Insurance claim for subsidence - update and opinions please

Kittian_the_Blue

OP
Whilst I usually agree with Oscar, I don't agree that an assessor would be to your benefit here - firstly as you state there is both insured works and works you are paying for yourself - you will definitely need your solicitor to sort out the uninsured rectification works and I would disagree that you need someone with insurance knowledge to manage the rectification of the insured damage - it's not a matter of cover, it's a scoping and standard of work issue, which is better dealt with by a qualified surveyor and a solicitor - in my opinion, a loss assessor won't be able to add anything to the situation and will not likely be interested in taking the job on as it's already well established and is quite complex in terms of the time required - Assessors like easy jobs where they make quick money - this is not one of those. I will though say that I have a low personal opinion of Assessors, as I regularly deal with them on the claims that I handle - they often cause more problems than they solve

As a final point, your solicitors costs will be recoverable from Aviva, the costs of an Assessor will not.

Insco

h.cowell wrote: »

Oscar: We cross posted, but I just read your post and found it very helpful, thank you. I had been unsure about the difference between a loss adjuster and a loss assessor, and your suggestion does seem like a good route to go. We already have a solicitor who knows the ins and outs of what is going on with us, and it was starting to seem she would be our only option. One thing I want to point out is that some of the work carried out by the contractor was to our own specifications, paid by us separately... stupid I know, but we had no idea of the pitfalls at the time. So this may need to be dealt with separately from the grievance we have with the insurer. The solicitor knows all this and is experienced in building disputes. It's hard to know what to do for the best but I do appreciate your opinion and will give it serious thought.

Sorry to see your problems. Contrary to other posts, a claims consultant / loss assessor could certainly deal with both the insured and the uninsured works. Scope of works and standard of work issues are matters that many loss assessors have to deal with on a daily basis for policyholders.

Some loss assessors specialise in disputed, problematical, complex or difficult claims; the comments by Kittian are a colossal generalisation and only opinion; there are many loss assessors, qualified insurance professionals who would be glad to attempt to assist. Indeed some loss assessors derive the majority of their work from the incompetence and inefficiencies of Insurers and their Loss Adjusters.

As you have a solicitor who who is dealing and who is used to dealing with building disputes it may well be best to proceed with them ( if you had said it was a high street solicitor who is not used to dealing with Insurers and Loss Adjusters it may have been worth reconsidering). However, make sure that your solicitors fees are recoverable if you progress with the solicitor - costs of presenting a claim are not gernally admissible whether they are from a solicitor or a loss assessor or any other party. Some of the solicitors costs may be recoverable if they commence legal proceedings and you were successful in court. However this matter should be capable of being resolved via the Loss Adjusters and the Insurers' own complaint processes.

If the Insurer advises that they are not willing to deal with the solicitors costs, it may be worth your while, given this is a moneysaving site comparing what a claim consultant would charge to see if it more economic.

Hopes this helps

Wol2

Hi - first of all my complete sympathies from one who has been (still is) in your situation.

All these different sets of people to deal with and they all pass the buck to one another. It took me months to work out what the procedure should be and there seemed to be no-one who could advise me so I had to work it out myself.

[FONT=&quot]This will be a very long post – so I will split it up

Firstly here's an outline of what happened to me:

Property flooded to a depth of 18" inside the house in July 2007. Loss adjusters appointed made incorrect assessment (they said it was merely a wet carpet job). Once i got it back on track with a new loss adjuster (same company) the insurance company handed everything over to the loss adjuster who essentially ran the claim. I was allowed to appoint a surveyor to act as my representative and the insurers covered his costs. The surveyor was my choice (becasue loss adujster delayed sending me suitable names) and I signed a contract with them directly. They prepared the build contract/specification and got it authorised by the loss adjuster. They also signed off and distributed the interim payments to the builders, again following authorisation from the loss adjuster. The builders were neither my choice nor that of the loss adjusters/insurance company. The insurance company's nominated builders had to tender and they dragged their heels and then didn;t so by the time we had authorisation to appoint our builders of choice they had accepted another job and couldn;t start for another 3 months. The insurers wouldn;t keep me in alternative accomodation for longer than was necessary so the surveyor appointed builders who were completing a refurbishment of another flooded property in the road, were prepared to match the tendered price and could start immediately. During the project I had additional works done which were my responsibility and the insurance company/loss adjuster authorised additional works that they agreed to pay for. I had to sign the contract with the builders....therefore I was legally liable for all payments.

Fast forward to a year later when I moved back in in Aug 08. The work wasn;t finished and done to an appalling standard. The final invoice submitted by the builders for payment contained the full details of charges line by line for works done and materials supplied. Over £10,000 of double charged/overcharged items, a further £5,000 charged for work done by others or not done at all and another £10,000 for work that was substantially defective. To date the insurance company had released some 85% of the original contract sum to the builders on the surveyor’s say-so and I had personally made an advance payment for additional works. The builders tried to bully me to sign off as completed, pay them what they said I owed personally (being the difference between the original contract sum approved by the insurance company and the full amount of their line by line invoice minus my advance payment) and obtain the final payment from the insurance company. This was further complicated because they wanted payment from me for work that should be covered under the insurance so I spent days and days going through the invoice apportioning the costs between me and the insurance company and working out what I thought might be a figure I would reasonably settle on.

....to be continued!


[/FONT]

Wol2

Post number 2: Here;s how things progressed:
The insurers/loss adjuster didn;t want to know - it was my problem because it wasn't their builders.
STEP 1 - DEALING WITH THE BUILDERS
My surveyor tried to negotiate/make an offer with the builders on my behalf. Over a period of 4 months as more defects became apparent, I supplied (and continuously updated) the details/photos/breakdowns of unfair charges/list of defects/snagging list etc so he had the necessary information to dispute of their invoice. I also got a quote for rectification from another builder of £25,000 and most importantly, the surveyor asked the insurance company to release the oustanding amount for the originally tendered re-instatment works back directly to myself rather than to the builders which they agreed to do.
[FONT=&quot]The builders wouldn;t engage and the surveyor was either out of his depth, hadn't overseen the work properly or didn;t want to get involved as it became clear he did the minimum required to represent my interests during the negotiations period As we neared the end of the 6 months defects period, the builders sent a letter to the surveyor accusing me of "stealing" the insurance money owed them and demanding full payment of a proposed settlement figure or they would take me to arbitration (I signed the contract so i was legally liable and the contract stated arbitration was the preferred dispute resolution method instead of court which was a shame as I wanted my day in court) –The insurance and loss adjuster said it was between me and them and not their concern, the surveyor didn;t want the hassle and expense of goingto arbitration becasue his fee wouldn;t cover his time...and the builders letter implied we were at fault for not engaging ..what a mess!. I had no strength left to try and argue the builders actually pay me in order to offset the cost of rectification so I bit the bullet, wrote the final offer letter for the surveyor to send and the outcome was both parties (ie me and the builders) walked away with no further monies being paid.

The only thing further I could do would have been to take the surveyor through the RICS complaints process and thence to court for professional negligence. However on studying the small print of that contract, it would appear that the scope of their work didn;t include for regular site visits to inspect the quality of work so I decided not to pursue it.

2. DEALING WITH THE INSURERS
By this time however I had made a formal complaint in writing to the insurers about the conduct of the claim from start to finish by them and their nominated agents (particularly the loss adjusters who delayed everything) requesting “reimbursement for financial losses incurred as a direct result of the mismanagement of the claim and failure to conduct/progress it in a timely fashion with due care and professional diligence”. At the same time I rang the Financial Ombudsman for advice and they started a case file.

I didn't get a final response within the statutory time frame required (because the insurers were waiting for a response from the loss adjusters - QED!) so I wrote again, updating my financial claim and copied my letter to the CEO's office. I also included a bundle of evidence so the insurance company could subsequently recover the losses i was claiming for from their agents. The bottom line here is that my contract was with the insurance company and despite them trying to pass me on to their agents all the time to resolve matters, ultimately i had no contract with their agents (i.e. the loss adjusters).

The letter to the CEO's office did the trick and during this time I negotiated the final contents claim with the loss adjuster/insurance to my satisfaction. However the end result was i was still some £40,000 out of pocket and needed to find an additional £25k to rectify the building work (which I didn;t include as part of my complaint to the insurance company) ……and the insurance company finally offered against all this the princely sum of £350 for stress and inconvenience. It should be noted that although the insurance company issued their final response letter, these negotiations (particularly on the contents claim) still carried on for a month or so after the date of the letter so be warned as time starts ticking from the date of the letter if you want to pursue the complaint further with the Ombudsman

So now I have submitted a formal complaint to the Ombudsman within the required 6 months of the date of the final response letter (they have been kept in the loop all the way through as I periodically rang them for advice throughout the process) They advised me to include the building rectification costs. The complaint therefore currently being adjudicated seeks reimbursement of some £70,000.

If the Ombudsman cannot resolve things (ie either myself or the insurance company reject the adjudication) it then goes to the senior Ombudsman. If after that the parties aren't prepared to settle..... I suppose my next option is professional negligence in court....hopefully it won;t come to that.

This has been a long drawn out process...and I still have kitchen worktops falling away from the walls, uneven concrete floors, cracked and broken floor tiles, no underfloor heating, wallpaper peeling off walls, splintering and curved oak floorboards, woodwork cut with blunt saws then not sanded or filled on joining, paintwork that looks like it came in contact with a herd of sheep whilst wet ..and the list goes on.

...to be continued


[/FONT]

Wol2

Post number 3 – my take on your situation
Firstly you CAN ring the Ombudsman and ask their advice and set up a case file number now before you make a formal complaint. They are very helpful.

The main difference in your situation if I understand correctly is that the builders were nominated by the loss adjuster/insurance company. Hopefully therefore, unlike me, you were not asked to sign the build contract directly with the builder. That means your only contract should be with the insurance company and it is their responsibility to sort this out. You won;t need a solicitor to handle this for you as the complaints procedure is relatively straightforward. You should submit a formal detailed complaint to the insurance company in writing (pronto recorded delivery) with all the evidence requesting them to resolve the matter with their suppliers (ie builders and loss adjusters) and reinstate your property to an acceptable standard and that until this is done, you will not sign off the works as completed. Include the quote for rectification, the independent surveyors report and claim for your time/expenses etc. Be prepared to go through the complaints procedure up to and including the Ombudman....this could take months.

As for the builders, they have no right to harass you if their contract is with the insurers. However if there is also a private arrangement between you and the builders for additional works, this will need to be resolved separately between the two of you - but if the works haven't been conducted to a reasonable standard and you have expert witness statements to prove that - hold fast and respond to them in writing stating the issues/defect and why you won;t be paying their invoice. Quote the cost for rectification of the private work and state that will be offset against the money they claim is owing from your private arrangement. (Have you paid them any money?) Inform them you have a formal complaint in to the insurance company about the standard of the work covered by the insurance claim and that you will not be signing the works off as complete. If you want to pay a solicitor to handle this side of things then fine.

If there is some debate over what constitutes your additional works and what comes under the insurance claim - this needs to be resolved as part of the complaints procedure with the insurance company. However you may have to settle the builders bill for that bit yourself and then include a claim for reimbursement for that amount from the insurance company as part of your complaint with them.....that is just my opinion and I am not legally trained so you may wish to seek legal advice on this particular issue.

Finally do you need a loss assessor? I initially appointed one when the claim started to go pearshaped right at the beginning. Their charges were 5% of the value of the whole claim. They withdrew shortly after starting, owing to ill health and by that time I thought it would go smoothly……how wrong I was. Looking back would having an assessor have improved the situation? – it might have speeded up payments/actions etc from the loss adjusters and maybe they might have had more clout and represented my interests better with both the claim progress and the standard of building work. It might have saved me the considerable amount of time, stress (and nervous breakdown) I suffered throughout the process…I just don’t know as I never got to find out how far their brief extended. In hindsight, if the last two years could have been prevented by employing an assessor I would definitely had paid their fee and considered it value for money.

Good luck – Pm me if you want any further info.

h.cowell

Sorry for the delay - I have been without and internet connection for a couple of days.

Wol2, I am really sorry to hear about your experience and will read through it carefully, to hopefully gain a bit more insight into the way things work. Even your short experience with the loss assessor is useful for me to know about.

At this point in time we are still thinking of going the legal route, particularly as the the solicitor we have already knows the situation. There comes a point when you just don't want to explain it all anymore! Nine days ago I e-mailed our complaint to the project manager at Cunningham Linsey along with a copy of the initial surveyor's letter (stating that the remedial works were insufficient in his opinion). No reply. Four days ago I e-mailed again, requesting confirmation of receipt. Reply today - 'there was no attachment'. No recognition of our complaints outlined in the body of the e-mail, no suggestion as to how we can move this forward.

I am beyond frustrated - I am furious!!!

Wol2

h.cowell wrote: »

Sorry for the delay - I have been without and internet connection for a couple of days.

Wol2, I am really sorry to hear about your experience and will read through it carefully, to hopefully gain a bit more insight into the way things work. Even your short experience with the loss assessor is useful for me to know about.

At this point in time we are still thinking of going the legal route, particularly as the the solicitor we have already knows the situation. There comes a point when you just don't want to explain it all anymore! Nine days ago I e-mailed our complaint to the project manager at Cunningham Linsey along with a copy of the initial surveyor's letter (stating that the remedial works were insufficient in his opinion). No reply. Four days ago I e-mailed again, requesting confirmation of receipt. Reply today - 'there was no attachment'. No recognition of our complaints outlined in the body of the e-mail, no suggestion as to how we can move this forward.

I am beyond frustrated - I am furious!!!

I too was fobbed off at first and told to complain directly to the loss adjusters by my insurance company and got nowhere. Not surprisingly - you do not have a contract with the loss aduster. Your contract is with the insurance company and it is they who are legally liable to you for the actions of their nominated agents. So you need to send the complaint headed "formal complaint" recorded delivery to the insurance company complaints department and specifically ask for their "final response" (it is very important you put those words in your letter otherwise they tend to ingore you- If they don;t give you a final response within 30 days you can take the complaint to the Ombudsman and if they give you a final response you are not happy with, you can still go to the Ombudsman)

If you go legal first I'm not sure whether you can then approach the OMbudsman for an adjudication - best to ring the Ombudsman and ask them, Equally if you go legal you might be asked why you hadn;t followed the official complaints procecdure all the way through to the Ombusman first before going to court - so you need to check this with your solicitor.

Hope this helps

Wol2
xx

h.cowell

Thanks again Wol2. We are waiting for our own surveyors final report and once we have that we are going to put our complaints together and do as you suggest - send the whole lot off to the insurer with some kind of ultimatum (put politely of course!). Having read your experience and on the advise of others, we have realised that complaining to the 'middle' man is just going to get us nowhere. It's so frustrating, as I'm sure you know!

At least we have a way forward now. And should this fail we will then go to the Ombudsman (who I've heard can take a long time to resolve and issue such as this?) and/or our solicitor.

Will update this thread when something happens!

huckster

I have heard that the FOS can take atleast 6 months to decide on anything that is complicated.

In regard to subs cases, I have come across a few cases over the years which have cost Insurers dear, because they did not carry out the appropriate repairs at the time. If the necessary works are not done or are carried out incorrectly, it could cost Aviva more in the long run. By getting further advice you are actually doing Aviva a favour, as it may stop them making a costly mistake. Many years ago, I remember a case where the Insurers paid out £20k for what turned out to be inadequate works. About 5 years later, the problem came back, but this tiime was worse and cost more than £50k to sort out.

It is not as if you are likely to be moving your insurance elsewhere. Aviva are stuck with the risk, so it is in their interest to ensure a proper job is done.

h.cowell

huckster wrote: »

It is not as if you are likely to be moving your insurance elsewhere. Aviva are stuck with the risk, so it is in their interest to ensure a proper job is done.

This is exactly why I don't understand the 'corner cutting' that seems to go on. Of course, Aviva probably don't know about this particular case yet, but there have no doubt been other cases. I can't believe no one has yet complained about the builders we were given...

Yes, it feels like we are doing them a favour. I just hope they are going to cover our costs.