Help- insurers not transparent

theJudge

bingbong1978 wrote: »

Nonsense, nonsense, nonsense!!

If somebody has a valid claim the only person that can make a decision is the Insured whether to pursue their claim.

OK, so I gather you did not have a particulary pleasant experience with your claim however, this is not par for the course, i can assure you.

How does it normally work then? When I made my claim, I got passed over to the claims management company immediately. I got a site visit a week later and then heard nothing for 5 weeks until I escalated my complaint to the claims management company's FSA registered officer. No explanation for the 5 week delay during which all emails were ignored and the phone was never picked up was offered, and the insurers complaints department just redirected me back to the claims management company.

I agree with your point that it's only the insurer that makes the decision as to whether the claim is valid and what they'll pay, but the communications to and from the policyholder and the insurer are dealt with via the claims management company. http://www.insuranceage.co.uk/insurance-age/opinion/1563999/the-bad-average, http://www.fsa.gov.uk/Pages/Library/Other_publications/commentary/firm_spec/index.shtml and http://www.ombudsman-complaints-data.org.uk/ all suggest that the level of complaints lodged against the insurance industry are very high and that my experience is not a one-off.

bingbong1978

theJudge wrote: »

How does it normally work then? When I made my claim, I got passed over to the claims management company immediately. I got a site visit a week later and then heard nothing for 5 weeks until I escalated my complaint to the claims management company's FSA registered officer. No explanation for the 5 week delay during which all emails were ignored and the phone was never picked up was offered, and the insurers complaints department just redirected me back to the claims management company.

I agree with your point that it's only the insurer that makes the decision as to whether the claim is valid and what they'll pay, but the communications to and from the policyholder and the insurer are dealt with via the claims management company. http://www.insuranceage.co.uk/insurance-age/opinion/1563999/the-bad-average, http://www.fsa.gov.uk/Pages/Library/Other_publications/commentary/firm_spec/index.shtml and http://www.ombudsman-complaints-data.org.uk/ all suggest that the level of complaints lodged against the insurance industry are very high and that my experience is not a one-off.

What you need to bear in mind though is that some of the complaints might be an "unjustified complaint" ie i go to an insured house, decline the claim, insured unhappy with the claim being declined so phones up to complain. There is hundreds of different scenarios where the insured could complain but have no grounds to do so but it would still need to be recorded.

Alot of the time LA's are "piggy in the middle". What i mean by that is that as part of our role we have to use the insurers approved contractors / restoration co's / suppliers. We appoint their approved company for whatever is needed done, they then screw up and we kop the flak for it from the insurer. It happens every single day and I am sure if there is any other LA's on this forum they would now where i am coming from.

I agree much needs to be done to improve the service but its a myth that LA's are out to screw people out of their money.

FlameCloud

Insurers appointed contractors are the worst part of my job. Cash settle everything on site, far easier.

bingbong1978

FlameCloud wrote: »

Insurers appointed contractors are the worst part of my job. Cash settle everything on site, far easier.

Some of the contractors in the area i cover are great, others not so.

Depends on the individuals circumstances whether i will go down the route of giving cash.

theJudge

bingbong1978 wrote: »

What you need to bear in mind though is that some of the complaints might be an "unjustified complaint" ie i go to an insured house, decline the claim, insured unhappy with the claim being declined so phones up to complain. There is hundreds of different scenarios where the insured could complain but have no grounds to do so but it would still need to be recorded.

Alot of the time LA's are "piggy in the middle". What i mean by that is that as part of our role we have to use the insurers approved contractors / restoration co's / suppliers. We appoint their approved company for whatever is needed done, they then screw up and we kop the flak for it from the insurer. It happens every single day and I am sure if there is any other LA's on this forum they would now where i am coming from.

I agree much needs to be done to improve the service but its a myth that LA's are out to screw people out of their money.

That's why we need better information from the FOS and FSA. I went to see my MP today who promised to write a letter to the minister asking for this and also asking that ADR isn't mandatory before approaching the courts. Given that he's a Tory and it was Tories who thwarted the last attempt to introduce decent insurance law in the 80s, I don't hold out much hope that the minister's response will be positive but at least I'm doing something. I don't particularly blame loss adjusters, they're doing a job that they're paid to do. It's the insurers who are pulling the strings.

In terms of better data, I'd like to see the number of complaints per claim and the payout compared to the requested payout for all upheld complaints. At the moment, hearsay suggests that when the FOS does uphold complaints their payouts are derisory compared to what a complainant has asked for. Case studies such as this:- http://www.financial-ombudsman.org.uk/publications/ombudsman-news/10/oct-repair-replace-cash.htm do seem to indicate that the payouts are very low. In this one, a flat owner experienced a flat and had to live in alternative accomodation for 2 years and 2 months when the repair work should have taken 7 months. For this he was given £2000 for loss of enjoyment of his flat for the 22 extra months he had to stay elsewhere and £750 for the distress. If the policyholder had the option to pursue damages through the courts, then the final result could have been much higher. Under the current law, a policyholder has no ability to claim damages via the court, so in this case Dr I has to be grateful for the derisory amount that the ombudsman did give him. In law, he was entitled to nothing.

bingbong1978

i think what the Dr was claiming was totally unrealistic and whilst perhaps what he got back was on the low side all in he received a substantial amount of money from his insurance co for living elsewhere which would be paid for by the insurer whilst the work was being done.

Back in 2001 the industry was far less regulated than it is now.

Complaints were never recorded like they are now.

There is definitely certain insurance co's that need to buck up their ideas, i can think of one in particular (who i will not mention) who i do claims on behalf of and they are shocking to say the least.

When a LA's goes out on a claim they always follow the Insurers philosophies. LA's don't make the rules, we just follow them.