Accused of fraud by travel insurance company

FTB_crossed

uk1 said:

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.

This is the step I’m going to go and take and insurance are ok with it. I am all for it BUT they won’t wait for FOS to make their decision and want to take their costs asap. They are going to take legal route if the money is not paid which in itself is contradictory at their part. One hand they are asking to go to ADR and get a third person’s view and at the same time enforcing their costs. I’m baffled. 

uk1

FTB_crossed said:

uk1 said:

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.

This is the step I’m going to go and take and insurance are ok with it. I am all for it BUT they won’t wait for FOS to make their decision and want to take their costs asap. They are going to take legal route if the money is not paid which in itself is contradictory at their part. One hand they are asking to go to ADR and get a third person’s view and at the same time enforcing their costs. I’m baffled. 

Email all of the organisations that provided you with receipts asking them to reply to you confirming that the receipts were genuine. You should receive confirmation fairly quickly. If things are EXACTLY as you state, then forward these confirmations to the insurers and tell the insurers that if they issue a summons you will simply provide evidence in defence to the court that you have obtained  the confirmations and that the insurers have refused your request to do so directly. If you have nothing to fear ... then you have nothing to fear about a summons being issued and you obviously wqouldn't pay any of the fees they have demanded.

If what you have said here is accurate and honest with no omissions, then they will lose and the insurers will pay up.  If things are exactly as you state then this will not go to court and you will be paid.

Your situation as you have explained it raises many doubts and I cannot add any more.

Voyager2002

FTB_crossed said:

This is the step I’m going to go and take and insurance are ok with it. I am all for it BUT they won’t wait for FOS to make their decision and want to take their costs asap. They are going to take legal route if the money is not paid which in itself is contradictory at their part. One hand they are asking to go to ADR and get a third person’s view and at the same time enforcing their costs. I’m baffled. 

I do not think you should be worried about the insurance company threatening court action. Let us be clear: if you had made a claim that was undoubtedly fraudulent, then they could reasonably charge you the cost of investigating to establish that it was fraudulent. However, that status of your claim will not be established until the FOS rules. So if, in the meantime, they take you to court to recover their expenses, once you made it clear that you were awaiting a ruling from the FOS as to the legitimacy of your claim the judge would simply adjourn the case about the insurance company's expenses.

FTB_crossed

uk1 said:

FTB_crossed said:

uk1 said:

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.

This is the step I’m going to go and take and insurance are ok with it. I am all for it BUT they won’t wait for FOS to make their decision and want to take their costs asap. They are going to take legal route if the money is not paid which in itself is contradictory at their part. One hand they are asking to go to ADR and get a third person’s view and at the same time enforcing their costs. I’m baffled. 

Email all of the organisations that provided you with receipts asking them to reply to you confirming that the receipts were genuine. You should receive confirmation fairly quickly. If things are EXACTLY as you state, then forward these confirmations to the insurers and tell the insurers that if they issue a summons you will simply provide evidence in defence to the court that you have obtained  the confirmations and that the insurers have refused your request to do so directly. If you have nothing to fear ... then you have nothing to fear about a summons being issued and you obviously wqouldn't pay any of the fees they have demanded.

If what you have said here is accurate and honest with no omissions, then they will lose and the insurers will pay up.  If things are exactly as you state then this will not go to court and you will be paid.

Your situation as you have explained it raises many doubts and I cannot add any more.

I have direct letters as correspondence from all parties involved. No hiding or anything else like that. I have lodged it with FOS but wait time to be allocated is around 5 months right now. But we will see.

FTB_crossed

Voyager2002 said:

FTB_crossed said:

This is the step I’m going to go and take and insurance are ok with it. I am all for it BUT they won’t wait for FOS to make their decision and want to take their costs asap. They are going to take legal route if the money is not paid which in itself is contradictory at their part. One hand they are asking to go to ADR and get a third person’s view and at the same time enforcing their costs. I’m baffled. 

I do not think you should be worried about the insurance company threatening court action. Let us be clear: if you had made a claim that was undoubtedly fraudulent, then they could reasonably charge you the cost of investigating to establish that it was fraudulent. However, that status of your claim will not be established until the FOS rules. So if, in the meantime, they take you to court to recover their expenses, once you made it clear that you were awaiting a ruling from the FOS as to the legitimacy of your claim the judge would simply adjourn the case about the insurance company's expenses.

That’s what I thought but when I spoke to FOS, I was told if courts are involved then they won’t look at the complaint but I am not sure because at this stage no courts are involved and case has gone to FOS. 

If insurance now pushes it to go to court over their costs then I don’t know whether FOS will be notified or what stance will this complaint hold. It’s bit odd but FOS said that they will speak to the insurance and try to tell them to wait for them to adjudicate.
Will wait but on the side I have a solicitor to act on my behalf if insurance has a follow up query.

Dr_Crypto

This doesn’t seem like a logical sequence. 

The FOS is free and consumer friendly. The courts are neither of those things. 

The whole value of this matter is fairly low - £4.5k for the claim and £950 for the investigation costs.
Using solicitors will quickly cost more than that. I’m also not sure what you’re using a solicitor for. 

If you write to the insurer and set things out clearly as a complaint and mention you will escalate to the FOS as needed that should hold them off. 

FTB_crossed

Dr_Crypto said:

This doesn’t seem like a logical sequence. 

The FOS is free and consumer friendly. The courts are neither of those things. 

The whole value of this matter is fairly low - £4.5k for the claim and £950 for the investigation costs.
Using solicitors will quickly cost more than that. I’m also not sure what you’re using a solicitor for. 

If you write to the insurer and set things out clearly as a complaint and mention you will escalate to the FOS as needed that should hold them off. 

I have instructed the solicitor but he’s not free till mid week and won’t touch them. I have got him onboard to deal with insurance and do an administrative view which includes speaking to them and try and resolve without having to go to court. Although if it goes to court, fees and costs will be added and I will have to make a decision then about what I need to do.

Yahoo_Mail

So you had a claim, which was denied.  And instead of accepting it you made a vexatious FOS complaint, which you also lost.  Now the same company doubts your story and a "dodgy" agent they've instructed demands a bribe or they'll deny your claim.
But you won't just take it to the FOS and a "barrister" "on the radio" tells you to submit a small claims court claim even though you haven't even exhausted the insurer's complaints procedure?

Oh, come on. Jackanory...

FTB_crossed

Yahoo_Mail said:

So you had a claim, which was denied.  And instead of accepting it you made a vexatious FOS complaint, which you also lost.  Now the same company doubts your story and a "dodgy" agent they've instructed demands a bribe or they'll deny your claim.
But you won't just take it to the FOS and a "barrister" "on the radio" tells you to submit a small claims court claim even though you haven't even exhausted the insurer's complaints procedure?

Oh, come on. Jackanory...

I have exhausted the insurance complaints process and have lodged it with FOS who are now going to take at least 5 months to investigate because of back log. 

In the mean time, I have gathered evidence against that dodgy investigator who gave insurance the report on the basis of which insurance denied the claim. Investigator and insurance have concluded their work long time ago- more than 2 months ago, I have since been going about trying to gather more information and evidence to back my claim as investigator has no basis of his statement and with conclusive evidence, I can prove them wrong because they won’t listen to me otherwise. 

uk1

Proving the investigator is a crook is not your business and no one reviewing these antics will think better of your claim.  In fact what you have done harms your credibility and harms you.  It doesn't help you at all.  You only need to prove that your claim was covered by the policy and that you made an honest claim and that the insurers were wrong to reject it.  That is it. Your insurers clearly believe they know stuff that no one here does as insurers don't normally behave in this way for normal claims. 

Sadly you are "all over the place" with this and do not seem to be listening to any of the advice people have offered here.