Does this constitute fraud under the Fraud Act 2006?

Valkyrie888

user1977 said:

Valkyrie888 said:

DullGreyGuy said:

So you have a policy with Home Protect, an MGA/Intermediary who write policies insured by Axa. Guessing the loss adjusters are GHG Solutions but there are a large number of firms out there. 

By "confirm liability" do you mean confirm indemnity, ie they will be paying your claim? Or are you holding a neighbour or something liable for damage to your property?

Not sure what "fraud" you believe may have happened? That you thought Axa were looking at a claim but they weren't? Insurance language isn't always the most helpful, some terms have multiple meanings, some are antiquated so helps if you understand industry history, some are just bad choices of words but have become the standard. 

As an MGA they have delegated authority, or in another way of saying it, Axa has given them their pen. Home Protect are not an insurer but Axa allows them to write business "on their paper" within whatever bounds they've set. This normally also covers claims handling which can be sub delegated to a third party administrator in a claims outsourcing agreement. 

Underwriter isn't a very helpful term, it can be a job title in multiple departments, it can be the entity that sets the price, it can be the company that ultimately is liable to the insured for funding claims. 

If you want help it would be better to say what the claim is, what the issue is and why you disagree than be cryptic about the parties involved or allege fraud etc.

More of a legal question than an insurance question. 

Well, yes, but it's also specifically a criminal law question. Why do you think that might be of any help to you? You can't (realistically) launch a private prosecution, and the police/CPS are hardly likely to be interested. And even if they were, it would take months/years for anything to happen, and the criminal process isn't going to sort out your claim for you anyway.

I am not seeking a prosecution but I wish to ascertain that this constitutes fraud and undermines the work being done on my claim. The loss adjustor has misrepresented information or withheld information on several occasions and these occurrences combined would form a code of conduct. As part of my complaint, I will put the onus on the insurer to investigate and determine criminality; it is not only me that has been subjected to this, it is also the insurer and underwriter. 

I think I am within my rights to have the work of the loss adjustor reviewed by a third party as this situation has undermined my faith in his ability to carry out his task in my claim. 

Valkyrie888

TSx said:

This feels like poor communication (endemic with loss adjusters, and I say that having done the job for a short period) rather than anything else. I very much doubt you will be able to meet the criminal burden of proof to demonstrate dishonest intent requires under s3 of the fraud act (failing to disclose information), and as pointed out above, the police will not be interested.

You could make a civil claim but you'd need quantifiable damaged, not just the fact you unnecessarily contacted the ultimate insurer of the policy. The law around damages doesn't consider hypotheticals so it needs to be actual loss.

If you've made a complaint, they will have 8 weeks to respond and then you can take it to the FOS. For the subject access request, they have 30 days (I'm not sure who you've made this to and what the data controller/processor relationship is but it's possible that e.g the Insurer won't actually hold the information you've asked for if it's all with the loss adjuster).

There are a lot of very experienced people on this forum who might be able to give you some further insight (and the best way of getting it sorted) if you can explain what has actually happened, but from the vague details you've given, the best advice is to wait for the outcome of a complaint, assuming you've raised one - although technically if you've expressed any 'material' dissatisfaction they should have already logged it.

Let me word this differently. 

Imagine the house insurance claim were my children. I have paid for child care to a childcare provider. The childcare provider has appointed an independent childcare provider to manage my childcare. This childcare provider has told me that my children are being looked after by the childcare provider in London. After I checked where the children were, it turns out they are in Surrey. 

It wasn't a mistake or a bit of a mix up; he has created a narrative and attributed acts to 2 different companies. Perhaps he has been told by the insurer that decisions have come from the underwriters but all I can prove is that this came from him and both the insurer and underwriter have confirmed this. I am open to the fact that he has relayed what he has been told but that will only come out following an investigation by the insurer, potentially the FCA and FOS. 

In terms of disclosure and data protection, I have submitted SAR to both the insurance company and loss adjustor. The insurance company are a data controller whilst the loss adjustor have said they are a data processor and so they have referred the SAR to the insurer. 

I think people are misunderstanding what I am asking and what I am seeking; I just wanted to clarify if this would be considered as a risk of loss.

cw8825

I would be curious to know what your end goal is?

are you not more concerned about the claim being dealt with rather than some elaborate fraud conspiracy theory? Which I don’t think it is because where is the benefit to them

 

Valkyrie888

cw8825 said:

I would be curious to know what your end goal is?

are you not more concerned about the claim being dealt with rather than some elaborate fraud conspiracy theory? Which I don’t think it is because where is the benefit to them

 

I understand that insurance companies and loss adjustors are notorious for trying to use delay tactics, scare tactics and bad faith behaviour. I can only assert that the majority of the people commenting on this thread must be in the employment of insurance companies. 

I have written proof from both insurers confirming that events that have been relayed to me have not transpired. 

user1977

Valkyrie888 said:

cw8825 said:

I would be curious to know what your end goal is?

are you not more concerned about the claim being dealt with rather than some elaborate fraud conspiracy theory? Which I don’t think it is because where is the benefit to them
 

I can only assert that the majority of the people commenting on this thread must be in the employment of insurance companies. 

Oh dear. We're all part of the conspiracy too, rather than just spending our time giving you free and accurate advice? I'm out.

cw8825

Valkyrie888 said:

cw8825 said:

I would be curious to know what your end goal is?

are you not more concerned about the claim being dealt with rather than some elaborate fraud conspiracy theory? Which I don’t think it is because where is the benefit to them

 

I understand that insurance companies and loss adjustors are notorious for trying to use delay tactics, scare tactics and bad faith behaviour. I can only assert that the majority of the people commenting on this thread must be in the employment of insurance companies. 

I have written proof from both insurers confirming that events that have been relayed to me have not transpired. 

Was it not your choice to have a loss adjuster? Why would you insist on that if you believed they were in cahoots

at a guess most giving advice will have worked in/with insurance companies so if you were to provide full details you may a better response. 

As it is anything said is generic/guesswork

Valkyrie888

cw8825 said:

Valkyrie888 said:

cw8825 said:

I would be curious to know what your end goal is?

are you not more concerned about the claim being dealt with rather than some elaborate fraud conspiracy theory? Which I don’t think it is because where is the benefit to them

 

I understand that insurance companies and loss adjustors are notorious for trying to use delay tactics, scare tactics and bad faith behaviour. I can only assert that the majority of the people commenting on this thread must be in the employment of insurance companies. 

I have written proof from both insurers confirming that events that have been relayed to me have not transpired. 

Was it not your choice to have a loss adjuster? Why would you insist on that if you believed they were in cahoots

at a guess most giving advice will have worked in/with insurance companies so if you were to provide full details you may a better response. 

As it is anything said is generic/guesswork

Yes I demanded the appointment of the loss adjustor as the water damage technician recommended it due to the workmanship/quality/expense of the house and the damage incurred. The insurance company had initially tried to have a 'survey' completed by a builder from company which is dormant on Companies House and has deleted its checkatrade profile.

I expect that poor practices are endemic throughout the insurance world as highly publicised in the media and covered in FCA and FOS cases. I pushed for the appointment of the loss adjustor but I certainly did not believe that he was being appointed to be impartial or benefit me. Just be less !!!!!!. Turns out I was wrong. 

I will not give out any details or particulars. I have asked about fraud.

cw8825

It is not fraud
the underwriters/broker/loss adjuster are being paid whatever decision is made - there is no gain to them
if you believe denying one claim will make a difference to the bottom line your sadly mistaken

have you been told conflicting information? poss 
is it poor service? yes

the FOS had 47k complaints last year regarding all insurance. 38% were upheld so around 17.5k
which compared to the total amount of all claims is minuscule 
Having being had experience at a broker/loss adjuster/underwriter I can comfortable say with the amount of regulations. Poor practice is the exception not the norm

XRS200

Nothing you have said indicates fraud has taken place.

I do not work for an insurer.

sheramber

 As part of my complaint, I will put the onus on the insurer to investigate and determine criminality; 

And if they donlt determine any criminality, what then?