DirectLine insurance claim on buildings

marshallka

We have had our toilet start to leak and my bathroom suite is discontinued. I telephoned DirectLine as they have a term in their policy that states

4 We will not repair or replace undamaged items which are part of
a set or suite unless they are part of a bathroom suite or fitted
kitchen and the damaged parts cannot be repaired or an exact
replacement found.

and told them about the toilet. They just said that someone called Philip Jordon would ring me about it. I left it there. WIthin the next couple of hours I got the call and after explaining the trap being to the floor and the base of the toilet I was told that he could supply and "exact" match colour BUT the base may differ hence our flooring would have to replaced. I said to him then that he could come out and look and mentioned that also I had a hole in the bath which I had done (and a couple of chips) by dropping a jar out of cupboard. He then said I am not ringing about your bath I am ringing about your toilet. I then said that maybe directline should replace the whole suite if they cannot get an exact match and he replied that by saying exact match it only meant colour. I then told him I would ring direct line.

I called them back and mentioned that the base of the toilet may be different and our flooring is cut around the toilet and I was told that is only consquential damage. I then said well my bath is also damaged and she said "do you want to claim for the bath?" I said I thought I would have no need to as they could not get an "exact" match toilet but if I have to I would. She then said that this was another excess amount and a seperate claim.

I then was told that I could find out myself from some obselete bathroom places if they could find a match OR get two seperate estimates for the bath and toilet replaced in white. I told her that their policy said that an they should renew if they cannot replace exact and she said but they are in colour and the flooring is nothing to do with us. I was really annoyed, I had two seperate claims now with two seperate excess's and I called a plumber for a quote.

My problem is my bath is only 650mm width and all obsolete places have the colour but again not that size. I was actually emailed by Philip Jordon to say that I had measured wrong he stated

Thank you for your enquiry for a replacement bath.

I suspect that the reason you cannot find a 650mm wide bath (in any colour)
is that baths were never made with this dimension.

I then emailed all the other obsolete places and was told the same but not quite in that they were never made!! I then had an email from another gentleman who had made enquiries about the size of my bath and he found out they were made in cast iron (which ours is) and also they were imported from Holland and have not been purchasable on the market for the last 50 years or so. He said that he knew of one estate in Welling Kent that had them.

I emailed this Philip Jordon with photos of me holding a tape measure from the middle of the taps and trap to the end of the bath which was 32.5cm and then again all the way across being 65cm. He then emailed me back not apologising but stating that direct line are the people I need to speak to.

I rang Direct Line back to say that my bath is not obtainable also and to have a 700mm one in my bathroom would not be an exact match and also mine is cast and not steel. They then said that they would send out a loss adjuster within 24/48 hours as I was arguing the case about their exact match. I was adament that "two" claims need not have been registered as they should have offered the full suite on just the one as an exact match of either item could not be found. We had the cistern replaced about 7 years ago by them and they just gobbed lots of filler in where it was different one and they had to remove tiles.

Anyway last nigh the hairline crack we had a fair leak from it. We had to syphon all the water from the toilet and then mastic it up and use a bucket til morning. Not nice but this morning it is fine again although still cracked but not leaking up to yet. We are going to b and q tonight to get some other better stuff.

I then called up Direct Line again to hurry the loss adjuster out and was told that there was no loss adjuster coming out and that my claim was now waiting to be validated. They said they had had a call from Philip Jordon and that it had been "closed" until validated. I was furious. I then argued that I wanted a loss adjuster out immediately so we could find out what direct line were going to do and she said she would read over the notes. She then told me that the validation team would be in touch in 3 to 5 days and then if they do validate the claim a loss adjuster would be in touch a few days later. I then said about the bank holiday weekend and she said "oh yes, it is bank holiday isn;t it". I argued that I had been told yesterday by "Lisa" that a loss adjuster would be out in 24 to 48 hours and she said "sorry that was wrong" the claim needs to be validated, we have spoken to Philip Jordon. Now I know that Philip Jordon was annoyed when I said to him that my toilet would not necessarily match because we have the trap cut into the floor and not the wall and being a bungalow we would have to have the concrete moved a bit and also it would mean a bigger job than average. If we are going to the trouble of that for another obsolete toilet (because the fitting may be different) and as the bath is chipped and has a hole in it then it seemed sensible to change to a white suite where all items are much easier to match and the trap could be converted to a modern one and we would not have this problem again.

I have now been told the claim is back open and that the loss adjuster will be out tuesday. I know that I told Lisa that she should know the words of the policy (as she had to ask me what page it was on cause she said it meant like for like. I know that Philip Jordon was annoyed cause he has not got a sale for a bath and toilet and directline just want to wriggle out of it anyway.

Can someone explain this exact match to me?

Sorry its so long

marshallka

After googling the "validation" department I have found out it is used when fraudulent claims are suspected. I cannot believe this as I asked on the day i rang for someone to actually come out and look at my toilet and was refused and also the bath (that we would not have mentioned and would not have claimed on either if the toilet had not cracked). It is now back open again and the loss adjuster will be out but it was only opened after I mentioned getting a subject access request from them (which I am still doing) and also taking a complaint to FOS about exact match and how they have handled the claim so far. I do not know now if there is a suspected fraudulent claim registered on my insurance and if there is I will not let up on this without an explanation and also that it be removed when they realise their mistake. It is not fraud to state a term from their policy that states "exact" and they keep saying it means like for like.

Please can someone actually tell me what exact means in insurance??? In dictionary terms it means
exaxt
1.strictly accurate or correct: an exact likeness; an exact description.

2.precise, as opposed to approximate: the exact sum; the exact date.

3.admitting of no deviation, as laws or discipline; strict or rigorous.

4.capable of the greatest precision: exact instruments.

5.characterized by or using strict accuracy: an exact thinker.

6.Mathematics. (of a differential equation) noting that the collection of all terms, equated to zero, is an exact differential.


exactadjective1.

accurate,
very,
correct,
true,
particular,
right,express ,
specific
careful,
precise,
idenital,



Must mean different in insurance

Bump..........

huckster

Judging by the the quality of your posts, you appear more than capable of resolving this claim yourself. Probably why no other reply since you posted.

I suspect the claim was passed to the validation team, as it appeared you were trying to claim for the updating of your bathroom, rather than an event, which was claimable as caused by an Insured peril. The Insurers don't like dealing with a separate claim for previous damage, which should have been subject to a claim at the time. It is not unknown for some people to damage different parts of a suite, so they can claim for all it. I once dealt with a case, where someone had sprinkled paint onto each part of a 3 piece suite, which was subsequently proven to be fraudulent.

My opinion is that the word exact means what it says. So if you cannot replace the damaged part, they should look at the other parts of the suite. Exact means, colour, appearance, size.

My advice is to wait for the loss adjuster to visit on Tuesday and see what happens. Sometimes the more you push, the more resistance you will meet.

marshallka

huckster wrote: »

Judging by the the quality of your posts, you appear more than capable of resolving this claim yourself. Probably why no other reply since you posted.

I suspect the claim was passed to the validation team, as it appeared you were trying to claim for the updating of your bathroom, rather than an event, which was claimable as caused by an Insured peril. The Insurers don't like dealing with a separate claim for previous damage, which should have been subject to a claim at the time. It is not unknown for some people to damage different parts of a suite, so they can claim for all it. I once dealt with a case, where someone had sprinkled paint onto each part of a 3 piece suite, which was subsequently proven to be fraudulent.

My opinion is that the word exact means what it says. So if you cannot replace the damaged part, they should look at the other parts of the suite. Exact means, colour, appearance, size.

My advice is to wait for the loss adjuster to visit on Tuesday and see what happens. Sometimes the more you push, the more resistance you will meet.

I do help people on here with PPI claims and have a knowledge of the complaints handling rules of FOS and the FSA rules and also a slight knowledge of the ABI but this was about an insurance claim which I have little knowledge of TBH. I just expected it to be easy like they say on the TV.


I hear what you are saying but I think that people should post up their experiences of insurance companies and claims handling. I just do not understand why they would think I was "planning" a new suite. It seems I am being penalised for not reporting every single claimable item in the first instance (which I will now do). I have lived with it for 15 years and only claimed for the cistern 6 years ago which was a complete and utter balls up TBH. Its not like I have just moved in or we have not worked hard on our bathroom as it stands.

I cannot wait for my SAR to arrive from them. I just wanted to know what the word "exact" means in an insurance policy as they are stating it means like for like really. The direct Line advisor had to ask me what page it said it on in disbelief as she said it only meant colour. I am not digging up my floor and getting a plumber to go into the drains for another obsolete toilet. I just want a normal trap in a normal place that would then fit any normal toilet.

magpiecottage

I was looking at an Ombudsman's decision on a disputed claim for something else earlier this month. She said that where the terms of a contract are ambiguous, this should, in the event of a dispute, normally be interpreted against the party drafting the contract - in that case and this, the insurer.

Logically, if they only meant it to refer to colour, they should have said so.

As you know, you need to allow the insurer eight weeks to respond before going to FOS. On the other hand, you can hardly survive for eight weeks without a loo and if you have to get a cheap one fitted in the interim I suspect, though I cannot be certain, that FOS would look on that sympathetically.

marshallka

magpiecottage wrote: »

I was looking at an Ombudsman's decision on a disputed claim for something else earlier this month. She said that where the terms of a contract are ambiguous, this should, in the event of a dispute, normally be interpreted against the party drafting the contract - in that case and this, the insurer.

Logically, if they only meant it to refer to colour, they should have said so.

As you know, you need to allow the insurer eight weeks to respond before going to FOS. On the other hand, you can hardly survive for eight weeks without a loo and if you have to get a cheap one fitted in the interim I suspect, though I cannot be certain, that FOS would look on that sympathetically.

Hi Magpiecottage, we can not do anything as if we do then this invalidates the claim completely. We are left with no option than to keep siphoning the water and redoing the mastic. I DID ring them immediately water was leaking and even if we had another obsolete toilet there is no guarantee that the fit would be correct to the floor (S trap fittings are ancient) and it "could" mean digging the concrete. IF we have to do this then we are certainly not doing it for another obsolete toilet when it would be sensible in this case to replace with a white toilet which would be replaceable by ourselves should we have any other problems. This exact should not be written into the policy in my view if it actually does not mean "exact". I shall be making complaints (the proper procedure of course) to both the FOS and also trading standards and also the FSA and whoever else I can think of. Its not like me to complain is it lol. I just cannot stand how these insurers treat us. We are not "regular" claimers and have only EVER claimed when we have had to like most people. Its only the ones that have made lots of claims that have spoilt it for genuine claimers. I just hope our toilet does not collapse or they will have more to deal with than a tiny bathroom claim. I have told them to come out and see for themselves and in fact when the loss adjuster does come out I think he will see what I mean and I shall ask him/her whether they think we have been treated fairly with a leaking toilet that could actually collapse as its only glass you are sitting on but glass with a crack over half the way around it.

I want them to accept my claim as per their own claims terms and conditions. They are leaving it this long so that we do invalidate the claim and replace it ourselves but I swear I would go to stay with friends first than give up on this.

I cannot wait for my SAR i shall be requesting from them.

marshallka

I have had UK assistance visit today and the lady was nice and said the mis advise I was given was because they thought I had ordinary insurance we have the home insurance plus policy and she has told me to get a quote for the full suite and whatever else needs doing (SHE mentioned the tiling not me!!) . I just hope nothing else goes wrong with this and IF everything goes fine with this then Direct Line are off the hook. She could see my loo "could" go at any minute also and also she could see the width of my obsolete bath is definately 650.

Just have to wait and see what she says after the quote.

huckster

The loss assessors that visit are often much more helpful, than the people you speak to on helplines, because they can see the damage for themselves.

Providing that their report is clear as to what needs to be done, I cannot see you having any further problems.

marshallka

huckster wrote: »

The loss assessors that visit are often much more helpful, than the people you speak to on helplines, because they can see the damage for themselves.

Providing that their report is clear as to what needs to be done, I cannot see you having any further problems.

I hope you are right. Its made me so stressed this claim. I just wanted someone to see in the first place. The lady told me to get a quote for whole lot to be done. Thanks for your support.

I just need to get hold of a plumber now!!!

marshallka

Just to update on UK Assistance and they have been completely different to deal with than Direct Line. The loss adjuster turned up on time and left a card with email address/telephone number to call her direct after getting my quote for the full fitting of the bathroom. I have emailed my quote yesterday and today I called her to check she received this and this evening she called me up with the amount that they are going to accept to put towards our new suite etc. I have to now ring her back tomorrow and she said she can send a cheque out immediately for the part that they are contributing towards the bathroom less VAT (if we decide to go ahead with this quote) and then after the work has been done I have to send the actual invoice over to them and they then pay the vat on the part they have paid already. IF this all goes as easy as she has told me this evening then I really cannot fault this company. I was told there was a mix up with the terms and conditions of my policy (Direct Line thought i had the cheaper version) and that was the immediate problem.

All in all thumbs up so far with UK Assistance.

If I have a grievance with a company then I will shout about it BUT on the other hand if I have been treated well by a company I will shout too and since been transferred to UK Assistance I cannot fault them.

marshallka

Well its been a week now and not heard anything from the Loss Adjuster or Direct Line and no cheque has arrived. We did speak to the Loss adjuster - UK Assitance last week and she said that a cheque would be sent out to us for their contribution to the bathroom and then VAT will be paid on receipt of the invoice after the work is done.

We have employed the bathroom fitter as per our quote (as she said it was OK to do it as they would only contribute what they were contributing) and the bathroom fitter is starting next week BUT I am now a little wary as we actually have nothing in writing from UK assistance???

Is this normal procedure for claims? I have emailed her to ask that she puts the agreement in an email and asked for a read receipt but not heard back? Am I being paranoid here!! She called me in the evening last week with the amounts but not heard anything since.