Accused of fraud by travel insurance company

Dr_Crypto

Why would you spend money issuing a small claims when you can use the FOS for free? 

I don’t really follow what has happened here. You were abroad in a third world country when you experienced a calamity and were hospitalised. You were then discharged and returned to the UK and made an insurance claim.
They thought the claim was dodgy so engaged a local investigator. You say he is corrupt and asked you for money. What proof do you have of that? Why didn’t you report his corrupt approach to the insurer? You then emailed him and offered to bribe him and wish to use this as proof he is corrupt? That looks pretty dodgy. 

csgohan4

Dr_Crypto said:

Why would you spend money issuing a small claims when you can use the FOS for free? 

I don’t really follow what has happened here. You were abroad in a third world country when you experienced a calamity and were hospitalised. You were then discharged and returned to the UK and made an insurance claim.
They thought the claim was dodgy so engaged a local investigator. You say he is corrupt and asked you for money. What proof do you have of that? Why didn’t you report his corrupt approach to the insurer? You then emailed him and offered to bribe him and wish to use this as proof he is corrupt? That looks pretty dodgy. 

OP have you considered the investigator baited you, than the other way round. You haven't thought this through have you?

warby68

If this was a genuine claim, why are you more worried about them pursuing you for costs than about them not paying up the £4500 of your claim? Why are you talking about fighting their claim rather than being the one claiming the far larger amount?
You mention 'one of' your previous travel claims - that makes at least 3 including this one. Very unlucky or another red flag?

FTB_crossed

Dr_Crypto said:

Why would you spend money issuing a small claims when you can use the FOS for free? 

I don’t really follow what has happened here. You were abroad in a third world country when you experienced a calamity and were hospitalised. You were then discharged and returned to the UK and made an insurance claim.
They thought the claim was dodgy so engaged a local investigator. You say he is corrupt and asked you for money. What proof do you have of that? Why didn’t you report his corrupt approach to the insurer? You then emailed him and offered to bribe him and wish to use this as proof he is corrupt? That looks pretty dodgy. 

All correct. My proof of them being a dodgy company is not linked with my correct email or name so he wouldn’t know plus I have approached the company to try and prove that if they can run into dodgy business with anyone out of nowhere on the internet then they can easily do it with us to which I don’t have any proof. It’s investigator’s statement against my statement. If and when it goes to court, judge will look at the evidence and decide who is right and who telling lies. He has a statement that he has forwarded to insurance and I’ll have statement along with evidence to show their worthiness along with investigator’s contradictory statements about the property in question. 

I approached him via made up email account covertly and it’s not linked with the case whatsoever. 

Imagine a reputable firm will ask you to send proposals, ID docs & paperwork but they were willing to investigate anything for money. Didn’t confirm anything from my side and sent me all their credentials like company registration documents, bank details and company management structures etc

FTB_crossed

warby68 said:

If this was a genuine claim, why are you more worried about them pursuing you for costs than about them not paying up the £4500 of your claim? Why are you talking about fighting their claim rather than being the one claiming the far larger amount?
You mention 'one of' your previous travel claims - that makes at least 3 including this one. Very unlucky or another red flag?

warby68 said:

If this was a genuine claim, why are you more worried about them pursuing you for costs than about them not paying up the £4500 of your claim? Why are you talking about fighting their claim rather than being the one claiming the far larger amount?
You mention 'one of' your previous travel claims - that makes at least 3 including this one. Very unlucky or another red flag?

The concern is that I was willing to go to FOS right from day 1 after they sent me their final response to go to ADR. That’s absolutely fine from their end as well but the problem is that they won’t stop to pursue me for costs and said they are not obliged to do it. FOS would look at this claim and might decide to investigate it but it will take 3-6months as I checked with them and in the mean time, insurance will take me to court for costs which is not what I want.
Going to small claims court first is the only way to get them to pay for the claim and when they counter claim for their costs then judge will look at the case as whole and decide. 

I’m keen to ask them to pay for my claim but I need to prove them wrong first. If they are proved wrong with the evidence I have for insurance not to pursue me for costs them it’s understood that they will have to pay the claim in question.

I had three claims in last 6 years out of which they paid 1st one for lost items, second one for lost phone wasn’t paid due to not being able to report with evidence within 24hrs and this is the third where they have taken help of a cunning & greedy investigator.

rs65

I would go to FOS regardless

Either going to court or being taken to court could result in a UK judge deciding that you have attempted fraud

alewin

FTB_crossed said:

   The thing is that I called up the consumer help on BBC radio and a barrister advised me to make a claim in small claims court online and not wait for insurance to do anything further

Did the barrister know that the investigator has emails from you basically offering him money to change the report in your favour, bribery?

FTB_crossed

alewin said: 

FTB_crossed said:

   The thing is that I called up the consumer help on BBC radio and a barrister advised me to make a claim in small claims court online and not wait for insurance to do anything further

Did the barrister know that the investigator has emails from you basically offering him money to change the report in your favour, bribery?

I didn’t do it for this particular case.
I did it after I had final response letter from insurance as they were adamant that they had a report from a reputable investigative firm that they were relying on to accuse me of fraud. 

I have done a email thread/ email exchanges to confirm the company first and then asked them questions where they would go an offer me a report on another matter if I was to pay them upfront.
What this shows is that the company is question who had done the investigation is neither reputable nor with awards winning credentials as claimed by insurance company. 

Barrister did not know that I had done anything to facilitate my case on my own after the claim was rejected. 

I can file with FOS but how do I stop them chasing me with deadline to pay the costs.
I think I’ll let solicitor deal with them and correspond on my behalf. 

People here judging the fact that the investigation was done in good faith then I can prove it wrong with evidence.
It’s same as investigator telling insurance that I went to the particular address and found out something and spoke to someone there. Next thing investigator tells the insurance in second statement is that the particular address doesn’t exist. 

How how how would you trust the guy???
Along with other evidence, investigator has lied throughout BUT insurance company doesn’t see any of this and they are blinded by personal grudge I think.

TELLIT01

The insurer is highly unlikely to be 'blinded by personal grudge'.  On the other hand, if they have had cause to question previous claims they will naturally take more interest in future claims i.e. the current one.  That is not a personal grudge, it is good business practice.

uk1

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 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.

Your statement of what has happened seems extremely odd.  However, ff everything is as you say then the issue seems to me to be easily solved.

Write a short letter to the insurer stating that you are making a complaint. Do not repeat any of your allegations.  Request that they reconsider their decision after contacting directly  all of those that provided you with receipts to confirm directly that all of the receipts you provided arecompletely genuine.  Tell them that if they refuse you will make a complaint to the FOS.  I suggest you do not go to court as you risk being confronted with a barrister whilst being extremely nervous and I think your account may not sound overly convincing to a judge.  The FOS is completed by written submission and would give you a better chance whilst risking no cash.