Accused of fraud by travel insurance company

FTB_crossed

Hello,

I am in dire state of help where I have been accused of making a fraudulent claim on my travel insurance. I made a claim while abroad and insurance company hired a local investigator to investigate the claim and it turned out that he wanted money in return and when challenged, he went out of his way to complicate the case and gave statement that all evidence is fake and forged.

Insurance company relied on the report and rejected the claim and asked me to pay investigative costs of £950 which apparently they had to pay to investigate the matter.

Total claim value was about £4500 and in all honesty they haven't lost anything by rejecting the claim as otherwise they would have lost £4500 claim payout. THIS IS ONE ASPECT that they should not be asking me this in the first place.

Claim was for Medical, Flights, Accommodation with evidence provided to insurance company but they won't accept it as their agent has told them otherwise.

I have since gone ahead and covertly had an email exchange with the investigative firm from a made-up Gmail account to get them to say that they would provide a report in exchange of money without any further documents if I pay upfront which would clearly show that they are dodgy people and can do anything for money.

I have consulted few other people and I have had a mixed response to what I can do next:

1. Wait for insurance company to go to court and try and recover their costs and then defend it with evidence.
2. File a case in small claims court from the start and recover claim amount and when insurance company counter claims it, deal with it in court with evidence.
3. Go to financial ombudsman but insurance company won't stop chasing me for money as they have said and will take legal action to recover- DO NOT UNDERSTAND WHY CANT THEY WAIT FOR ADR TO MAKE A FINAL POINT.

Anyone with similar experience or who can put me in the right direction would be appreciated.

TELLIT01

FTB_crossed said:

Total claim value was about £4500 and in all honesty they haven't lost anything by rejecting the claim as otherwise they would have lost £4500 claim payout. THIS IS ONE ASPECT that they should not be asking me this in the first place.

Of course the insurnace company has lost something - they have lost the cost of employing the investigator and are looking to recoup that cost.  They clearly believe the claim is fraudulent and if you don't agree to pay their costs you may well find yourself in court for more than their out of pocket expenses.

If you can show that they are wrong in their belief then you should go to the financial ombudsman.

huckster

 "I made a claim while abroad and insurance company hired a local investigator to investigate the claim and it turned out that he wanted money in return and when challenged, he went out of his way to complicate the case and gave statement that all evidence is fake and forged."

So why did you not report this to the Police in the country where you were visiting. ?
It is not too late to do this now and ask the Police for a reference number, which you can provide to the Insurance company and Court if it comes to that.
If it goes to Court at some point, you can point to the Police report.

FTB_crossed

huckster said:

 "I made a claim while abroad and insurance company hired a local investigator to investigate the claim and it turned out that he wanted money in return and when challenged, he went out of his way to complicate the case and gave statement that all evidence is fake and forged."

So why did you not report this to the Police in the country where you were visiting. ?
It is not too late to do this now and ask the Police for a reference number, which you can provide to the Insurance company and Court if it comes to that.
If it goes to Court at some point, you can point to the Police report.

Actually this is a good point but problem is that its a third world country and to report this and to deal with its fallout is not less than a dealing with a big mess. I have evidence to back up my points in claim and at the same time they have statement and from investigator but no evidence to prove me wrong. Let's see that now I have instructed a solicitor who is going to be talking to the insurance company on my behalf.

I have statements and evidence from Hospital to prove medical, tenancy agreement to prove accommodation & letters from travel agent to prove reservation and invoice.

I am not sure if it goes to court what evidence will they provide to prove me wrong but they are adamant to recover costs and not budging one bit.

FTB_crossed

TELLIT01 said:

FTB_crossed said:

Total claim value was about £4500 and in all honesty they haven't lost anything by rejecting the claim as otherwise they would have lost £4500 claim payout. THIS IS ONE ASPECT that they should not be asking me this in the first place.

Of course the insurnace company has lost something - they have lost the cost of employing the investigator and are looking to recoup that cost.  They clearly believe the claim is fraudulent and if you don't agree to pay their costs you may well find yourself in court for more than their out of pocket expenses.

If you can show that they are wrong in their belief then you should go to the financial ombudsman.

I appreciate your input but I read an article somewhere that if insurance company hasn't lost over all, they are not likely to win investigative costs.

If the claim was for £500 and they spent £950 to investigate it then it would have made sense to recover £450 as its their ultimate loss but in this case they have saved over £3500 and still asking to recover costs. Strange!!

In the policy booklet it states that if they found the claim to be fraudulent, they may cancel the policy and will not pay the claim furthermore they will take any money already paid in the claim from day 1. I have not received a penny and they are claiming that their legal right to claim the costs but it doesn't say in the policy document anywhere.

I am perplexed at the situation is getting dragged on so much that I can't bear it anymore so got the solicitor involved.

Thrugelmir

FTB_crossed said:

I have since gone ahead and covertly had an email exchange with the investigative firm from a made-up Gmail account to get them to say that they would provide a report in exchange of money without any further documents if I pay upfront which would clearly show that they are dodgy people and can do anything for money.

Perhaps they aren't as stupid as you think. 

FTB_crossed

What do you mean by that. I didn't get it?

comeandgo

FTB_crossed said:

Hello,

I am in dire state of help where I have been accused of making a fraudulent claim on my travel insurance. I made a claim while abroad and insurance company hired a local investigator to investigate the claim and it turned out that he wanted money in return and when challenged, he went out of his way to complicate the case and gave statement that all evidence is fake and forged.

Insurance company relied on the report and rejected the claim and asked me to pay investigative costs of £950 which apparently they had to pay to investigate the matter.

Total claim value was about £4500 and in all honesty they haven't lost anything by rejecting the claim as otherwise they would have lost £4500 claim payout. THIS IS ONE ASPECT that they should not be asking me this in the first place.

Claim was for Medical, Flights, Accommodation with evidence provided to insurance company but they won't accept it as their agent has told them otherwise.

I have since gone ahead and covertly had an email exchange with the investigative firm from a made-up Gmail account to get them to say that they would provide a report in exchange of money without any further documents if I pay upfront which would clearly show that they are dodgy people and can do anything for money.

I can't honestly see how you getting involved in suggesting corrupt activities will help you prove anything other than you are willing to participate now.  If you have completed forms and receipts and witnesses then let your solicitor deal with it.  

CKhalvashi

IMO, you need to go through the proper complaint process with the insurer and if that doesn't yield the results you want, to the Ombudsman.

I too am skeptical that you didn't speak to the police. I've travelled extensively in the former USSR over a number of years and have found any police/other officials I've dealt with to be efficient and fair. I've never had to make a complaint in these countries though and speak Russian fluently, which may help.

If there is a corrupt individual/company somewhere, you need to complain and provide any evidence that may help you to the insurer. If you, yourself have attempted to corrupt someone else, then it may be best to pay and leave it.

Sandtree

Also, the second they asked for money why didn't you speak to the insurers? The fact you've waited until an unfavourable report has been submitted and only then claimed there are issues with the investigators as an outsider seems very suspicious and further compounded by not reporting it to the police either.

FTB_crossed

I thought without evidence they won't believe any BS that's comes out but it turned out that's not the case. I am now going to report the matter to local police and going to the country again in next week or two. I will also gather more evidence in terms of statements from all parties involved namely landlord, travel agent and hospital. 

The woman at the insurance company dealt with another one of my travel insurance claims before and it didn't go well for me where I had no evidence of loss of mobile phone reported within 24hrs and hence lost the claim but I gave a runaround to Financial Ombudsman for few months and SAR took more of her time etc. I think she's taken it personally and causing this aggravation on baseless accusations. 

Thanks for all of your suggestions and I will feed my solicitors anything extra I can get to facilitate the case.