Wrong information regarding medical claim..

HillStreetBlues

Grumpy_chap said:

HillStreetBlues said:

DullGreyGuy said:

HillStreetBlues said:

DullGreyGuy said:

HillStreetBlues said:

You could put in a complaint stating that you believe rejecting the claim fully isn't correct as you believe they still would have insured you if you had declared it.
If they still reject the claim try https://www.financial-ombudsman.org.uk/consumers/complaints-can-help
It won't cost you anything and they will look at claim as see if they made the correct decision.

If they would cover it or not is irrelevant if they believe it was reckless that the OP didn't declare it... an intentional or reckless non-disclosure results in a void policy under CIDRA.  There really has to be an explanation as to why it was only careless and not reckless.

But what they believe doesn't have to be the final word.
Hence the  suggesting to take it to the Ombudsman, as they will rule if that believe is correct if they have declined it for that reason.

The ombudsman too isn't the final word either if you want to be picky as you can always go to court if the ombudsman sides with the insurer. Success rates however are very low. 

Also being picky then the order would matter, if you went to the court first and court sided with the insurer,  you can then raise it with the Ombudsman.

I don't think that would work as the court is the higher authority, so any subsequent appeal to the Ombudsman would likely be rejected on that grounds.
I also understand that the court would look unfavourably on a claimant that had not sought to exhaust all versions of ADR first.
So, AIUI, the order would matter.

No they are different as the Ombudsman doesn't have to follow the same rules are a Court has to. An Ombudsman can rule due to what's "fair" but a court has to follow the legal rules fair or not.
I expect there are many claims that go directly to the small claims court, so can't see not using an Ombudsman would count against you.
 

DullGreyGuy

HillStreetBlues said:

DullGreyGuy said:

HillStreetBlues said:

DullGreyGuy said:

HillStreetBlues said:

You could put in a complaint stating that you believe rejecting the claim fully isn't correct as you believe they still would have insured you if you had declared it.
If they still reject the claim try https://www.financial-ombudsman.org.uk/consumers/complaints-can-help
It won't cost you anything and they will look at claim as see if they made the correct decision.

If they would cover it or not is irrelevant if they believe it was reckless that the OP didn't declare it... an intentional or reckless non-disclosure results in a void policy under CIDRA.  There really has to be an explanation as to why it was only careless and not reckless.

But what they believe doesn't have to be the final word.
Hence the  suggesting to take it to the Ombudsman, as they will rule if that believe is correct if they have declined it for that reason.

The ombudsman too isn't the final word either if you want to be picky as you can always go to court if the ombudsman sides with the insurer. Success rates however are very low. 

Also being picky then the order would matter, if you went to the court first and court sided with the insurer,  you can then raise it with the Ombudsman.

No you cannot, if it's been to court the ombudsman won't touch it. Its why its one of the filtering questions on if legal proceedings have been started

HillStreetBlues

DullGreyGuy said:

HillStreetBlues said:

DullGreyGuy said:

HillStreetBlues said:

DullGreyGuy said:

HillStreetBlues said:

You could put in a complaint stating that you believe rejecting the claim fully isn't correct as you believe they still would have insured you if you had declared it.
If they still reject the claim try https://www.financial-ombudsman.org.uk/consumers/complaints-can-help
It won't cost you anything and they will look at claim as see if they made the correct decision.

If they would cover it or not is irrelevant if they believe it was reckless that the OP didn't declare it... an intentional or reckless non-disclosure results in a void policy under CIDRA.  There really has to be an explanation as to why it was only careless and not reckless.

But what they believe doesn't have to be the final word.
Hence the  suggesting to take it to the Ombudsman, as they will rule if that believe is correct if they have declined it for that reason.

The ombudsman too isn't the final word either if you want to be picky as you can always go to court if the ombudsman sides with the insurer. Success rates however are very low. 

Also being picky then the order would matter, if you went to the court first and court sided with the insurer,  you can then raise it with the Ombudsman.

No you cannot, if it's been to court the ombudsman won't touch it. Its why its one of the filtering questions on if legal proceedings have been started

I took that as meaning if a case is on-going as there has been court cases paused to it can go to the Ombudsman.,  but I could have misunderstand the wording.

Okell

If a court has made a decision on a case it can't be overturned by the (or any other) Ombudsman.

If a claimant has lost a case in a lower court their only recourse is to appeal to a higher court - assuming they can get permission to appeal and they can afford to do so.

MeteredOut

Okell said:

If a court has made a decision on a case it can't be overturned by the (or any other) Ombudsman.

If a claimant has lost a case in a lower court their only recourse is to appeal to a higher court - assuming they can get permission to appeal and they can afford to do so.

Is that written into the Ombudsman's rules? How is it adjudicated?

There's a very good chance someone could take a supplier to court, and lose, but then want to go to the ombudsman for a related but lesser issue.

I agree the Ombudsman is not there overturn the court case, but I can't see why a claim should not be possible on a related but distinct matter.

Okell

MeteredOut said:

Okell said:

If a court has made a decision on a case it can't be overturned by the (or any other) Ombudsman.

If a claimant has lost a case in a lower court their only recourse is to appeal to a higher court - assuming they can get permission to appeal and they can afford to do so.

Is that written into the Ombudsman's rules? How is it adjudicated?

There's a very good chance someone could take a supplier to court, and lose, but then want to go to the ombudsman for a related but lesser issue.

I agree the Ombudsman is not there overturn the court case, but I can't see why a claim should not be possible on a related but distinct matter.

Are you suggesting that an Ombudsman could overturn the decision of a court?

I didn't realise they'd usurped the courts and Parliament in deciding what the law is.

I can't think of any set of circumstances where a consumer would lose a court claim against a trader and then be able make a successful claim to an Ombudsman based on the same facts.  I don't know what you mean by either "a related but separate issue" or a "related but distinct matter"?

Alderbank

What about goodwill payments for inconvenience?

Okell

Alderbank said:

What about goodwill payments for inconvenience?

Sorry - what about them?

Alderbank

The courts are bound by law. The ombudsmen are not so restricted and can order their member to make a non-statutory payment for inconvenience, for example.

On reflection I agree that a consumer can't go to court then go to the ombudsman afterwards, as per your example.

HillStreetBlues

Alderbank said:

The courts are bound by law. The ombudsmen are not so restricted and can order their member to make a non-statutory payment for inconvenience, for example.

On reflection I agree that a consumer can't go to court then go to the ombudsman afterwards, as per your example.

https://www.financial-ombudsman.org.uk/consumers/complaints-cant-help
for example, we won’t usually look into a problem that’s been decided by a court

That would suggest that can/do  otherwise "usually" would be omitted.  It might very very rare thou.