Does this constitute fraud under the Fraud Act 2006?

dunstonh

I expect that poor practices are endemic throughout the insurance world as highly publicised in the media and covered in FCA and FOS cases

Yet the stats do not support that.

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

Simple answer is that it isn't fraud.  

I do not work for an insurer.

Grumpy_chap

Valkyrie888 said:

Hello,

I have submitted a claim on my house insurance with H____ P_____. A loss adjustor from G____ S______ was appointed at my behest after I found the performance of the insurer's claims handler below the standard I expected. 

The loss adjustor had stated in an email that the claim would be sent to the underwriters, A___, to determine liability and expected to get an answer within 7-10 days. 

After several weeks had elapsed, I asked the loss adjustor the status of the claim and he said that there was a delay as there were variances from my statement of fact which had been flagged to the Underwriters. He stated that it took  5 and 10 working days for a response from the Underwriters (HP)  to be passed on to the Insurers before being communicated to the loss adjustors (GS). I asked if there was an internal dispute resolution process that I could initiate with the Underwriter, (A); he confirmed that there was but stated "The first stage in this instance if you have a dispute would be to raise it with me and I will happily register it for you."

I contacted the CEO of A (Underwriter), imploring them to deal with my claim fairly and in a timely manner; my request was referred to the complaints department and after I submitted my policy information, I was told that A had no involvement in my claim. 

The loss adjustor responded to an email and provided an update highlighting that the Underwriters were still scrutinising the claim and had not accepted liability. When asked to confirm who was scrutinising the claim, the loss adjustor confirmed that it was A. I immediately contacted A and renewed my queries regarding my claim and their involvement and they refuted all involvement except for handling my initial contact with the CEO. 

I engaged with the Insurer, HP, and relayed some of my concerns regarding the alleged involvement that A was having with my claim; it was confirmed in writing that A had not been involved in the claim and that the Insurer's underwriters had been dealing with the claim. 

Would this code of conduct meet the criteria for a fraud charge under the Fraud Act 2006? 

It is the gain or loss which I am struggling to determine. By false representation/failing to disclose information could it be argued that he undermined my knowledge of the claim with a view to influencing my decision making regarding the claim? 

​​​​​​​Many thanks

I am rather confused by the process here that you have followed.

You have buildings insurance with "HP".  Any contact you have in relation to the claim needs to be with HP as they are the organisation with whom you have privity of contract.

Yet, you have been contacting "GS" and "A" even though "A" may not be related to the claim if there is a different underwriter acting / accepting the policy liability.

Any contact with anyone other than the insurer "HP" would seem to just be likely to create confusion.

Valkyrie888

sheramber said:

 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?

My intent is for the insurer to use their internal dispute resolution process to look at whether the code of conduct constitutes fraud or incompetence. I expect they will go for incompetence rather than trying to wriggle out of everything.

Happy to let the insurer argue it's not fraud 

DullGreyGuy

Valkyrie888 said:

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

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.

Maybe social media?

In their last annual data published the FOS dealt with 1,716 complaints about Home Contents insurance across both sales and claims, 31% were upheld, so less than 1 in 3. By the way, there are about 1.32m claims a year so 0.04% have a complaint that the FOS upholds if you assume all the complaints are about claims and clearly plenty will be about auto-renewal etc.

Valkyrie888 said:

sheramber said:

 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?

My intent is for the insurer to use their internal dispute resolution process to look at whether the code of conduct constitutes fraud or incompetence. I expect they will go for incompetence rather than trying to wriggle out of everything.

Happy to let the insurer argue it's not fraud 

HP or A?

Assuming HP has DUA from A then their decision is the underwriters and the cash paid out is ultimately A even though all it will be is one line in a spreadsheet sent once a quarter with HP doing everything in A's name

Valkyrie888

dunstonh said:

I expect that poor practices are endemic throughout the insurance world as highly publicised in the media and covered in FCA and FOS cases

Yet the stats do not support that.

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

Simple answer is that it isn't fraud.  

I do not work for an insurer.

Cheers dits

Valkyrie888

DullGreyGuy said:

Valkyrie888 said:

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

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.

Maybe social media?

In their last annual data published the FOS dealt with 1,716 complaints about Home Contents insurance across both sales and claims, 31% were upheld, so less than 1 in 3. By the way, there are about 1.32m claims a year so 0.04% have a complaint that the FOS upholds if you assume all the complaints are about claims and clearly plenty will be about auto-renewal etc.

Valkyrie888 said:

sheramber said:

 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?

My intent is for the insurer to use their internal dispute resolution process to look at whether the code of conduct constitutes fraud or incompetence. I expect they will go for incompetence rather than trying to wriggle out of everything.

Happy to let the insurer argue it's not fraud 

HP or A?

Assuming HP has DUA from A then their decision is the underwriters and the cash paid out is ultimately A even though all it will be is one line in a spreadsheet sent once a quarter with HP doing everything in A's name

I'm not going to utilise social media for this. I am more hopeful that the FCA will get involved as they have been very useful so far. 

I'm not disputing the relationship between HP and A. What I have called out is that the loss adjustor has said the claim in being dealt with by A; confirmed a process was in place whereby decision making for the claim was originated from A, it was passed to HP and then passed to the loss adjustor and then relayed to me. 

DullGreyGuy

Valkyrie888 said:

DullGreyGuy said:

Valkyrie888 said:

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

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.

Maybe social media?

In their last annual data published the FOS dealt with 1,716 complaints about Home Contents insurance across both sales and claims, 31% were upheld, so less than 1 in 3. By the way, there are about 1.32m claims a year so 0.04% have a complaint that the FOS upholds if you assume all the complaints are about claims and clearly plenty will be about auto-renewal etc.

Valkyrie888 said:

sheramber said:

 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?

My intent is for the insurer to use their internal dispute resolution process to look at whether the code of conduct constitutes fraud or incompetence. I expect they will go for incompetence rather than trying to wriggle out of everything.

Happy to let the insurer argue it's not fraud 

HP or A?

Assuming HP has DUA from A then their decision is the underwriters and the cash paid out is ultimately A even though all it will be is one line in a spreadsheet sent once a quarter with HP doing everything in A's name

I'm not going to utilise social media for this. I am more hopeful that the FCA will get involved as they have been very useful so far. 

I'm not disputing the relationship between HP and A. What I have called out is that the loss adjustor has said the claim in being dealt with by A; confirmed a process was in place whereby decision making for the claim was originated from A, it was passed to HP and then passed to the loss adjustor and then relayed to me. 

The FCA doesn't deal with individual disputes, the only thing it will look at direct report from consumers for is companies acting without a licence. 

But HP acts as A, is the whole point of a DUA

Valkyrie888

DullGreyGuy said:

Valkyrie888 said:

DullGreyGuy said:

Valkyrie888 said:

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

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.

Maybe social media?

In their last annual data published the FOS dealt with 1,716 complaints about Home Contents insurance across both sales and claims, 31% were upheld, so less than 1 in 3. By the way, there are about 1.32m claims a year so 0.04% have a complaint that the FOS upholds if you assume all the complaints are about claims and clearly plenty will be about auto-renewal etc.

Valkyrie888 said:

sheramber said:

 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?

My intent is for the insurer to use their internal dispute resolution process to look at whether the code of conduct constitutes fraud or incompetence. I expect they will go for incompetence rather than trying to wriggle out of everything.

Happy to let the insurer argue it's not fraud 

HP or A?

Assuming HP has DUA from A then their decision is the underwriters and the cash paid out is ultimately A even though all it will be is one line in a spreadsheet sent once a quarter with HP doing everything in A's name

I'm not going to utilise social media for this. I am more hopeful that the FCA will get involved as they have been very useful so far. 

I'm not disputing the relationship between HP and A. What I have called out is that the loss adjustor has said the claim in being dealt with by A; confirmed a process was in place whereby decision making for the claim was originated from A, it was passed to HP and then passed to the loss adjustor and then relayed to me. 

The FCA doesn't deal with individual disputes, the only thing it will look at direct report from consumers for is companies acting without a licence. 

But HP acts as A, is the whole point of a DUA

A friend of mine suggested contacting the FCA as they had been investigated by the FCA and they said it was 5h1t scary.  

I'm not disputing that HP acts as A. What I am saying is, the loss adjustor made a clear distinction, A is doing it, but in reality, HP were doing it. I sought clarification on the parties from him and he has fabricated a narrative. 

eddddy

Valkyrie888 said:

My intent is for the insurer to use their internal dispute resolution process to look at whether the code of conduct constitutes fraud or incompetence. I expect they will go for incompetence rather than trying to wriggle out of everythind g.

Happy to let the insurer argue it's not fraud 

I might have missed some key points somewhere in the thread... but you seem to be alleging that people have knowingly (or unknowingly) given you false information - or told lies.

Telling lies isn't fraud. 

It only becomes fraud if somebody tells lies in order to make a gain for somebody, or cause a loss to somebody. You haven't explained how you believe the lies have caused you a loss, or resulted in a gain for somebody else.


Here's the relevant extracts from the legislation:

2 Fraud by false representation

(1) A person is in breach of this section if he

    (a) dishonestly makes a false representation, and

    (b) intends, by making the representation

       (i) to make a gain for himself or another, or

       (ii) to cause loss to another or to expose another to a risk of loss.

Link: https://www.legislation.gov.uk/ukpga/2006/35/section/2

DullGreyGuy

Valkyrie888 said:

DullGreyGuy said:

Valkyrie888 said:

DullGreyGuy said:

Valkyrie888 said:

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

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.

Maybe social media?

In their last annual data published the FOS dealt with 1,716 complaints about Home Contents insurance across both sales and claims, 31% were upheld, so less than 1 in 3. By the way, there are about 1.32m claims a year so 0.04% have a complaint that the FOS upholds if you assume all the complaints are about claims and clearly plenty will be about auto-renewal etc.

Valkyrie888 said:

sheramber said:

 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?

My intent is for the insurer to use their internal dispute resolution process to look at whether the code of conduct constitutes fraud or incompetence. I expect they will go for incompetence rather than trying to wriggle out of everything.

Happy to let the insurer argue it's not fraud 

HP or A?

Assuming HP has DUA from A then their decision is the underwriters and the cash paid out is ultimately A even though all it will be is one line in a spreadsheet sent once a quarter with HP doing everything in A's name

I'm not going to utilise social media for this. I am more hopeful that the FCA will get involved as they have been very useful so far. 

I'm not disputing the relationship between HP and A. What I have called out is that the loss adjustor has said the claim in being dealt with by A; confirmed a process was in place whereby decision making for the claim was originated from A, it was passed to HP and then passed to the loss adjustor and then relayed to me. 

The FCA doesn't deal with individual disputes, the only thing it will look at direct report from consumers for is companies acting without a licence. 

But HP acts as A, is the whole point of a DUA

A friend of mine suggested contacting the FCA as they had been investigated by the FCA and they said it was 5h1t scary.  

It can be expensive, it isn't scary. Most the time its just a pain because they want records going back year (eg the current DCA investigation) and whilst going back 2-3 years is ok, trying to find documents from the 1990s etc can be a pain. It may be different if you are personally being investigated but the majority are against companies not people.