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Exclusion question
foggytown
Posts: 325 Forumite
I have my own views on this matter however I am not 100% sure and would like the opinions (or absolute knowledge) of others.
I know that the burden of "proving" a claim rests with the insured. If the insurer relies on a policy exclusion to deny a claim, does the burden of proving that the exclusion applies rest with the insurer or does the insured have to prove that the exclusion doesn't apply?
I think the burden of proof shifts to the insurer.
I know that the burden of "proving" a claim rests with the insured. If the insurer relies on a policy exclusion to deny a claim, does the burden of proving that the exclusion applies rest with the insurer or does the insured have to prove that the exclusion doesn't apply?
I think the burden of proof shifts to the insurer.
42 years of experience in the insurance industry.
And nothing the industry tries do to us surprises me any more!
And nothing the industry tries do to us surprises me any more!
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Comments
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The standard legal principal would apply- he who asserts must prove, so the burden would lie with the insurer to prove that the exception is in operation- off the top of my head the CII uses Firestone v Volki to test students on.
Anderson v NU found that as the PH was asserting something he had to prove it was true (and couldnt, and thus failed) so if an insurer was trying to prove an exception the same would apply.0 -
well if the exclusion is decalred at outset and you accept the terms surely you're admitting the exckusion is ok?0
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well if the exclusion is decalred at outset and you accept the terms surely you're admitting the exckusion is ok?
Um, not quite what I was talking about. It isn't whether or not the exclusion per se is valid, it is whether or not it can/should be applied to a particular set of circumstances.42 years of experience in the insurance industry.
And nothing the industry tries do to us surprises me any more!0 -
Um, not quite what I was talking about. It isn't whether or not the exclusion per se is valid, it is whether or not it can/should be applied to a particular set of circumstances.
What are the circumstances and what is the exclusion? If the circumstances of the claim are not clear at the point you reported it the insurer (i.e. not clear enough for them to definitively say 'no' to your claim) then they would more than likely appoint a loss adjustor to investigate the circumstances in more detail and provide a report and recommendation to the insurer based on their finding.
If you feel that your claim has been declined in error you should initially make a formal complaint to the insurer (known as a Stage 1 complaint). They will investigate and possibly overturn their initial decline. If you are not happy with their response you should complain to the Chief Executive of actual insurer (the company you bought from is not necessarily underwriting the risk). If you are not happy with their response you can then take the matter to the Financial Ombudsman www . financial - ombudsman . org . uk0
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