The Great 'How do insurers decide whether to pay out?' Hunt

mattymoo

Denzelpuppy wrote: »

You might be batting on a sticky wicket as to the value of the vehicle as Insurance comapnies do not use Ebay or Ad mag to value vehicles but have a monthly database as to car values which basically falls into what they could buy it trade for not what it could be bought for

Not strictly true. Yes, we have access to trade databases and guides, normally Glasses. These are used by the motor trade in general.

The guides show several values including dealer forecourt price, trade in price and the market value based on a private sale. It is this last figure, adjusted for mileage and extras fitted (though these make little difference) that the insurers use when writing off a vehicle.

There is normally a range shown and the engineer may go low or high in that range and this is what gives scope for negotiation on values.

mattymoo

Harryhound - try http://www.hpicheck.com/newfrontend/glossary.jsp#_Write-off

Cumbrian_Male

Scruff wrote: »

Don't bother with travel insurance myself. Take the health passport when I'm in the EEC. If you lose anything it should be covered under your house insurance and if you need something medical - more than likely it won't be covered under your "Travel Insurance" if you've bought one - so why bother? I've had experience with different people over the years where they've taken ill abroad and the insurance company have not paid up for one reason or another so what's the point?

All insurance companies will try and wriggle out of a claim if they can. Car insurance is compulsory but all other insurance is optional in my book. The biggest con of all is travel insurance. People think they MUST have it - then don't. An amusing tale if ever there was one was a couple of years ago my old dad tried to get travel insurance to go for a week to Majorca. He's over 70, has asthma, angina and many years ago was successfully treated for prostate cancer. He eventually got a company to quote a price for the weeks travel insurance - £1,800. The actual holiday was only £150. Ridiculous. He went on the EEC card for nothing and had a great time.

I have to disagree with you.

Let me recount a personal experience.

My father suffered from Mycosis Fungoides a type of Non-Hodgkin lymphoma and this resulted in him having a foot amputated.

Because of his extensive medical history he had specialist annual travel insurance.

While on holiday in Spain he had an accident, due to some confusion he exited the lift on the garage level instead of the lobby of his apartment building, he wheeled his wheelchair out of the lift and toppled backwards down a small flight of stairs. This caused him to break his hip. Whilst in hospital for ten days he developed breathing difficulties, and his surgery to pin his hip had to be delayed. As his condition worsened he had 2 heart attacks which proved fatal.

I received a phone call from my Aunt (dad's sister) on 27th December to tell me he had died. At this point both my Aunt and dad's girlfriend hadn't contacted me to even tell me he was in hospital, that's a whole other story.

Because of the holidays it was impossible to repatriate his body, Spain was effectively closed until 2nd January. The insurance company and Consulate were very good and once he was returned, and I made a formal identification he had an autopsy and I was able to lay him to rest on 17th January.

If he hadn't had proper travel insurance there would have been no way I could have paid for the repatriation. The only alternative would have been to have him cremated in Spain and to have brought back his ashes for a remembrance service.

Moral of the story?

You only know the true value of insurance when you need it most.

Melusine

I have claimed three times on household policies. Once some years ago with NU, when my son somehow burned a hole in my living room carpet. I asked them to come out and fix a piece of carpet roughly two inches across. The assessor came out and deemed it necessary to replace the whole carpet and, since it matched, hall, stairs and landing too. It was done and dusted within a month.
Some years later, my son put a pork chop to grill, forgot it and blew the grill up. I asked them to repair the grill. They replaced the entire cooker within a fortnight.
I changed insurers for financial reasons and am now with Nationwide through the Building Society. Last year, a power surge hit our home, blowing a computer and my freezer. The insurers asked for a report from the electricity board. The board did tests and said it was their fault. A new computer came within days and I was authorised to go and buy a new freezer and was sent a cheque for contents almost by return of post.
They're cheap policies. Have I just been lucky?

johnedwards3005

Fascinating reading in this thread - but I agree that it provides a disproportionately worrying picture. I've had several successful claims over the years on all types of insurance and I'd say that the key is (as with all contracts) to read the wording carefully - both while buying the policy and again when contemplating a claim: you can expect the insurer's actions to be governed by the precise wording - and you should insist that they do so if they try to short-change you (as they often seem to - I had a cheque today for a supplementary amount 'apologising for the oversight'!).
Perhaps I could seek an insider's view on particular problem I'm having at present, although it's small beer compared with some of the stories posted. Having had a claim paid under my annual travel policy for the last-minute cancellation of a weekend break in Bratislava, arising from an emergency heart procedure three days earlier, the insurer deducted the airport taxes and charges from the Ryanair 'cancellation invoice' (which took ages to get from Dublin) on the basis that they were recoverable from the carrier. Following their advice, I wrote again to Ryanair three times (including recorded delivery) but have received no response at all. As more than three months had passed, I reverted to the insurer (or, rather, their claims handling agents) claiming the deducted amount, as the policy wording says that I am entitled to compensation 'for the financial loss suffered', with no mention of potential refundability. Although this met with immediate rejection, I am persisting by asking that it should be referred to management.
Bearing in mind that nowadays the taxes and charges can make up the majority of the cost of a no-frills carrier's flights (plus Ryanair's well-known reluctance to incur any cost they aren't forced to - and lack of UK contact point), can anyone say from experience what the normal practice is in such circumstances?

Beautiful_smile!

inertmale wrote: »

I insure my pet dog with Direct Line and made a claim for the removal of some lumps from the dog. Because the vet report said "removal of lumps,cysts and lipomas" the insurance took three lots of excess from me leaving me £180 out of pocket even though the dog only had one operation! Surely this is an unfair interpretation of my policy.

Get your vet to phone or write to your insurers explaining. I particularly had a bad experience with Pet Plan, eventhough my dog was insured for 12 years, past few years paying £25.00-28.00 a month and thay have changed the policy cover and 'not covered' specification in an yearly basis. At the end paying for an excess of £130.00 + 20% of the rest, which has cost us a fortune. Also not insured for any legs, not insured 'death by illness' The last tablets he had before we had to put him to sleep, refused to pay because they say 'it was a new year' and 'needed to pay another £130.00 + the 20% of the value of the tablets as every month', :mad: as well as £28.00 insurance a month. I have another 2 alsations and they are not insured. I am sure it will save me money at the end. Regards Y.:beer:

ken1414

Insurance is little more then a lottery. I used to work for a major insurance company and the claims systems are designed to avoid paying claims whilst not appearing to be seen doing so. This even went so far as amending management reports produced for a new CEO who demanded all claims were settled within 28 days of agreeing terms. Local management simply fiddled the report to make him believe they were paid in the time period. Why? Because the longer the claim sat in the claims area the more interest the insurer makes on the outstanding claims amount and the more likely the claim will be dropped. Investment returns are a key part of an insurers profits and without interest on premiums paid the insurer would go bust.

Complaining about these matters is a waste of time. You can complain until you are blue in the face but it will make no difference. The regulator will support the insurers unless you fall into one of the regulator’s special interest group.

As an example. I was made redundant whilst off long term sick. I contacted my insurer, unfortunately my employer, regarding a legal claim for unfair dismissal and Disability Discrimination. This was clearly covered under the terms of the legal expenses policy ( contractual employment disputes were clearly covered and even mentioned in the examples). My claim was denied point blank by a very unhelpful telephone operator. After years of letters of complaint and delaying tactics the case was finally referred to the Financial Ombudsman. They upheld the insurers position because there was a 90 day period to notify the insurer of a claim. Despite informing the insurer when I was made redundant the Ombudsman upheld the insurers position as I had to complain within 90 days of the START of my employment contract. Such a position is ridiculous as I had been with the company for 4 years. How could I know when I first joined that I would be made redundant 4 years later!

Clearly the Ombudsman was abusing their position and the law but any complaints about the conduct of the Ombudsman aren’t entertained. Instead you will simply get a phone call from the police threatening to arrest you for harassment if you contact them about the matter further.

If you aren’t happy get a solicitor and go to court. How ridiculous employ a solicitor to pay for a legal case when you have taken out insurance to meet such an eventuality.

I preceded with the employment tribunal case anyway. Result the insurer kept lying and cheating. I was refused all access to work documents as Tribunal decided it was excessive to expect my employer to disclose them! At the final hearing the insurer even denied I had an employment contract, despite later admitting in writing that the contract I supplied to the Tribunal was valid! I lost as you might expect and was expected to pay the £300,000 legal bill of my insurer/employer.

Oh yes and then my partner, who had a serious mental health problem, died of an accidental overdose soon after the Tribunal hearing. Why because she took the insurer and tribunal’s opinion that it was unreasonable for her to contact me at work when unwell and reasonable for me to be disciplined if she did. This literally killed her as she simply died rather then disturb me after an adverse reaction to the prescribed drugs she was on! Pathetic when woman with kids were skiving off at a drop of the hat where I worked, but Tribunals favour mothers claims but discourage/reject claims linked to mental health problems.

Insurers are nothing but liars and cheats. They will rip you off whenever they get the chance so why not return the favour. Treat them with contempt and you won’t go far wrong. Don’t expect any help or assistance.

However if you are lucky enough to find an insurer that pays claims stick with them. You pay for insurance for help in a crisis. Don’t go for the cheapest premium as it is likely matched by poor claims service. I have worked in several insurance companies and there is a clear correlation between premiums paid and claims experience. You get what you paid for and if you buy cheap expect problems.

Obviously I can’t name the insurer concerned. All I will say is that they are the same insurer who refused to pay out for £120 for policies issued via the moneyback website Quidco (mentioned elsewhere on this site). Clearly they abuse everyone if they can.

ken1414

Insurance is little more then a lottery. I used to work for a major insurance company and the claims systems are designed to avoid paying claims whilst not appearing to be seen doing so. This even went so far as amending management reports produced for a new CEO who demanded all claims were settled within 28 days of agreeing terms. Local management simply fiddled the report to make him believe they were paid in the time period. Why? Because the longer the claim sat in the claims area the more interest the insurer makes on the outstanding claims amount and the more likely the claim will be dropped. Investment returns are a key part of an insurers profits and without interest on premiums paid the insurer would go bust.

Complaining about these matters is a waste of time. You can complain until you are blue in the face but it will make no difference. The regulator will support the insurers unless you fall into one of the regulator’s special interest group.

As an example. I was made redundant whilst off long term sick. I contacted my insurer, unfortunately my employer, regarding a legal claim for unfair dismissal and Disability Discrimination. This was clearly covered under the terms of the legal expenses policy ( contractual employment disputes were clearly covered and even mentioned in the examples). My claim was denied point blank by a very unhelpful telephone operator. After years of letters of complaint and delaying tactics the case was finally referred to the Financial Ombudsman. They upheld the insurers position because there was a 90 day period to notify the insurer of a claim. Despite informing the insurer when I was made redundant the Ombudsman upheld the insurers position as I had to complain within 90 days of the START of my employment contract. Such a position is ridiculous as I had been with the company for 4 years. How could I know when I first joined that I would be made redundant 4 years later!

Clearly the Ombudsman was abusing their position and the law but any complaints about the conduct of the Ombudsman aren’t entertained. Instead you will simply get a phone call from the police threatening to arrest you for harassment if you contact them about the matter further.

If you aren’t happy get a solicitor and go to court. How ridiculous employ a solicitor to pay for a legal case when you have taken out insurance to meet such an eventuality.

I preceded with the employment tribunal case anyway. Result the insurer kept lying and cheating. I was refused all access to work documents as Tribunal decided it was excessive to expect my employer to disclose them! At the final hearing the insurer even denied I had an employment contract, despite later admitting in writing that the contract I supplied to the Tribunal was valid! I lost as you might expect and was expected to pay the £300,000 legal bill of my insurer/employer.

Oh yes and then my partner, who had a serious mental health problem, died of an accidental overdose soon after the Tribunal hearing. Why because she took the insurer and tribunal’s opinion that it was unreasonable for her to contact me at work when unwell and reasonable for me to be disciplined if she did. This literally killed her as she simply died rather then disturb me after an adverse reaction to the prescribed drugs she was on! Pathetic when woman with kids were skiving off at a drop of the hat where I worked, but Tribunals favour mothers claims but discourage/reject claims linked to mental health problems.

Insurers are nothing but liars and cheats. They will rip you off whenever they get the chance so why not return the favour. Treat them with contempt and you won’t go far wrong. Don’t expect any help or assistance.

However if you are lucky enough to find an insurer that pays claims stick with them. You pay for insurance for help in a crisis. Don’t go for the cheapest premium as it is likely matched by poor claims service. I have worked in several insurance companies and there is a clear correlation between premiums paid and claims experience. You get what you paid for and if you buy cheap expect problems.

Obviously I can’t name the insurer concerned. All I will say is that they are the same insurer who refused to pay out for £120 for policies issued via the moneyback website Quidco (mentioned elsewhere on this site). Clearly they abuse everyone if they can.

djez

A similar thing happened to me at a junction, and even though the other driver admitted liability and his insurer paid my claim, Admiral loaded my policy at renewal. They also loaded my wife's policy as i was a named driver. The reason given to me was that a no fault claimant becomes a higher risk because they are likely to have an accident within 12 months that is their fault.

smiffy wrote: »

My car was recently damaged while stopped at a pedestrian crossing. The other driver admitted full responsibility and her insurance paid for repairs to my vehicle.

I've now begun the process of renewing my insurance and have found that the Admiral group want to charge me almost £60 a year more as a result of the "claim". I'm quite insistent that I’ve not made a claim as the other insurance company paid out in full, no claim forms were completed, and I did not even claim from my insurer either.

I'm not best please - so I've written to the other parties’ insurer and requested compensation for the increase premiums I now face due to their customers’ carelessness.

Chrysalis

FlameCloud wrote: »

Hopefully I can be of some help here.

I work in the special investigations department for one of the largest underwriters. We underwrite a policy that has, shall we say, got a reputation for dodgy claims (around 75% we reckon). As a result, we have sold the interest in the policy to RSA (fools! ). Part of my job is to register claims for that particular policy (it is so bad they have decided that all claims will be vetted by SI before being allowed to continue) so I have some experience in this area.

Firstly, I would ask the customer to describe what has happened, as this usually gets an answer. I would then check what coverages they had whilst they were telling me. I find you can usually tell within moments whether you will cover it, my allowing the customer to talk you usually give them enough rope to hang themselves. It is not about being harsh, meeting targets etc. I know the policy inside out, and if your claim should be paid under the policy I will register it, if not then I will decline it on the spot. If you disagree, you can argue, but it will not make a great deal of differnce if it is clear from what you have said that it is not going to be covered (i.e. 'My TV's stopped working. Can I have a new one' No, from what you've said, its clearly wear and tear, mechanical breakdown. If you disagree, prove it through an engineers report.)

What happens next depends on the type of claim. Broadly-

Escape of Water (EOW), passed straight through to loss adjusting side or resotaration companies for a full report.

Accidental Damage, loss or theft. Put customer on hold, perform a CUE search there and then for undisclosed claims, Check their bank balance for arrears/difficulties, analyse the voice graph we have to check for signs of stress in voice. If happy, appoint suppliers. If not, either appoint Crawfords or Cunningham Lindsy Fraud solutions for a full investigation, or VFM/Aquilo/internal for conversation managment.

The rest- judge on their own merits. Try and pay it out there and then, as it is not normally worth our while keeping it for longer.

For example of what we do in a day- today I recieved-
5 AD to laptop claims (all water spilt on them)
6 AD to carpet caused by paint spillage

4 of the carpet claims we thrown out as a few days earlier they had said to one of us that their dog had done its business on it and was declined. 3 of the laptop claims, CUE threw up undisclosed claims, so I referred the matter through to the underwriters to void the policy.

hope it helps! What you say and how you say it REALLY matters. Be an !!!!, and I can guarentee you will get the handlers back up enough to be difficult. If you are really abusive then we will go out of our way to pick something up

The way you can access banks worries me greatly I think this cooperation between financial institutes needs to stop and be outlawed not only does it allow people eg. to check their neighbours bank balance but also I think discriminates against poorer people. Thanks for your postings they are very appreciated.

On insurance in general I would be inclined to avoid it and only take 3rd party for cars since the way I see it you either pay for years and claim nothing or very little or make a big claim and get a large payout obviously the number of people getting large payouts will be small and subsidised by loads of insurers not claiming, so insurance works on the basis most people will not claim or claim very little and a few will claim large amounts. I know someone who written of their car and got a claim payout for around 6 grand which sounds great but thenhis annual insurance double and 8 years later the insurance company has their 6 grand back.