Insurance Insiders: Presumably Insurance Companies can see what is on the CUE itself?

Annemos

I am at Adjudication stage at the FOS. 

Several changes have to be made to the CUE entries. And the Insurance Company has now agreed to make those changes.

My problem is.... it take a month for me to do a new Data Request to get an extract of the CUE, to find out what the CUE is actually showing. Adjudicator is saying the FOS Case cannot be held open at Adjudication stage while I wait for it. 

(It is not enough for me just to be told, that the Insurance Company has made the changes on their Internal Systems. I want to see the actual CUE evidence/proof. They have let me down in the past over this issue.) 

Am I right in thinking, that surely the Insurance Companies do indeed have access to the CUE itself? They surely must be able to view it, when setting up new policies to set premiums. Or to check if there have been any prior claims? 

So surely I should be able to be sent an actual screenshot by the Insurance Company? 

If I cannot get this proof.....

I have the impression I am going to have to send this forward for full Ombudsman Review and hope I get the required extract from the MIB before the actual Ombudsman starts the case up again. 

Grateful for any thoughts. Many thanks. 

DullGreyGuy

Ultimately it would be prudent to escalate the complaint to an Ombudsman because ultimately you need to see the result via a DSAR to have absolute certainty they've fulfilled their commitment rather than taking their word for it. The queue for an ombudsman to pick up a case tends to be fairly long so hopefully you can retract it before an ombudsman is actually assigned.

It may be even more prudent to do more than one DSAR as have personal experience of a complaint related correction (CRAs not CUE) which was then overridden the next month by the automated feed. 

CUE is one of those things that many know about it, most have a reasonable idea how it works, a reasonable proportion do work as a result of stuff thats gone to or back from CUE but very few know the intricate details of the feeds, mechanisms for reviewing/correcting etc. My ex used to work in counter fraud (policy, not claims) and even her work queue included items in response to CUE searches but never directly accessing the data. Insurance industry is full of these types of feeds to databases, regulators etc etc and most are built by someone in IT to meet the spec and they just work so no one investigates them, the person leaves and it becomes a black box. Ive had the need to open the lid on a few of them in the past but never CUE

Annemos

Many MANY thanks DullGreyGuy. 

You have confirmed the bad vibes I was feeling. 

All I have from the Adjudicator is:  "I have asked them to tell me when they have done it." 

And your impressions of the "bad links" between the Insurance Company's Data Systems, the knowledge of the people at the Insurance Company in how to use those systems and the way it actually feeds into the CUE itself, is exactly what I have been encountering. 

Mine is possibly made worse by the fact that their initial inputting was done in February 2018, so quite some time ago. And this Insurer has now pulled out of the Home Insurance Market. (RSA). So the people involved have left the business stream. 

Another worry I have is that the correction involves the RSA system using an Incident Date that it outside the Policy dates on the RSA system, so I wonder if the RSA system will create an error message!  

If I have a final Ombudsman Decision, that will also be more binding than the one obtained at Adjudication Stage. It will be there in black and white for all to see. 

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(RSA is the Previous Insurer under the ABI Domestic Subsidence Agreement. I was originally of the opinion that they should not be entering anything on the CUE, as they did not handle the Claim. And I did not have a policy with them when the Subsidence Event happened.

But I am happy to settle for the compromise that their "Contribution" will be entered on the CUE, but all the facts will EXACTLY match the actual claim itself: Thus Incident Date, Date of Closure etc. 

Their original entries were way off. They had an Incident Date 6 months before I actually reported the Subsidence Claim and they had a Date of Closure a year after my claim was actually closed.

My main Insurer does not use the CUE. So what I shall end up with is one CUE entry by RSA, as if my own Insurer had used it, with their correct dates. That is acceptable to me.) 

DullGreyGuy

Annemos said:

You have confirmed the bad vibes I was feeling. 

I work in insurance, ironically that means by nature I am risk adverse. I dont say there are bad vibes but acknowledge there is a prudent / risk adverse way through things. 

Annemos said:
If I have a final Ombudsman Decision, that will also be more binding than the one obtained at Adjudication Stage. It will be there in black and white for all to see. 

It is the only binding decision, an adjudicators decision isn't binding on either party. An ombudsman decision is binding on the financial services company if the consumer agrees.


I know you like rabbit holes so indulge me a little... legally, as a non-legal professional, the whole Ombudsman situation is a little amusing. The ombudsman will openly admit that their decisions are not required to follow the letter of the law because their remit under FSMA is to find "fair" outcomes not to be a pseudo court. For example with CCA S75 complaints you will often see them highlight this fact and say a court of law wouldn't find the same decision. 

A decision by a FOS Ombudsman however is binding on the FS company. If the FS company doesn't comply then you as the complainer can raise the matter with the court. This isn't a normal Small Track case though, where you'd have to reprove your case, but instead it's an alternative pathway where basically a judge automatically makes a court order inline with the FOS decision. Once you have the court order that opens up various pathways for recovery of monies due (eg a winding up order, third part debt order etc).

So technically a court can order an insurer's (or bank etc) bank etc to settle up a debt that is acknowledged as not strictly what certain law requires. The English Law (-v- Roman Law) system opens up so many more oddities and weirdness if you stop and think but can adapt so much quicker without reference back to politicians. 

Annemos said:
Another worry I have is that the correction involves the RSA system using an Incident Date that it outside the Policy dates on the RSA system, so I wonder if the RSA system will create an error message!  

Insurance systems are generally poor, even the most modern commercial systems have to deal with legacy issues and RSA are not a company that started 2 years ago and decided to write a modern system from scratch. 


I wouldn't be concerned about "error messages" too much, many very bright IT wizards quickly realise how bound their hands are and accept things that shouldn't be. Id be slightly more concerned that there are batch processes that go on that people dont understand that could over wright changes but I believe (not an expert) that changes are much more change based than CRAs that are a broader current status basis. 

Annemos

Very interesting. And I had not focused in on the fact that the Adjudicator decision is not binding. 

I just assumed, that if both parties agreed with the solution obtained at the Adjudication stage, then that solution would become binding. 


The adjudication is actually "Correct the CUE or you must delete it."

So if the DSAR requests still show that RSA have not been able to achieve the corrections, then I shall respectfully request the Ombudsman to order its complete deletion. 

(Such a pain requesting those DSAR's!   I have already done it 3 times, only to find that RSA had not made the changes after they said they would.    That's why I am at the FOS!) 


As a homeowner outside the Industry, "bad vibes" are the sixth sense I have, that even when I think something is settled on my Claim, it will turn out not to be the case.  So here I am 6 years and 1 month later, still getting that 6th sense that there is still the potential for something to go wrong. (Now at the FOS stage.)


Many thanks again DullGreyGuy.   
        
PS..... I hope I don't have to get a Court Order! 

Annemos

Final update on this. 

THANK YOU, DullGreyGuy. 

The Adjudicator was indeed about to close the Case, because the Insurance Company had said they would implement all the date changes.

But after this discussion, I asked if he/she could keep it open until the Insurance Company had actually provided me with proof confirming the new CUE entries (changes). 

It has taken another month, but now they have sent us a correct CUE Extract.

(And I have also just done a new CUE Request, now I have that.)


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So the result of this Adjudication was

This concerned: An Insurer who made a Contribution under the Domestic Subsidence Agreement (but was not the Primary Insurer handling the Claim).  

The Adjudication was    "The Information shown on the CUE must be correct OR it must be deleted." 

My Primary Insurer does not enter anything at all on the CUE. So there was just this Contribution Insurer's entry on the CUE. But all the dates were wrong. 

I was happy to settle for all the Dates to be completely corrected to match the actual Subsidence Claim. 

(Until this was done: They had their "Claim" starting 7 months before the Subsidence Claim even happened. And they had the Date of Closure as 11 months after the actual Claim was closed. And the Policy Dates were shown as just one day, when I did not even have a policy with them on that date.)