Ongoing battle with loss adjusters over subsidence claim

Bluntington88

FAO Annemos:,the loss adjuster employed by the Loss Adjuster Company is CILA registered. I briefly looked at the CILA complaints info.  Did you complain using the CILA process when you were involved with your subsidence complaints? It is only the last loss adjuster that is registered with CILA. I asked  for qualifications etc when the last response was issued. Thanks for any advice you can give 

DullGreyGuy

Bluntington88 said:

Thank you for this very useful clarification of the process. At what point would you use professional input for your case eg drawing up the complaint for the Adjudicator after the Insurance Company has  issued their response to your complaint with which you disagree? 

Most don't use a professional at any point, like the small claims court its intended not to be necessary however there may be some cases where it would be beneficial.

The ombudsman service is not quick and if either disagree with the Adjudicator/Investigator (they seem to switch the tier 1 name occasionally) its not like the Ombudsman looks at the case the next day, you go back into another queue for a few months (or longer) before the case is assigned to one. As such it's certainly preferable to settle the case at the first tier than have to rely on the second tier. Naturally at the same time it'll increase the potential costs if you use a professional up front as inevitably you'd want their opinion again were it to go to the second tier. 

Annemos

Yes the process DullGreyGuy describes is correct. I only did the FOS Complaint process. (Not CILA, as mine was not covered under CILA.)


I did it myself. This is because, as DGG says, one is aware of the costs involved if one calls someone else in to do it. 

But hopefully your Structural Engineer Report is complete and has all the required facts and evidence. Here's how I tackled it ......  


First I had researched the FOS cases on the same issues. So I felt a certain amount of confidence that a decision could be made in my favour. (It is always nerve wracking. However confident one is, one always has a doubt it might not go the way one hopes.) 

The other CRUCIALLY important thing was my own Structural Engineer's report, which supported what I was asking to be done. And it also fully explained exactly what was wrong with the Insurance Company's actions on the claim. I could thus refer to this report in my own submission. And it carried a lot of weight with the Adjudicator. (This is Tier 1, before you get to full Ombudsman. I was able to stop at this lower level, thank goodness.) 

I also attached photos to show what had happened. 

So the structure of my own submission was as follows:   

Part 1     An outline of what the Claim is and what has caused it. 

Part 2     A Timeline of exactly what the Insurance Company has done 

Part 3     A description of what I disagreed with, in what they had done. Referring in detail to my own Engineer's report which confirmed what was wrong with it. 

Part 4     A list of exactly what I was requesting to be done. Supported again by my own Engineer Report. And here I also listed a summary of the extra costs that I had incurred with a request for their reimbursement. 


I sent it all off and always received prompt acknowledgement of my submissions. Someone in the office at the FOS then started to get the file ready. 

Then the Adjudicator was allocated to my case. She had a long telephone call with me about what had happened. She told me that there is a special team that handles the Subsidence cases, due to the technical nature. I was incredibly impressed with how interested she was in gathering all the facts. She really listened to me and I was left feeling that she would do her utmost to come to a fair conclusion. 

I then left her to come to the Conclusion. 

This whole process had taken about 5 months. (There had been a delay in mine, because the file was so large, the Insurance Company's system was crashing when they tried to send it over!!) 

She e-mailed me the Conclusion and she discussed anything I did not fully understand. There was also one thing I had raised that she said would have to be considered as a new Complaint: she did tell the Insurance Company they should look into it. But that particular item was not included in her final summary of what the Insurance Company was required to do. (They did do it later for me, however.) 


Just a couple of extra notes. 

a   Please note that the FOS Adjudicator etc are NOT technical experts from an Engineering point of view. They rely COMPLETELY on the technical conclusion from the Insurance Company. PLUS the evidence that you provide that supports your own position as supported from your own Engineer.

If they only have the Insurance side of things, then that is all they will use. 

Perhaps a suggestion if you are feeling unsure is.... get your outline together as above. And then if necessary bounce it off your own Structural Engineer again, to see if there is anything he/she wants to add or if he/she has any comments. 

b   Also note. The FOS can only consider anything that happened up to the date of the Final Response Letter from the Insurance Company.

(I found this out, because in my case, something exceedingly closely related to that first Complaint had actually happened a month AFTER that date. Then, technically,  it can only be considered if the Insurance Company agrees to it being included when the FOS considers that first Complaint. If they don't agree, then a new Complaint process would have to be started for that later issue.  My Adjudicator did say that she would short cut the process, if they did not agree and open up a new Complaint herself.) 

Annemos

PS. It is definitely time to get the FOS involved when it gets to the stage you have described. Things at a complete deadlock.

In the end, mine was refusing to deal with me any more. It came as a real shock to be completely cut off, as I had not been expecting it. (I was quite hurt!)  

It does feel very nasty when it is going on and it is very upsetting. I think it is part of the course when we don't agree with them. 

The FOS process will now decide what the next steps are as far as the Insurance Company is concerned. They will not be able to get around any final decision. 

I do hope you get a really good resolution to this, that you are totally happy with. This may not be quick, but it has to be done. 

(Remember you should also continue to be covered by your Insurance Company while this claim is going on. They are not allowed to drop you. And normally after the claim is finished, they should continue to insure you, as long as they are in agreement with what is ultimately done to conclude the claim. "Repairs are done with their Approval". )


 

Bluntington88

FAO Annemos  Massive thanks to you for all this methodical and supportive evidence. We are meeting with my structural engineer on Thursday and I will approach the discussion along the lines you suggest ie ask him to respond to the claims and proposals made in the insurance company’s final response. 
I hope you have a nice time away.  I will update you on what happens next (hope you don’t mind)! Once again, my sincere appreciation of your time and depth of detail given which has meant a lot to me in this stressful situation. 

Bluntington88

FAO DullGreyGuy. Thank you for pointing out the timeframes of the FOS process. All this is certainly a reality check for me in  dealing with insurance claims. I appreciate your experience and advice very much. 

Marley16

I too have posted my story on MSE forum of ongoing battle with Loss Adjusters hired by AVIVA to "manage" my claim - it's been going on for more than 20 years.  See my post to read what I've written.  It's hard to tell the story as has had many twists and turns, but most important is that Loss Adjusters cannot be trusted as they are employed by Insurer.  I didn't realise this in the beginning, was fobbed off.  Only time you will get some slim form of justice is when you have your own Structural Engineer on board and this needs to be from the outset, or could try using a Loss Assessor and I believe what they do is manage the works and take a percentage but maybe for this option you need to accept a settlement.  I wish you luck as it very wearing.

I truly believe the UK needs to fully investigate the "unsavoury" relationship between Insurer and Loss Adjuster and also Insurer and Financial Ombudsman Service as they are "all in bed together".  Plus Financial Conduct Authority does nothing for us "little people" and remember nor do FOS!on't be tricked into believing you will get anywhere.  I got a pittance - its like a kick in the teeth.  They are not trustworthy and are not experts in the field which they are investigating.  Truly unbelievable.  I think they have been set up by the Government.  Well, says it all really - Sub-Postmaster Scandal being a good example.

Bluntington88

Thanks for sharing your experience. It’s very dispiriting to hear your negative experience of the FOS which we are just about to use after the Response to the Complaint time-frame from the insurers has expired. You sound as if the FOS didn’t uphold your complaint or, if they did, only gave a small percentage of what you were asking for to settle the Claim? Would you be able to give any advice re drafting the Complaint to the FOS so we can learn from your experience please? 
Thanks again 

Annemos

Marley16, 20 years sounds so crushing for you. 

Please see my reply to the other post where you posted. I feel that one has to do lots of research on the Ombudsman's cases, to find fact patterns like our own. To find out what is allowed and what isn't. What is actually expected to be done and at what stage. 

Marley16. I do tend to agree with you and so do other Engineers agree with us. And they are also astonished, that it can merely be a desk-based survey far away from the home, that has been provided  ........ 

To have the one Claims Handler who is also your Structural Engineer and also your "Loss Adjuster", working with delegated authority from the Insurance Company, is indeed a potential for a conflict of interest. Hard for us to prove. They strenuously deny it, of course. But we can sense when a less than accurate assessment has been done. One feels they want it off their desk as quickly as possible. 

When I took my own Engineer, because of many problems with the one provided by the Insurance... the step up in Professionalism was absolutely HUGE! 

The problem we have as homeowners, is that we often do not know all this, when we put in a claim. And it is difficult to find an expert in Subsidence, since we are not experts. 

I found my Structural Engineering Company through a wonderful Tree Inspector who had handled Tree Issues and he had worked with Structural Engineers on large structures that had subsided. I was so fortunate they accepted my case. 

Marley16

Message for Bluntington88:  My apologies for not getting back to help you.  I'm not sure I can do this through a forum such as this.  These claims/complaints are so complex especially due to long duration meaning the filing worsens by the year.

Annemos:  Its lovely to find people who understand one another - but how can we form a group/an alliance as the Subpostmasters did.  Any ideas please?  I am furious, but time-limit of 6 years is fast running out for me to get compensation for what I believe is professional negligence -the failure to install damp proof membrane to kitchen/breakfast room floor added an additional 2 years to the already 4.5 months - spread over 3.5 year period.  I'm very angry to have been so poorly treated.  More than 20 years of my life have been blighted.  Damage to my lovely home was allowed to continue due to the tactics, deviousness of loss adjusters and those substandard contractors they employed to in a nutshell "just do botched jobs".