Have your say on the Financial Ombudsman Service

shortchanged_2

So lets clear this up then. If someone dies as a result of manslaughter there are clear grounds for a insurance pay out as the death is accidentally caused.

So Magpiecottage what else DO insurance companies class as accidental death then?

This is the issue I have with many insurance companies selling the products they do such as this accidental death or critical illness policies.

They should not be allowed to sell these policies if there are get out clauses for them such as underlying illnesses. It is very likely that a large proportion of the population have some form of underlying illness, be it diabetes, high cholesterol etc, to name but a few. Insurance companies are too quick to blame underlying illnesses to wangle out of paying out. Which is why so many of these policies are not worth the paper they are written on.

magpiecottage

shortchanged wrote: »

what else DO insurance companies class as accidental death then?

Wikipedia defines an accident as "a specific, unidentifiable, unexpected, unusual and unintended external action which occurs in a particular time and place, with no apparent and deliberate cause but with marked effects."

That seems about right to me. So the death would need to be consistent with those definitions

shortchanged wrote: »

So lets clear this up then. If someone dies as a result of manslaughter there are clear grounds for a insurance pay out as the death is accidentally caused.

No it isn't. Take the example of a couple arguing. In the heat of the moment one grabs the carving knife and stabs the other.

It is clearly manslaughter rather than murder but it was still a deliberate act and therefore does not meet the definition of accidental.

That doesn't mean no form of manslaughter will result in an accidental death pay out but it will depend on the circumstances of the case.

shortchanged wrote: »

This is the issue I have with many insurance companies selling the products they do such as this accidental death or critical illness policies.

Accidental death and critical policies are completely different products.

Accidental death pays out if you die, and only if you die, as a result of an accident.

Critical illness pays out if you suffer, and survive by a defined period, one of a number of specified medical conditions.

shortchanged wrote: »

They should not be allowed to sell these policies if there are get out clauses for them such as underlying illnesses. It is very likely that a large proportion of the population have some form of underlying illness, be it diabetes, high cholesterol etc, to name but a few.

This makes no difference to an accidental death policy apart, I suppose, from the fact that a pre-existing condition might carry you off before you get round to stepping under a bus.

Critical illness policies are medically underwritten. That is to say you are asked about your circumstances and medical history, and that of your family, when you take the policy out.

shortchanged wrote: »

Insurance companies are too quick to blame underlying illnesses to wangle out of paying out.

An insurer can avoid paying if it can show that it was given inaccurate or incomplete information on which to base its decision about what, if any terms it would offer the policy on.

However, it can only do so if it can show that the person disclosing it knew or ought reasonably to have known that this was information it was likely to need in reaching its decision.

Sometimes firms deny claims because the policyholder did not tell them of a condition simply because they didn't know about it. They should not do so and can normally verify this by contacting the policyholder's GP.

Nevertheless some cases do need to go to FOS to sort out although insurers are now beginning to learn!

The second reason is that the policyholder did know but didn't think it relevant. An insurer is more likely to be able to defend this because it is for the insurer that is taking the risk and it is therefore entitled to decide what information it wants in deciding the terms.

In these circumstances, the usual outcome would be for the case to be settled on the basis of the cover that the premium paid would have purchased.

Again, these sometimes do go to FOS but that is the approach adopted. It is, of course, possible that the firm would not have provided cover at all if the policyholder had disclosed what they knew at outset. In that case they would normally be entitled to simply refund the premiums.

A final outcome is that the firm decides it can conclusively prove that the policyholder took the policy out with the intention to defraud it. In that case it is entitled to simply cancel the policy and keep the premiums although I am not aware of any case in which that has happened, no matter how sure it is that there has been an attempt at fraud.

shortchanged_2

You've just about cleared that up then. To the lay person it is clear as mud.

Your answers show why it is likely 9 times out of 10 the consumer will get shafted because the majority of the public have very little legal knowlege and I'm sure the significant majority of the public do not take out insurance policies to be fraudulent.

Your explanation of manslaughter also sounds a bit iffy because you mention the word deliberate in your explanation which surely brings it into the realms of pre meditated therefore surely it is murder.

How does one therefore define the difference between deliberate and accidental. Surely the example you're highlighting is self defence, therefore it is not a deliberate action to harm but is an accident with fatal consequences.

magpiecottage

shortchanged wrote: »

I'm sure the significant majority of the public do not take out insurance policies to be fraudulent.

I never said they did - my point is that if you are asked you should say. An accidental death policy will not ask about health issues - though it may ask about occupation or hobbies.

shortchanged wrote: »

Your explanation of manslaughter also sounds a bit iffy because you mention the word deliberate in your explanation which surely brings it into the realms of pre meditated therefore surely it is murder.

Murder IS premeditated and would not be covered because the premeditation means it must have been deliberate.

However, a deliberate act need not be premeditated. If somebody loses their temper, grabs a knife and pushes it into somebody on the spur of the moment there would not be premeditation but it would still be a deliberate act.

The same would apply if it was self defence because you cannot defend yourself by accident.


In the vast majority of cases, a policy will meet a claim but a policy will only pay out in the circumstances that it says it will but not otherwise.

An accidental death policy does what it says on the tin, nothing more and nothing less.

I wouldn't buy it to protect my family any more than I would buy something in a tin which said "Dulux" on it if I was looking for supper.

shortchanged_2

magpiecottage wrote: »

An accidental death policy does what it says on the tin, nothing more and nothing less.

I wouldn't buy it to protect my family any more than I would buy something in a tin which said "Dulux" on it if I was looking for supper.

OK, so are you agreeing that they are a waste of time and that companies that sell these policies are actually being deceptive in that they know damn well there is probably more chance of winning the lottery than paying out on one of these policies.

If we use another example; say a person is knocked over by a bus and later dies in hospital as a result of significant blood loss. This person has a pre existing heart condition but as you (magpiecottage) stated in an earlier thread they do not need to declare this prior to taking out this insurance.
So in this case the insurance company would not pay out because the person had a previous heart condition even if the 'accident' with the bus had caused their death.

Please feel free to correct me if I'm not understanding you because all I can see is mis-selling on behalf of the insurance companies that offer this cover.

With trudij's case as they state it is not likely that their father had deliberately choked on food, regardless of any underlying medical condition.

magpiecottage

shortchanged wrote: »

OK, so are you agreeing that they are a waste of time and that companies that sell these policies are actually being deceptive in that they know damn well there is probably more chance of winning the lottery than paying out on one of these policies.

No I never said that. I simply said they don't do what I want to do. I have not said they are a waste of time but my decision not to take one does not rely on my industry knowledge, simply on reading the information provided, considering whether it would meet the needs of my family if I died some other way, deciding it wouldn't and choosing something else.

I think you are also overlooking the fact that if a death is unnatural, sudden or unexpected (as in the case of Trudig's father) it will be referred to a coroner who represents neither party and whose service is paid by local taxation.

If (s)he decides it was unnatural then there will be an inquest. If at the end of that it is found to have been an accident then the policy will pay out. So it is will not be the insurer but the coroner who decides whether the condition required for a valid claim has been met.

An inquest would reach a verdict of unlawful killing if murder or manslaughter had been committed and lawful killing if it was self-defence.

Technically, if a coroner has decided that the death was not accidental the insurer can argue that FOS has no jurisdiction to consider the complaint at all because the coroner is higher in the judicial pecking order than the FOS and has already found that the requirement for a valid claim has not been made.

stereo_mike

PPI_Help wrote: »

We work on PPI cases on behalf of member of the public, and over the past 2-3 months we've seen a sudden drop in the quality of decisions from adjudicators. We can of course then ask an ombudsman to review, but I wonder how many consumers who go direct are dropping valid claims at this stage.

Poor adjudicator decisions of late have included:
Rejecting claims for policies sold by A&L that perfectly match the period and channel in which they received a record fine for telephone mis-selling.

Failure to follow FOS's own guidelines regards to whether to believe a customer's recollection of a sale and siding with the banks by default.

Taking signatures on paperwork to indicate consumers have read and agreed to PPI terms even when they've clearly been marked with an x and handed over for a signature in face-to-face selling situations, where the consumer has not been given the opportunity to read the paperwork.

Ignoring 'being told it was compulsory' as an indication of mis-selling.

Failure to use 'inquisitorial' powers to look beyond the evidence provided by the consumer or representative and into data the consumer does not have access to such as sales scripts and lender documents in force at the time of sale.

A lack of understanding of the difference between the cause of the complaint (i.e. mis-selling) versus the supporting evidence provided, some adjudicators ask us to start the process again from scratch with the banks as new evidence comes to light.

As a claims firm (yikes) we're well-versed in all this and of course fight on. Consumers going directly however may be put off and denied their rightful compensation - we'd love to know whether the Citizen's Advice Bureau has seen a similar decline and whether anyone at FOS is aware of this.

The reason claims management companies are getting so many more declines from the FOS recently is that the FOS have stated that standard paragraphs and statements (which CMC's constantly use) hold little or no weight, and they prefer the actual recollection of clients rather than being guided to pre-empted answers by CMC's.

Although the FOS is basically a kangeroo court and most decisions they reach would never be reached in a court of law, they do get one thing right and that is advising people to stay well clear from CMC's, and to progress a claim by themselves.

magpiecottage

stereo_mike wrote: »

The reason claims management companies are getting so many more declines from the FOS recently is that the FOS have stated that standard paragraphs and statements (which CMC's constantly use) hold little or no weight, and they prefer the actual recollection of clients rather than being guided to pre-empted answers by CMC's.

Although the FOS is basically a kangeroo court and most decisions they reach would never be reached in a court of law, they do get one thing right and that is advising people to stay well clear from CMC's, and to progress a claim by themselves.

Exactly so.

Remember, too, that some financial firms have terms in their contracts with you that allow them to charge you to charge for their time and costs incurred as a result of you or somebody acting on your behalf making a statement they know, or ought to know is untrue or misleading (or likely to be untrue or misleading).

The FSA has allowed this. One firm tried it and was told that what they had put in the contract was unfair, so they redrafted it and the new version was accepted.

This may sound harsh but essentially, it boils down to a balance - you cannot be charged to pursue a genuine complaint in good faith via the firm and, if necessary, FOS - even if they are not upheld. On the other hand, one of the FSA's statutory aims is to reduce financial crime and it cannot do that if it insists on an approach which prevents firms from reasonable provision to protect themselves from the consequences of fraudulent complaints against them.

So if you are going to use a CMC then be warned. Make sure nothing is sent in your name that you have not read and agreed.

dilbert222

Not strictly true to say it is a free service, as it is financed by the banks who rely on our money. My complaint was straightforward, against Abbey then Santander breaking the terms of my mortgage contract. Santander actively encouraged me to go to the FOS and after 15 months I have a pile of letters sent at two monthly intervals telling me my case is still in the process of being prepared for the ombudsman. I have had about six different adjudicators so far and the last one asked me (yet again) if I had any more information for them and also to advise them if I was seriously ill as a result of the hardship endured by the time taken for the case to have made no progress whatsoever. Unless I was, I would receive another holding letter two months hence.

One adjudicator actually wrote to me to say that paying off extra on my mortgage would not save me any money!

Rats.

shortchanged_2

dilbert222 wrote: »

One adjudicator actually wrote to me to say that paying off extra on my mortgage would not save me any money!

Rats.

That is actually quite scary :eek: