Insurance co stopped my ombudsman investigation

Duckiedoos

Hello to you all.


We had an ombudsman investigation into a complaint in progress against our insurance company earlier this month - They want to cancel our policy.

I went through the Insurance company's complaints procedure and then went to the ombudsman - An option given by the insurance company's own policy.

However 2 wks ago the insurance company issued a court claim against us asking us to declare that they were right to avoid our policy through their solicitors. They are also asking for a large court fee.

If we don't do this we must defend ourselves in court.
They were aware of our difficult financial situation/time restraints as we'd previously made our situation clear to them when expressing the importance of retaining our insurance cover.

The Ombudsman investigator has responded by telling us they're now unable to continue their investigation as there are now legal proceedings against us.

We've sent an acknowledgment to court stating our intention to defend - although I'm not sure how.

I asked the ombudsman service to provide us with the relevant regulations to justify their actions but they don't include all of the relevant ones - what they have included seems a little vague & open to interpretation.

The reg they gave states that the ombudsman 'may' choose not to take on an investigation if there are court proceedings in progress relating to the complaint.

However: 1) It doesn't clarify if this applies before or after Ombudsman has begun an investigation.
Our complaint with the ombudsman was already underway and according to their regulations - the insurance company should not start legal proceedings once an Ombudsman investigation has started and they should also notify the Ombudsman before they consider taking any legal action relating to the investigation.
2) Once legal proceedings have begun - The courts have not yet looked into our case, we have not set foot in a court.
The action was initiated by our insurance company - we have only sent the form of acknowledgment back to court - does this count as court proceedings in progress?

The insurance company's own policy informs us of the option to use the ombudsman service if we're unhappy with the outcome of our complaint with them.
I'd also understood we had 6 months to do this.

The insurance act/fca also state that businesses must not treat consumers unfairly.
If this isn't unfair treatment then what is?

We feel as though we've been fobbed off by the Ombudsman and forced into a situation by the Insurance company where we have no choice but to comply with them due to financial & time restrains and the Ombudsman service is simply going along with it - possibly due to lack of staff/knowledge?

What can we do? we simply don't have the money or the time to defend against them in court and it's certainly not a fight I or anyone else can see us winning against one of the largest Insurance organisations in the UK.

Are there clear regulations that enable the Ombudsman or other authority to put a stop to this outside of court?

It seems to call into question the effectiveness and reliability of the Ombudsman service when a large company can use a means to effectively bully a consumer into agreeing with them despite what their own policy and Ombudsman regulations state.

The Insurance co. have a complaints procedure but it didn't warn us that if we took it up with the Ombudsman that they'd take us to court - that wasn't part of their procedure as I recall.

In other words...'Buy our insurance but dare to complain and we'll take you to court!' am I allowed to name names here btw?

k3lvc

So without giving too much away what's the story. They're not likely to do this lightly and your mention of 'fraudulent claim' rings warning bells. The Ombudsman is unlikely to take the case if there is overwhelming evidence of fraud provided by the insurer (and the fact they're threatening proceedings suggests they're confident in their evidence)

[Deleted User]

What does 'avoiding your policy' mean?

What is the backstory here?

NCC-1701

The word is voiding.

[Deleted User]

The insurance company won't be threatening court proceedings simply because the case has been referred to the Ombudsman.

Too little information to comment further.

This should be on the Insurance Board..

Duckiedoos

The fraudulent claim is nothing to do with us - someone is making up an injury claim to get money from us - we have evidence to prove this but we needed our insurance cover to use legal representation to take the fraudster to court.

The Ombudsman should not be taking the decision to go along with the insurance company because their regulations state that a business should not take legal action against a consumer when an ombudsman investigation is in progress.

We have done everything as recommended and followed the insurance company procedures.

The dispute is over unclear/ambiguous wording in the policy - The Ombudsman was investigating this and we had provided evidence that the policy wording was ambiguous and why.

I can't understand why the Insurance company has been granted the authority to take this action.

If they can do it to us, insurance & other companies can and will do it to others once it catches on.

[Deleted User]

Still not enough information. On what basis is the insurance company taking you to court if all you are doing is taking an alleged fraudster to court yourself?

It sounds as if the Ombudsman is withdrawing because their investigation had yet to properly begin when court proceedings were issued.

Duckiedoos

They are simply asking us to make a declaration that they were right to avoid our policy on the grounds of material non-disclosure and misrepresentation. - they also seek court fee costs.

We cannot agree with them however, based on the fact that we were led into choosing the wrong type of policy as a result of ambiguous wording of a question on the broker comparison website.
We chose the insurer Based on our understanding of the wording on policy set up. - There was a lack of clear information.

This is why we took our complaint to the Ombudsman who had said they were able to see our side of things.
It was looking like we had a good chance of getting our insurance reinstated until we received court papers from a solicitor acting on behalf of the insurance co and were told by the Ombudsman that they could no longer investigate.

There is no other information I can add other than that both we and the ombudsman agreed that the insurers were probably doing this to avoid paying out to the person making a fake injury claim against our company - we know it's a fake claim, but the insurance co. aren't aware of our evidence as they were not prepared to continue to insure us so we couldn't use someone on their board of solicitors.

It seems very strange of the Insurance company to do this - The Ombudsman investigator has also expressed surprise at the situation as they have never come across this before

Nearlyold

Is this Business/Employer Public Liability, Home Insurance Legal Expenses/ Public Liability, Motor Insurance related or what. On what basis is your insurer proposing to void your cover? What are they alleging is your wrong doing is it non disclosure? Appreciate that you are not wanting to identify yourself thru too much information but as it is at the moment with what we have to go on we are plaiting fog. Bit of a cross post with your further info above. Is the Ombudsman "seeing your side of things" a statemen in writing from them or an off the cuff remark with their telephone helpline?

[Deleted User]

Duckiedoos wrote: »

we took our complaint to the Ombudsman who had said they were able to see our side of things so it was looking like we had a good chance of getting our insurance reinstated

Unless it was an Ombudsman adjudication which said this in writing then there is absolutely no way to know which side the Ombudsman would have found in favour of.

No one here can help you I fear, especially as you haven't provided any real detail.

You need professional legal advice.

Duckiedoos

The Ombudsman investigation was already in process because they had confirmed this themselves.

The regulations also state that a business should not start legal proceedings until it has finished.

The Insurance company policy also gives the option to complain the the Ombudsman.

They must also treat customers fairly.