'Unfair' Exclusion ?

mrbluejay

I have formally complained and I am waiting for their response.

Anybody have any views on the change of cover, I guess the policy book is a notification of the change in cover, but is this sufficient ?

olly300

mrbluejay wrote: »

I

Anybody have any views on the change of cover, I guess the policy book is a notification of the change in cover, but is this sufficient ?

If you have an issue you complain to the fsa.

http://www.moneymadeclear.fsa.gov.uk

When you first take out insurance especially with a broker they have to highlight the key facts in a policy e.g. excesses, what is not insured. However I'm not aware of any requirement that for normal insurance products (house/travel/motor) where they change the policy after the 1st term has finished and you renew they have to notify you.

raskazz

olly300 wrote: »

If you have an issue you complain to the fsa.

http://www.moneymadeclear.fsa.gov.uk

When you first take out insurance especially with a broker they have to highlight the key facts in a policy e.g. excesses, what is not insured. However I'm not aware of any requirement that for normal insurance products (house/travel/motor) where they change the policy after the 1st term has finished and you renew they have to notify you.

At renewal retail customers must be provided with:

(1) a statement of any changes to the terms of the policy;
(2) an explanation of those changes, where necessary;

according to the FSA's Insurance Conduct of Business rules.

I would have a very careful look at your renewal documents.

impy78

Having worked for an insurance company, I don't think that an item left unattended in an open, public place for 36 hours containing high value items such as the ones mentioned would be covered under ANY insurance policy.

foxyuk

mrbluejay wrote: »

Hi All,

I need some help.

I have tried to make a claim on our household contents insurance and it has been rejected out of hand, I feel the exclusion is unfair and I would appreciate your thoughts.

In a nutshell here goes...

I was due to play football, arrived late, walked onto the playing ground the game had started. I had already taken my watch off and placed it in my bag for safekeeping. I put my gym bag down and watched the game, being no more than 15 feet away from my bag. After the game I drove back to Wales (The game was a works arranged game in Newport Pagnell). About 36 hours later I realised I did not have my bag. The only assumption I can make is that I left my bag at the ground and got straight into my car and drove home. Although the bag was within 15ft of me at the ground, my insurers rejected the claim within half an hour of me phoning them as they believed the bag was not within my care at the time. I believe it is more to do with the value of my watch and other items within my bag (i-pod, clothes, sports gear).

This seems incredibly unfair to me and to be a rather catch-all exclusion. The annoying thing is, is that this exclusion has only been in place since April when the policy was renewed, but no mention was made at the time of renewal.

I suppose I am asking two things...

1) Do you believe this is an unfair exclusion ?
2) Should the insurer have specifically told me of this change, does it materially change the policy ?

I have complained to them formally and I am waiting for a reply. I have also contacted the FSA/Ombudsman.

Your opinions would be appreciated.

You are wasting your time !!!! insurers are correct

DavidMack

I think that you have got a case for getting the claim paid, however, the insurer's initial reponse is probably fair, and not entirely unexpected.

If it was me making the claim, I would be making the following points:

- That the bag was generally under your care and control, at all times,
other than on the occasions when you were watching your colleagues.

- On the balance of probabilities / to your best knowledge / as far as you
are aware (delete/amand/correct as most appropriate), the bag was still
there when you left the field, therefore, the situation is no different to
someone who has lost an item of jewellery for example. It is just that
you know where you lost it. Therefore, the insurers arguement that the
claim arose because you did not have sufficient control over the bag,
becomes less effective. It would seem to me that, on the balance of
probabilities, the bag was lost because you forgot to pick it up, not
because you did not have sufficient control/care prior to the loss
occurring.

- I would mention that you have been a policyholder of xxxxx insurance for
xx years, as loyalty can still count these days - sometimes.

- I would mention that your claims record is very good (if this is the case)
and that you are not in the habit of making such claims.

Finally, I would suggest that the All Risks/Personal Effects section of a household policy is unlikely to stipulate that any personal effects must be in your care and control at all times. What the insurer needs to know is that it was not neglect that led to the loss occurring. Ultimately, you will need to demonstrate that the proximate cause of the loss was 'accidental loss' rather than neglect.

At the end of the day, your success will depend on how strong an arguement you can put accross, and who the insurer is, and how the policy is worded.

You should read the policy carefully to see how the insurer's reason for declining the claim, aligns with the actual exclusion. At the end of the day, an insurance policy is a legal contract, no different to any other contract.

Good luck!

foxyuk

DavidMack wrote: »

I think that you have got a case for getting the claim paid, however, the insurer's initial reponse is probably fair, and not entirely unexpected.

If it was me making the claim, I would be making the following points:

- That the bag was generally under your care and control, at all times,
other than on the occasions when you were watching your colleagues.

- On the balance of probabilities / to your best knowledge / as far as you
are aware (delete/amand/correct as most appropriate), the bag was still
there when you left the field, therefore, the situation is no different to
someone who has lost an item of jewellery for example. It is just that
you know where you lost it. Therefore, the insurers arguement that the
claim arose because you did not have sufficient control over the bag,
becomes less effective. It would seem to me that, on the balance of
probabilities, the bag was lost because you forgot to pick it up, not
because you did not have sufficient control/care prior to the loss
occurring.

- I would mention that you have been a policyholder of xxxxx insurance for
xx years, as loyalty can still count these days - sometimes.

- I would mention that your claims record is very good (if this is the case)
and that you are not in the habit of making such claims.

Finally, I would suggest that the All Risks/Personal Effects section of a household policy is unlikely to stipulate that any personal effects must be in your care and control at all times. What the insurer needs to know is that it was not neglect that led to the loss occurring. Ultimately, you will need to demonstrate that the proximate cause of the loss was 'accidental loss' rather than neglect.

At the end of the day, your success will depend on how strong an arguement you can put accross, and who the insurer is, and how the policy is worded.

You should read the policy carefully to see how the insurer's reason for declining the claim, aligns with the actual exclusion. At the end of the day, an insurance policy is a legal contract, no different to any other contract.

Good luck!

dont agree

Bag should have been left in a locker or left in the car out of sight.

in respect of personal possesions cover they do state in exclusions that they are in your control

i took out insurance with direct line 6 months into policy i got a letter with exclusions re- my rolex watch...

only covered when im wearing it..... so i need to be mugged or have accident... aint covered in house or anywhere so i would need to sleep with it on....

not covered in house or out unless on wrist

This item is specified and i pay an extra £236 a year for the cover

TOTAL RIDICULOUS EXCLUSIONS

cancelled policy

peterbaker

I agree with DavidMack's very well structured arguments.

I also agree with foxyuk's assessment of the Directline Rolex restrictions!

ben500

Davidmacks approach may or may not work but is certainly worth a try, I essentially believe (without knowledge of the specific policy being discussed) that the repudiation is sound, however using DM's example above you may well be able to manouvre the claim handler into making a political decision to overturn the repudiation, a referral to the ombudsman will cost the ins company £750 or thereabouts irrespective of whether the decision finally falls in your favour or not, so there is incentive for them to cave in and save money on referral, try not to throw your toys out this may result in some numpty digging their heels in and making life difficult.

mrbluejay

Thanks for all your comments...

While I obviously want the claim to be accepted and cannot therefore be objective, there are some comments here which demonstrate a lack of understanding as to what happened. The bag was by my side at the beginning and then no more than 15ft away. There were only 4 other spectators, all of whom I work with, so security was not a prime concern, never the less I did keep a sporadic eye on my bag.

FoxyUK - Why would the bag be left in the car ? I left the car with the intention of getting changed and playing, however the team was doing OK so I watched the game. The same issue with the bag going into the locker, had I got changed this would be reasonable.

The fact that the bag was in the field for 36 hours is a big assumption, I only realised the bag was missing after this time. As some other posters say, surely a loss is still a loss even i you know/think where you have lost the item.

I have contacted the regulators and received an initial response from both Paymentshield and Royal & Sun Alliance (Underwriter).

We have never claimed on our contents or building insurance (6 Years).

A concern is the speed within which the claim was rejected - literally under an hour, is this just a case of the insurer trying it on or is this a indicator of how strong they feel their position is ?