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

RichyRich

I'm not flamecloud but I'll have a stab at some of your questions for you

insured wrote: »

1. How bothered are insurance companies about the financial service ombudsman?
I was told by the ombudsman that I could either use their office for the complaint or the court. I was told that any court decision would supercede the ombudsman decison.
I have an ongoing matter and the insurance company clearly want me to use the ombudsman's office. They have said that if I go to court they will say they have offered the ombudsmans office when deciding costs. Clearly they are concerned they will lose if they are talking about costs.

A court decision will always overrule a decision of any kind of ombudsman: the court being the agent for application of the law; the ombudsman for application of good practice. The insurance company have a vested interest in you using the ombudsman instead of the court: they can't fine them as much, have a smaller choice of remedies and it costs them considerably less to go down this route. That said, English courts are obsessed with parties acting "reasonably". The fact that you refused to arbitrate via the ombudsman may signify that you weren't willing to negotiate.

insured wrote:

2. How much access do insurance companies have to bank accounts, credit card statements held with other institutions. eg How easily can Barclays insurers for example access Nat West accounts.

Under the Data Protection Act 1998 it is unlikely that two unconnected banks can get access to such information. However it is not impossible. Look out for clauses (waivers) in your terms and conditions permitting access to other institutions' information. As liability claims are essentially an action in tort a judge may order the release of information from one institution to another. If the banks are part of the same group it is likely that information will be shared and that you will have agreed to this.

insured wrote:

3. I know that the Inland Revenue should not give information to anyone other than the taxpayer or his agent, but how much do insurance companies use private investigators to get at this information.
Thanks in advance.

Sorry, I have no idea on that question.

If I am wrong on any of this I am happy to be corrected, but I'm almost certain what I have written is correct.

Best wishes
Richard

bouncydog1

hoathfarm wrote: »

My normal vet x/rayed her and sent plates to another vet for confirmation of problem, they both said she had to be put down, then when my vet contacted NFU and their consultant vet said no. I then took her took another vet for further x/rays and was told she should be put down either there and then or in a couple of weeks, I could not put my horse through the trauma of another journey so agreed to have her euthanized that day. According to NFU because the horse could still stand and graze she did not qualify to be put down, apparently she did not fall into the category of 'destruction due to inhumane suffering' according to the BEVA guidlines. Has anyone any ideas on how to beat these so called advisers at these insurance companies.

How dreadful for you - have you been back to your vets re: BEVA guidelines and asked for their comments? One of the general conditions of the policy is that you allow NFU the opportunity to have the animal examined by a vet of their choice if they deem it necessary. Did this happen?

As you have the opinion of two vets supporting the action that was taken, I would write to The General Manager, NFU Mutual, Tiddington Road, Stratford upon Avon, CV37 7BJ, setting out the circumstances of your case and asking for a review.

If this fails the write to the Financial Ombudsman Service, South Quay Plaza, 183 Marsh Wall, London E14 9SR - phone 0845 080 1800 and ask for a case review.

I certainly would not give up without a fight as individuals employ vets for the benefit of their professional advice and this is what you followed. If the NFU consultant vet did not examine your mare, then how could the decision be arrived at? Good luck.

karenmc_3

My brother in law went on holiday. On the plane home before take off he had a fit. He was taken to hospital in palma where he stayed mon to fri. The insurance co have refused to pay out saying its a pre existing condition,
He had 7 fits in his 20s and hasnt had one for 25 years, no medication etc.
On the questions from the co there was nothing about fits.
Can they do this? He was with his father in law , so its air fare doctors and hospital costs etc. A lot of money!
Any help would be great, the co stopped anwsering their calls whilst he was in hospital and were very rude

s66blade

Last year my wife was flying to Spain, literally she was in mid-air when her father died of a heart attack. It was his second, having had one 10 years previously but his GP checks since then showed he was fit and healthy, low cholestrol etc.
She obviously flew straight back. A few weeks later I claimed on her travel insurance policy for the holiday. It was refused on the grounds of a pre-existing condition. Bearing in mind that it was NOT my wife who was ill but her father had died what the insurers were telling us that if any relative/friend who has had a potentially life-threatening illness in the past then we should NOT go on holiday.
The insurers were a company who advertised in the companies corporate magazine as giving preferred rates to staff.

Fortunately, due to the fact that my wife works for a company that employs over 50,000 people in the UK alone and that I threatened that she would be sending an email to EVERY employee about this refusal of the claim they decided that they would pay out (obviously minus the excess).

In addition to this, they had bought a £10,000 caravan the year before and taken out an AA loan with life insurance attached. At the time he disclosed he had previously had a heart attack.
The insurers (Black Horse) refused to pay out as the GP's report listed that he was on daily medication for this. (This medication was one aspirin a day).
Unfortunately they ended up repossessing the caravan, a heartbreaking day as 3 weeks prior to his death we had enjoyed a family holiday in it.

Yet amazingly for months after this, his widow continued to receive mailings from Black Horse offering loans, insurance and all manner of financial products in her husbands name. In the end I rang them and said that I had kept EVERY piece of paper they had sent, recorded details of every call made to tell them again and again that they KNEW he had died as they had refused to pay out and that should one more piece of paper from them drop through her door I would be suing them for harassment and causing distress. (I also told them NEVER to send me anything at my address either and it seems to have worked).

Sorry but my experience of insurers in this regard is not good.

They can't all be heartless b*****s though

FlameCloud

insured wrote: »

Hi Flamecloud
These are excellent and informative posts.
I have a couple of questions.
1. How bothered are insurance companies about the financial service ombudsman?
I was told by the ombudsman that I could either use their office for the complaint or the court. I was told that any court decision would supercede the ombudsman decison.
I have an ongoing matter and the insurance company clearly want me to use the ombudsman's office. They have said that if I go to court they will say they have offered the ombudsmans office when deciding costs. Clearly they are concerned they will lose if they are talking about costs.
2. How much access do insurance companies have to bank accounts, credit card statements held with other institutions. eg How easily can Barclays insurers for example access Nat West accounts.
and finally
3. I know that the Inland Revenue should not give information to anyone other than the taxpayer or his agent, but how much do insurance companies use private investigators to get at this information.
Thanks in advance.

Happy to help--

1. In some ways, they are not bothered, in others they are. I would say however, that if the complaints department of the insurance company are happy for you to proceed to the ombudsman, then you probably do not have much of a case. If you like, PM the details if you do not want to post it on here and I'll try my best to help with it.

2. Again, it depends on the bank, and whether you have had any financial history with that particular company. Alot of banks have reciprocal agreements with each other to allow them access to accounts for certain reasons and with good reason to look at them. I know we can access around 85% of accounts, although that is mainly down to the companies position within the mortgage market.

3. AFAIK, we have no influence with them. Dont take that as gospel mind

misswig

:eek:

schoolfundraiser wrote: »

I heartily endorse all of that as I am still waiting for the payout on our expensive joint £22K life policy (taken out 14 years ago when my husband was a smoker which was disclosed and younger and fitter ) 10 and half weeks after his death from a very sudden and unexpected heart attack. (He had to have a post mortem to determine whether it was natural causes which it was.)

The insurance company took 4 weeks to ask for a medical attendant's report from his GP and by the time the practice received the request they had sent back his paper notes to the health authority for storage having held on to them for a month as is normal practice. So of course his notes can't be found. Not that they would help as he was in good health - normal cholesterol levels normal blood pressure and he had given up smoking six years ago and only went to the docs with such as a bad foot (went to casualty for an X-ray just sprained etc) and sinus infection after a cold.

To get the insurance company to do anything to speed it up to get it to the underwriter stage I had to cry down the phone (and believe me by this stage I was a nervous wreck living on my credit cards with no income coming in at all and funeral expenses needing to be paid). But two weeks later I am still waiting and my complaint is drafted as I kept copious notes of all telephone conversations and the gp practice manager has been most helpful with dates and procedures etc.

Needless to say I won't be using this very well advertised and well known company again ever. There is a reason they advertise so much on the TV - they must need to get new customers all the time as they certainly don't do anything to keep their old ones.

:eek:

It is hard enough being widowed without the money problems it causes - your husband's bank accounts are frozen your child tax credit ceases until you reapply your income drops dramatically and you're having to print money to pay for the funeral. Then the insurance companies start taking the mickey on the policy you have paid out on for all those years!

First of all can i say how sorry i m for your loss. This is an awful time for you without having financial pressures on top of it all. I am in a very similar circumstance myself at the moment.

My ex husband died earlier on this year from lung cancer. His estate was intestate as he had not signed a will so everything was left to our DS(3) with me acting as an an administrater. Whilst we were married we took out a joint life insurance/critical illness for £72K with each other as beneficiaries. For some reason only known to him, when we split up he carried on paying the premium so i am the beneficiary of this even though we are no longer together. On top of this there is another critical illness for £82k which covers the vast proportion of the mortgage for his house (which is now my sons). As i had to apply for a letter of administrtion from the courts, i put everything into the hands of my solicitor (after 4 months i still havn't got it due to what i believe to be his incompetance-long story) so both these claims were sat on for 2 1/2 month by him with me believing he was doing something about them. When it transpired that he in actual fact he wasn't, i took over dealing with the one for £72k. after 1 1/2 months of sending off documents they asked me for medical consent to release info from his GP which i duly signed and sent back. I have now been told tht it will take 6-8 weeks for them to obtain this before they will assess the claim not only for my life insurance but also for that pertaining to the house!! Can they refuse it?? He had a crital illness refused when he was diagnosed with cancer for 33k based on not declairing a sprained wrist 11 YEARS previously. My solicitor dealing with this one but dont hold out much hope as he is a bit usless imho but if i get a new one i will be faced with a bill i cannot afford to pay at this moment in time.:eek: :eek:
Good luck

Vx

MrC77_2

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.

On the face of it, this appears to be an appalling decision by your insurers. You should appeal by calling up the insurer and stating that you are not happy with the decision. This should then get logged as an FSA reportable complaint if not resolved by the end of the next working day (if not, complain again!). The Insurer should then write to you confirming the complaints proceedure. Should you still get no further you should take this to the Insurance Ombudsman who I suspect will take a dim view of the insurers antics.

Hope this helps,
MrC (insurance worker for a large firm for too many years!).

RibAd

Voyager2002 wrote: »

And why does the claimant have to provide the insurance certificate? Surely the insurance company keeps records of the policies they have issued: or perhaps this is a way to save money on filing?

To prove they actually have VALID INSURANCE ie not just faking a copy or using an old one

RibAd

karenmc wrote: »

My brother in law went on holiday. On the plane home before take off he had a fit. He was taken to hospital in palma where he stayed mon to fri. The insurance co have refused to pay out saying its a pre existing condition,
He had 7 fits in his 20s and hasnt had one for 25 years, no medication etc.
On the questions from the co there was nothing about fits.
Can they do this? He was with his father in law , so its air fare doctors and hospital costs etc. A lot of money!
Any help would be great, the co stopped anwsering their calls whilst he was in hospital and were very rude

he failed to disclose a material fact. check the policy wording and terms and conditions. It doesn't matter if he didn't have a fit in 25 years, if it's on his medical record, he should have disclosed it.

RibAd

Voyager2002 wrote: »

I am at a loss to understand why insurers need booking invoices for air tickets and hotels. I generally arrange my accomodation locally, often staying in small places where payment is on a cash basis, and so could not provide this kind of documentation.

The last time I had to make a claim, it was only when I requested a claim form that I was told that such details were relevant. I had obtained a police report relating to the loss (theft on public transport) and had kept receipts for the items that had been stolen. But I was asked for the kind of documentation that would only have been provided with a package holiday (itinerary, etc): surely travel insurance is for different kinds of travellers!

booking invoices, air tickets, etc are all proof of what you're claiming for. do you really think you can put in a claim for cancellation of flights or hotels and for them to take your word for it that the flight was that day and cost £xyz??? and pay out?????????

if you tried to return something to a store, surely you would need to provide the receipt to say you bought it in that store?????

as for claims forms, they are general for whatever section you're claiming under. So some sections naturally won't apply.