always try and stay non judgemental in my posts so I will try and keep this that way.

a) The builders on Insurance contracts are often (Not always) working to very tight budgets, it sounds like the light bulb was not in their schedule of works so because it takes them time they decided to charge for it (Many would have done this for free). Because of delightful Health and Safety rules they would have to turn off the power.

b) As other posters have pointed out an Insurance policy is to replace the item the that was damaged / lost in the claim. With items such as kitchen cupboards an Insurer normally only needs to replace / repair this item (Depending on the policy wording). They will do their best to match the replacement however normally they do not have to replace the whole kitchen. The ombudsman agrees with them doing this but normally rules they should contribute 50% of the cost of replacing the rest of the undamaged cupboards. This is why your Insurer finally agreed to contribute the 50%.

C) Mistakes can happen, the claims handler would normally expect the information supplied by the contractor to be correct. They have to be able to justify their actions if the claims file is audited at a later date so they like things in writing to cover this. It sounds like that after receiving an explanation that the cupboard was not reusable they agreed to replace this item.

d) Try and look at the whole claim from another persons view, you are very quick to accuse the builders of exagerrating their costs and accuse them of fraud. Other people looking at the information you have posted could form the opinion what you have done with the hote; / food payments to be an exageration or fraud of the same or even greater extent.

To get your claim resolved you either need to either get the Insurers that you did not intend to defraud them and for them to pay the claim. Alternatively you accept they will not pay the claim and then argue about the quality of the work. If this happens it becomes quite a grey area as the Insurers instructed the builders but have now withdrawn from the picture and you are in effect their paymaster.

If you do not get the Insurers to accept the claim and delete the policy cancellation / void it will have massive impacts on you being able to obtain Insurance. Have you informed your Motor Insurers and your partners Insurers plus any other Insurers for any other Insurance Policies you have. If you have not then there is a very good chance you will find they also deny any claims and cancel their policies should they discover the matter when you put a claim in

dacouch

jasoo wrote: »

thaks. this was usefull. but if insurer are asking for repayment of cost of work carried out by contractors, then the insurer must review the amount it is asking me to repay as they are reclaimin from me what the contractors are charging them. They have assumed that the contractors figure is correct without looking into it forthemselves and trying to gt me to pay what i don't owe.
Is this getting a bit confusing now?

I'm trying to get the insurer to acknowledge that we have both been in the wrong at some point " so lets just compromise".

The Insurer will not accept the excuse of your contractor messed me about and we had arguements about the exact cost of my claim but I also defrauded you as an excuse. The things you have described are arguements with the Insurer over the settlement of your claim and then arguements about the contractor.

The ombudsman will often rule that someone who has defrauded the Insurer but only obtained what they would have been entitled to if for instance they had not faked a receipt for an item they could not find the receipt for. The ombudsman will reject a claim if you have obtained money you are not entitled to which it sounds like the hotel/food money is

ben500

jasoo wrote: »

Thanks for making me see it from insurers prespective. I'd like to make a few clarifications: a) it was the builder that was on site that charged £30 for switching main light switch off. not a qualified electrician
b) our policy speaks about resonable replacements, like for like - surely my bathroom would not have looked resonable with non coordinated tile?
c) we sent insurer picture of the damaged wall units that the builder said was replacble - when challanged the non qualified builders judgment the insurer and senior contractor than agreed that it was all damp from leakage and rotting. - so we were not asking them to throw in a new kitchen.
d) we did not sign document that asked us to confirm the jobs were carried out satisfactoly as it id not contain any breakdown of work/costs. It was on request for the breakdown of what we would be signing for that led us to discover that contractor were trying to over charge / exagerate and in some cases tried to charge us for work not done eg. removal of old units (which still sit in my garage).And at this stage we had to point out all the poor quality / standards of work.

Have they not tried to fraud the system knowing that most people wouln't ask for breakdown of costs particularly when it is an insurance calim and the insurer is paying for it?

Do u think its worth me putting this petty argument to the contractors who have admited over charging and agreed to regroat the floor tiles? also they have charged us for replacing floor boards in the bathroom which we know for a fact has not happened. We are prepared to undo the floor tiles to show this. but does all this make insurer case a little more weaker? we are prepared to pay out the cost of hotel accomodation already paid to us even though we incurred cost by staying at family. Is it reasonabe to requet them to carryout all the jobs agreed (as they have been put on stand still due to our disagreement)

What did he ask you to sign then, there must have been something on the document, pretty much the only document a contractor would request you sign would be a satisfaction note which would be clearly identified as such, this is in order to obtain payment and or satisfy performance requirements.

I wouldn't be in too much of a hurry to rip the tiles either as someone is going to need to pay to put them back and guess who that is.

jasoo

thank you for your impartiality. i guess looking at yours and others comments that I should pay back. If I pay up hence admiting thier accusations, would they give me a better reference and refraim from geting a ciminal reference on me (which is something they implied when we first started the disputing)

ben500

It is unlikely that if you pay what you owe they would pursue criminal procedings against you, to be honest if they were going down that route you wouldn't be having this conversation now, you'd be looking for different kind of help altogether. I wouldn't upset the builder too much either if you want him to come back and finish off any snagging issue as the insurers are unlikely to apply any pressure on your behalf and I'm sure he will already be aware of this.

In short your stuffed but could have come out of it a lot worse off than you will be.