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

FlameCloud

mattymoo wrote: »

Have edited your post into 2 bits I want to query.
Firstly, do you advise the customers you are using voice stress analysis (Digilog?) systems?
Secondly, are you actually delving into bank accounts or getting an online credit report. I seem to recall you work for Halifax so presumably you can look into the banking side from the insurance side.
Third item - you refer to the CUE database and undisclosed claims. Are these claims that have arisen since inception of your policy (suggesting multiple insurances / claims) or where they on the CUE db prior to inception. If so, why is your organisation carrying out its underwriting at the claims stage and not at the inception stage?

Ok, here we go!

1st They are warned by a voice recording before we speak to them.

2nd Actual bank accounts themselves. Main areas of concerns are a)mortgage arrears, b)Credit card minimum repayments c)Average Monthly balance and d)average income.
If for example, they are claiming for a £10000 ring, yet have no money, are in arrears and are pushing for a cash settlement, it would indicate more searching needs to be done!

3rd We do not administer this policy. We merely underwrite it. The ONLY details we have of the customer are the address, DOB of the oldest polic holder, their coverage and the last amendment date (not what it actually was). An utterly crap system that forces use sometimes to spend ages on the phone to policies finding out info. The main problem with this policy is that it is sold soley (I believe) through mortgage brokers. They recomend it because it gives a fantastic comission. The amount of claims we come accross where the customer says at some point (after finding undisclosed claims) is 'my broker told me I wouldnt get insurance if I declared it). Today I had to deal with a customer that had lost a £5000 wedding ring (genuine, we were satisfied). however, the policy limit for unspec'd jewellery is £1500. Her broker told her it wouldn't matter as long as she had £5000 worth of PB cover, but even a glance at the PB section would tell you thats wrong.

Hope it helps!

andria_53

silverfoxuk wrote: »

One broker markets themselves as specialists in helping those with 'conditions' get insurance by speaking with underwriters on your behalf to see what (if any) loading would apply. I have never dealt with them so have no idea if they are good or bad, but they have a blog which is reasonably informative:
http://www.theinsurancehelpline.co.uk/blog/
A good IFA would of course offer the same service.

Hi there

I've read the blog and whilst it appears to be informative if you don't know the underwriting system of life and healthcare insurers, it seems that they are trying to sell policies under the guise that being told you are uninsurable is common place.

The fact is it's not. In all the years I have worked in the industry I have known of only one person who has been declined life cover and I deal with all the big insurers, NU, Liv Vic, Standard Life, Scot Eq, BUPA, Pru, blah, blah.. Most folk including those with a list of ailments and health problems as long as your arm will get cover. All they do is simply exclude the condition itself and any condition that arises from that illness from being covered, and alter the premium accordingly. So if you have major heart problems and get knocked down by a bus and die then your policy will pay out because the heart condition didn't kill you. We even managed to get a large amount of life cover for a publican who was on the verge of scirrosis (sp?) of the liver and drank about 20 pints a day - a reputable IFA (try IFA promotions website) will always try their best to get you a policy as long as you give honest answers to the medical history questions.

In this way most people will be insurable. The client in question had been diagnosed with early onset Parkinsons and wanted a PHI policy as he was self employed. He was obviously declined cover in that particular instance and then went on to find out that his medics were wrong and he didn't have Parkinsons at all. Did nothing for his nerves I expect. :eek:

lapat

1st They are warned by a voice recording before we speak to them.
i have concerns here as do you actually warn them that they are being detected for voice changes or do you mereley state that the call is being recorded for training purposes.????????

2nd Actual bank accounts themselves. Main areas of concerns are a)mortgage arrears, b)Credit card minimum repayments c)Average Monthly balance and d)average income.
and on this point are you not required by the fsa to inform the person on the other end of the phone that you are doing a credit search.??????????

FlameCloud

Yes, they are warned that we use VRA technology.

No, becuase it is not a credit search.

orlao

Hi

A quick question, I'm still waiting for my motor insurance company to sort out who ia at fault after a minor crunch last December! I've had to pay the excess and a much higher premium on renewal to have my car repaired. They (NIG) are blaming Fortis for delaying things and said they didn't notice that the damage to my car didn't match the other drivers account. He said I ran up the rear of his car but the imprint of his wing mirror was in the side of mine!They keep trying to settle it as 50/50 claim and I keep objecting. Should I go straight to an official complaint or keep talking to them?

Not such a quick question, sorry!!!
btw I can recommed a '92 Merc for toughness......not a scratch on his a new wing needed on mine...

RibAd

I work in travel insurance in the sales and service department. I don't deal with claims directly but I often have to confirm eligabillity in making a claim and outlining the claims conditions.

Claims are taken on a case by case basis, especially if a claim should fall outside the terms and conditions and underwriting criteria, or if exceptional circustances or underwriting is put in place.

Often claims are declined on basis of the necessary paperwork not being returned with the claims form. This can be anything from evidence like booking invoices of air tickets and accomodation, to receipts of the items claimed, to the insurance certficiate itself. Failure to produce these pieces of information will result in the claim being declined.
Other cases are declined because ther claimant has not read the terms and conditions correctly.

A good insurance cover will provide information on what is covered, what is not covered and what the claims conditions are under each section. The claims conditions stipulate what needs to be done and what paperwork needs to be collected. Often claims that should have paperwork like police reports, property irregularity reports etc which are not obtained will be declined.

Other reasons for declining claims would be based on the terms and conditions itself. claims relating to disinclination to travel will not be
covered, also failure of a tour operator, transportation company or travel agent to fulfill the booking, overbooking of seats on a flight (airline responsible)

It would also be circumstances described in the general exclusions, for example, terrorism, bankrupty/ liquidation of a travel agent, tour operator, airline (these would be handled by ABTA and ATOL), suicide,
consequences of excess alchohol and drugs, unlawful act, etc.

Most insurance companies would also have a time limit when a claim can be made on the first instance. Once that time lapses, and you attempt to make a claim, it will be declined.

Non disclose of material facts, for example, not disclosing pre existing medical conditions, is a biggie for a claim being declined.

Scrudge

FlameCloud wrote: »

No, becuase it is not a credit search.

Are you saying that banks allow to view accounts of your claimants? Why would they do that?

FlameCloud

Because most banks are also insurance companies? In this case the bank is (practically!) the underwriter.

And it pays for them to cooperate with each other!

Fairbs1983

fad1211 wrote: »

I had been with Liverpool victoria for a number of years for my house insurance. Last year, my 2 tots decided to destruct my living room. They marked with felt-tip pen all my furniture, from coffee table, carpet, 3 piece sofa, wallpaper. He also reached my camera from the mantle piece and chucked it on TV, breaking the camera and slightly marking the TV screen. I was upstairs ironing, totally oblivious to what was happening downstairs. Anyway, the marks would not shift, so I rang Liverpool Victoria and told them exactly how it was. As their were 8 different items (3 pc suite counts as 3 items), they treated it as 8 claims with 8 lots of excesses. They would not treat it as 1 incident. I did not want to go ahead with all the items, but was told it would still be logged on my file as a claim. As a consequent at my next renewal they refused me insurance for the future. Nobody will insure me now for household or building as it is linked, due to the amount of my claims.

This clearly is not fair, does anybody know how I can appeal or where I can go to have this case looked at. Any advise will be appreciated.

First things first, you will need to complain directly to the Household Claims Department at Liverpool Victoria. Explain your long association with the company etc. To class the claim as 8 seperate incidents is ridiculous. Insurance companies' should look at the 'proximate cause' of the damage i.e. the initial or dominate cause. As your children used the pen to damage all items (the camera and TV is different as the pen was presumably put down in order to throw the camera), at the same time, the Insurance Company has an obligation to honour it as one claim. The camera damage may be considered a seperate incident. Do you have accidental damage cover? If not, don't bother contacting them - you'll never get anywhere!!!

When you first reported the claim, did you just speak to one person and accept their decision there and then? If so, call them again, explain the situation to a different advisor and I bet you will get a completly different response to the first one.

All the items that were damaged were contents and you should only be required to pay one XS (presumably £50).

DO NOT LET THIS GO! Liverpool Victoria (or LV= as they are now) should be honouring this claim if you have Acc/Dam cover. At worst, they will class as two seperate incidents (furnishings and then camera/TV) and you will pay 2x XS'.

By the way, if the Insurer does not pay any money towards a claim and it is not 'repudiated' (turned down), they will only log this as an incident and not a claim. If you are looking for insurance elsewhere in the future, you must disclose this as an incident only.

ps, the 3 piece suite is never, EVER classed as 3 seperate items as long as they are matching. I think when you called to register the claim, somone was having a seriously off-day. (see matching sets and suites in your policy document)

Hope this helps!

mattymoo

FlameCloud wrote: »

Because most banks are also insurance companies? In this case the bank is (practically!) the underwriter.
And it pays for them to cooperate with each other!

Nothing personal FlameCloud, I know this is your job, but I have a very uneasy feeling about this power you have to view a customers accounts like this. No doubt it is covered in a contract term relating to sharing of information within the group but it does seem to be a touch big brotherish.
The other issue is the interpretation of that data. We use forensic accountants on major commercial BI claims (Business Interuption / loss of profits) and they hold all the relevant qualifications to do this work. Who is interpreting the bank account data in these cases?
At the moment I guess I can breath easy, I bank with Nationwide and insure with More Than and they do not have a financial connection. It does make you wonder about Direct Line / Churchill / RBS / Natwest / HBOS though.