Insurance NOT paying (QBE)

Maxjenkins88

Hi there guys, I have a tricky situation....sorry in advanced its long winded,


So I own a business (gym) in the north east of England (Scarborough). June 3rd I got flooded and my insurance company paid me £57,000 so I can purchase my new equipment that got damage.


End of July a massive flash flood happened which caused a stupid amount of rain fall, so severe that caused part of my business get damaged roughly £30,000 worth but its actually more important this equipment as they are used for my classes and that's 50% of my income.

So I went to do a second claim, showed them the footage, they did a in depth investigation (taped interview) etc and they bought up I was charged with GBH with a pending court case 2 month prior to opening my business in 2015 then it was on going in 2016 November when it came to crown court as NOT guilty final result.
QBE insurance argument and denial of the second claim and I quote "if they were told about the GBH charge that I didn't disclose they would have not insured me but they are not asking for the £57,000 back they gave me first time around".
When I was asked about not disclosing this charged it was a "oversight", when you are opening a business and spending "200,000" on a business you just want to get through the jobs ready to open, it was a simple over sight. In the terms and conditions of what the broker has given me, it said "convictions" nothing pending. Also I didn't even sign anything or send anything to my insurance, the only thing was I remember agreeing to was in "2015" but I cant recall if she said pending charges but I DEFINITELY didn't sign anything.

My argument here:

- In the court of law its innocent until proven guilty
- I was found NOT guilty so all charges are dropped
- If it was that much of a issue of me being paid out they would asked for the £57,000 back
- In the period time I was insured (November charges being dropped and Not guilty) to this point now, I have no charges anyway against me so I have a clean record, so really its only 2 months worth the insurance is realistically voided.


Can I have some sound advice here? no stupid things like "moron", I have gone to the Financial OS about this. this causing me stress and is getting me ill.




someone please help, im desperate


Max

Norman_Castle

- I was found guilty so all charges are dropped

Do you mean not guilty?

Maxjenkins88

yes Norman sorry, I edited it now... I am abit all over the place

verityboo

Were you specifically asked when taking out the insurance about any pending prosecutions?

The insurance company has a duty to clearly ask any questions (as well as you to give honest answers)

paddyandstumpy

Check the statement of facts (which your broker would have given you and you had a duty to ensure was correct).

As above, if a clear question wasn't asked about pending prosecutions then you should pursue that angle.

Don't pursue the "I didn't sign anything" angle as a lot of insurance works of statement of facts rather than signed proposals now.

Don't pursue the "innocent until proven guilty" either, the insurer has a right to ask about pending prosecutions and base their acceptance on the answer.

Fundamentally if you were asked about pending prosecutions and didn't disclose it; you've non disclosed.

If they didn't ask, you haven't non disclosed.

The fact you were since found not guilty is irrelevant; the non disclosure occurred and if they wouldn't have accepted you if they knew about it, then they shouldn't be on risk and have the right to void.

P.S. since CIDRA in 2015 and the subsequent Insurance Act in 2016 they cannot recover claims paid already.

Maxjenkins88

My Argument is this:


1st point Non disclosure was a simple and honest oversight, I was trying to open my business in 2015 and when you have equipment, painting and doing everything around a 7 thousand square feet place
its a simple over sight and very innocent to just over look it as everything was coming so quick to open.


- Second point in 11th of August a email from confirming by"that my insurance is "renewed", I had only a brief conversation with her but no reminders of my circumstances changing however the GBH charged in 2 months and half were dropped. Additionally I never signed any documentation or sent any documents back, I remember briefly being over the phone same as 2015. I don't recall "pending charges being mentioned" or even convictions in verbal contract or verbal agreeing terms.


- Third Point: During the claim of Junes flood and Julys Flash flood (video evidence) I have got a CLEAN record therefore there is NO GBH charge pending, so if I did take out a policy or has policy taken 2 months after my court case I would be insured and would counted surely.


Its a simple over sight that is all.... I admit I put my hands up in one sense

Quentin

Your two options are FOS (which you have done), and if that fails court action.


Worth following the FOS route as it is no cost to you, and their adjudication is only binding on the insurer. So if you don't like their reply you can go down the court route though that will involve some upfront costs that you can only recover if you win your case

Maxjenkins88

Quentin,


Yes I have done the FOS route. FOS have agreed on the phone I have a strong case and agree what they have seen its a "over sight" and I was proven not guilty. I am screwed with out this in all fairness however insurers have been very harsh and have wriggled out of this in my opinion with a legit answer however it was a over sight of panicing to open my premises and at the times of the claims I have a clean record. I just feel I have a case! but I doubt you guys think I do

Quentin

Have you actually progressed through the insurers complaints procedure and then the FOS??


You need to, and FOS cannot intervene till you have complained to the insurer and either got their reply or been ignored for 8 weeks


(The FOS adjudicating in your favour will come to you in writing, not by phone)

paddyandstumpy

I assume the FOS verbally telling you you have a strong case (which I'm not sure they should have done, they don't offer opinion they just investigate fact and rule based on that) will be based on you telling them your side of the story.

As with anything, there are two sides to every story.

They will investigate what was asked and what was answered and base their decision on that.

Mungo76

QBE underwrite a lot through Lloyd's, you'll also have to go through their complaint process prior to the FOS.

Unless rules have changed since my day, the underwriter will get 2 weeks to resolve, after that it goes to Lloyd's for 6 weeks.

Lloyd's issue the final response, not the underwriter.