Loss Adjuster offer question

mitchino

Equipment was stolen from my business premises and I made a claim to my insurance company. I was eventually made an offer of full payout by their loss adjuster, which I accepted in writing and by telephone and supplied my bank details for payment. Four weeks later the insurance company rejected my claim.

Is this legal? I thought the offer of full payout and the acceptance by myself would constitute a binding contract between myself and the insurer?

BarelySentientAI

Yes, it is almost certainly legal.

What was the wording on the offer from the adjuster?

mitchino

The loss adjuster stated:

"I can provisionally agree settlement in the amount of £5,155.00 and will now submit our report to Insurers for settlement. I’ll give you a call shortly to verbally verify your bank details."

He called and asked for my bank details and said the money would be with me in a couple of days.

XRS200

"Provionally" and "submit to insurers".

Not therefore binding.

cw8825

mitchino said:

Equipment was stolen from my business premises and I made a claim to my insurance company. I was eventually made an offer of full payout by their loss adjuster, which I accepted in writing and by telephone and supplied my bank details for payment. Four weeks later the insurance company rejected my claim.

Is this legal? I thought the offer of full payout and the acceptance by myself would constitute a binding contract between myself and the insurer?

Have you been given a reason for the claim rejection?

mitchino

They say the policy only provides cover for items stolen from the premises. What happened is a fraudulent trader sent a courier to collect the items, then didn't pay me for them. The insurance company says the theft therefore took place away from the premises. I argued that the courier was acting as an agent of the fraudster, and therefore he in effect did steal the items from the premises.

BarelySentientAI

XRS200 said:

"Provionally" and "submit to insurers".

Not therefore binding.

Precisely.  Which part of "provisionally" suggests a binding contract?

mitchino said:

They say the policy only provides cover for items stolen from the premises. What happened is a fraudulent trader sent a courier to collect the items, then didn't pay me for them. The insurance company says the theft therefore took place away from the premises. I argued that the courier was acting as an agent of the fraudster, and therefore he in effect did steal the items from the premises.

I agree with the insurer.  This was not theft from the premises.

mitchino

I also had a call from the loss adjuster to confirm my bank details, on that call he said the money would be in my account within 48 hours.

Anyway, thanks for all the opinions, I have actually already taken this case to the Financial Ombudsman, and they have just found in favour of the insurer. The whole affair has taken 18 months from the initial crime to the FO's conclusion and I am extremely disappointed and utterly exhausted by it all.

mitchino

Been re-reading the insurance company's response to my complaint, they state:

Sedgwick reviewed all the correspondence and sent an email to you on 11th October 2023, confirming a cash settlement of £5,155.00 is agreed and requesting bank details for the payment.

and later:

Whilst the decision to decline the claim is correct, I have noted the fact that a settlement was agreed between you and Sedgwick and later retracted. Your expectations have clearly been set to receive the agreed settlement and whilst the eventual decision is correct, you haven't been treated fairly.

They did offer me £350 compensation for being treated unfairly, but I still don't understand why it isn't a legally binding contract when an offer has been agreed with the loss adjusters, who were employed by the insurers? Surely they would have to have something in their Ts and Cs stating "any offer agreed between the loss adjuster and the claimant is subject to review and possible amendment by the insurer"?

Phoenix72

mitchino said:

Been re-reading the insurance company's response to my complaint, they state:

Sedgwick reviewed all the correspondence and sent an email to you on 11th October 2023, confirming a cash settlement of £5,155.00 is agreed and requesting bank details for the payment.

and later:

Whilst the decision to decline the claim is correct, I have noted the fact that a settlement was agreed between you and Sedgwick and later retracted. Your expectations have clearly been set to receive the agreed settlement and whilst the eventual decision is correct, you haven't been treated fairly.

They did offer me £350 compensation for being treated unfairly, but I still don't understand why it isn't a legally binding contract when an offer has been agreed with the loss adjusters, who were employed by the insurers? Surely they would have to have something in their Ts and Cs stating "any offer agreed between the loss adjuster and the claimant is subject to review and possible amendment by the insurer"?

But as said earlier it was provisional.

No point going over and over it if FOS have not upheld and your only option now is legal action if you believe you have a case.

DullGreyGuy

mitchino said:

Been re-reading the insurance company's response to my complaint, they state:

Sedgwick reviewed all the correspondence and sent an email to you on 11th October 2023, confirming a cash settlement of £5,155.00 is agreed and requesting bank details for the payment.

and later:

Whilst the decision to decline the claim is correct, I have noted the fact that a settlement was agreed between you and Sedgwick and later retracted. Your expectations have clearly been set to receive the agreed settlement and whilst the eventual decision is correct, you haven't been treated fairly.

They did offer me £350 compensation for being treated unfairly, but I still don't understand why it isn't a legally binding contract when an offer has been agreed with the loss adjusters, who were employed by the insurers? Surely they would have to have something in their Ts and Cs stating "any offer agreed between the loss adjuster and the claimant is subject to review and possible amendment by the insurer"?

For there to be a contract, assuming you're not in Scotland, you need an offer, acceptance and consideration... what do you believe the consideration has been to form the contract?

Even if a contract had been formed you would only be entitled to your actual losses caused by the other party breaching the contract. What actual losses have you sustained due to the breach? £350 sounds fairly generous unless you can substantiate you went out and bought a load of stuff on a very high APR loan because you knew you could pay the loan off with the settlement and would have not taken out the loan/bought the stuff had you known there would be no settlement.