Building Insurance Issues after Full & Final Settlement

knowledgeseeker365

Hi everyone, I wonder if someone can assist me with understanding Full & Final settlement and assist me with the situation I am in.

Background:
I had a water leak which was timely reported to the building insurance upon discovering and fixed immediately to limit damage. However, this leak was hidden leak, and this caused damage to kitchen and bathroom (next door) floor and tiles. As the leak was hidden, the insurer stated, they would be happy to pay for the cabinets to be cut to provide trace and access. What we discovered was that there was also a rot to the kitchen cabinets due to water but all pictures were taken at the time. 

The insurer firstly delayed the issue quoting some admin issues, but eventually asked me to send in pictures of the damage and quotes from builders. I posted job on a well established website, got the builders to come have a look, who said that due to damage, kitchen and bathroom floors including under floor structure and tiles will be replaced. Also the kitchen cabinets would also be replaced, as the floor cabinets had a damage, rot plus we had to cut cabinets for trace and access. 

These required pictures and quotes were sent in but when I did not hear back from insurer I called them up and spoke to a claim handler over the phone.

During the phone call the claims handler, if I would be happy to wait while he accesses the claim to which I agreed and after a while, the claim handler stated that they have reviewed the evidence and quotes and they would be happy to offer me a sum of £xx amount, based on the lowest quote, as FULL and Final Settlement Offer. I agreed, and they took my bank details.

The next day I called and spoke to same claims advisor, and I asked I had not received the money to which he said, the process takes 3-5 days, on his side he has raised the form and is waiting for it to go through, something he should have told me the day before. I double checked if he had correct bank details,  to which he confirmed and that is how the call ended.

The Issue:
Now after 5 working days I contacted insurer, and some different claims agent picked up the phone. I stated that I was advised I would be receiving the money in 3-5 days, but that has not happened. This other agent said, they need to check with the manager why the payment has not gone through and would contact me back.

Then I received an email back asking me to send details of why kitchen is being replaced, send in full wide angle videos of all the damages  so they can review the settlement something which they had previously done so.

To me this is baffling that not only they are wasting time, but asking videos, after pictures had been sent, reviewed and full and final settlement offered, and accepted. 

I am not an expert in law, but I did not wanted to fall in their trap, by sending more evidence after the full and final settlement was offered and accepted, as I think that could have possibly overridden the settlement offer which I see as a contractual binding. Therefore, I have replied the agent back asking them to speak with initial claims handler, as they had already offered full and final settlement on a particular date and took my bank detail after acceptance, followed by another conversation with advisor following day where they gave me a timeframe, while asking them to confirm the payment date, requesting them to process payment without delay.

All this conversation took place over the phone, not in writing, but on calling insurer, it always says calls are recorded for quality and training purposes so I assume that phone should not be an issue. 

Advice Required:
I am unsure where does law stand on their action, if they are allowed to ask for videos, after offering settlement and giving me a timeframe of when I should receive the money by. I would greatly appreciate if someone can advise me on this issue, i.e. if full and final settlement offer and acceptance  a contractual obligation?

Is the insurer in their rights to further delay this and ask me for videos at this stage? and finally what should my actions and options be to tackle this situation? As stated previously I have emailed them to check with other claim handler, as full and final settlement had already been offered and accepted, asking them to process payments without delay.

Any suggestions and guidance would be appreciated and apologies as I am new to this situation and forum.

DullGreyGuy

To take it to an extreme for obvious reasons... if the agent had offered you £10m as full and final settlement rather than whatever number it was (I am assuming vastly less) do you still think it is legally binding or not? 

Generally offers are not binding, though the Ombudsman doesnt look well on insurers giving wrong information out. However, the ombudsman will also look at the consequences of the misinformation has been... if you have gone out and ordered a Roundhouse Kitchen with full Sub Zero and Wolf appliances without any cooling off period in anticipation of the £10m arriving then the response is likely to be different than if you've done nothing other than just wasted some time on phone calls. 

Ultimately you need to assist them, it may well be after the video they say the former agent was correct in which case you are adding as much delay as them by not providing them the information. If they change the offer then see what the difference and their reasoning... as a former claims handler I've certainly peer reviewed a team mates work and increased the offer despite the insured accepting the lower offer because they had made mistakes.

knowledgeseeker365

DullGreyGuy said:

To take it to an extreme for obvious reasons... if the agent had offered you £10m as full and final settlement rather than whatever number it was (I am assuming vastly less) do you still think it is legally binding or not? 

Generally offers are not binding, though the Ombudsman doesnt look well on insurers giving wrong information out. However, the ombudsman will also look at the consequences of the misinformation has been... if you have gone out and ordered a Roundhouse Kitchen with full Sub Zero and Wolf appliances without any cooling off period in anticipation of the £10m arriving then the response is likely to be different than if you've done nothing other than just wasted some time on phone calls. 

Ultimately you need to assist them, it may well be after the video they say the former agent was correct in which case you are adding as much delay as them by not providing them the information. If they change the offer then see what the difference and their reasoning... as a former claims handler I've certainly peer reviewed a team mates work and increased the offer despite the insured accepting the lower offer because they had made mistakes.

To put things into perspective, the total figure is well under £20k, and I have not yet gone out to order anything. However, I would like to do so as the damages are preventing full use at the moment

knowledgeseeker365

I emailed the claim agent to check with the other agent as my query was about checking why my payment was not made a week after agreeing full and final settlement but I am yet to receive a reply.

All together it has been nearly 2 months since the claim was notified to insurance and there is nothing but delay while kitchen keeps sinking in slowly with time. I have also noted that people I am dealing with are claim management company who deal on actual insurance behalf.

it wise to send actual insurance company a complaint, with claim management company copied in the complaint, giving them 7 days to make payment? Informing them that if they fail to do so I would raise this issue with Financial Ombudsman?

DullGreyGuy

knowledgeseeker365 said:

I emailed the claim agent to check with the other agent as my query was about checking why my payment was not made a week after agreeing full and final settlement but I am yet to receive a reply.

All together it has been nearly 2 months since the claim was notified to insurance and there is nothing but delay while kitchen keeps sinking in slowly with time. I have also noted that people I am dealing with are claim management company who deal on actual insurance behalf.

it wise to send actual insurance company a complaint, with claim management company copied in the complaint, giving them 7 days to make payment? Informing them that if they fail to do so I would raise this issue with Financial Ombudsman?

Follow the process per your policy book. Some insurers delegate all claims to the same TPA and that includes complaints about the claims service. Others only partially outsource or delegate and retain certain things in-house inc complaints. 

knowledgeseeker365

DullGreyGuy said:

knowledgeseeker365 said:

I emailed the claim agent to check with the other agent as my query was about checking why my payment was not made a week after agreeing full and final settlement but I am yet to receive a reply.

All together it has been nearly 2 months since the claim was notified to insurance and there is nothing but delay while kitchen keeps sinking in slowly with time. I have also noted that people I am dealing with are claim management company who deal on actual insurance behalf.

it wise to send actual insurance company a complaint, with claim management company copied in the complaint, giving them 7 days to make payment? Informing them that if they fail to do so I would raise this issue with Financial Ombudsman?

Follow the process per your policy book. Some insurers delegate all claims to the same TPA and that includes complaints about the claims service. Others only partially outsource or delegate and retain certain things in-house inc complaints. 

Thanks for the advice. 

Having looked at Insurer's website that is what I found:

We're proud of the service we provide to our brokers and clients, but we know that sometimes things can go wrong. 

Our aim is to get it right, first time every time. If we make a mistake we will learn from it and try to put it right promptly. We will always confirm to you the receipt of your complaint within five working days and do our best to resolve the problem within four weeks.

If we cannot, we will let you know when an answer may be expected.

If we have not resolved the situation within eight weeks and you are an 'eligible' complainant you may be entitled to refer it to the Financial Ombudsman Service. 

Does it mean this is at least a 8 week wait before Insurer makes a payment which was already agreed 2 weeks ago under "Full and Final Settlement" with payment promised 3-5 days later? (approximately a week ago)

The issue is that the kitchen is slowly sinking in, with bathroom tiles wobbling. Not only some areas have been out of use, as cupboards had to be cut out/sunken tiles etc, this is also a potential health and safety issue as the floor may collapse anytime. Personally I think this is ridiculous and a delay tactic, something the management company has been doing over period of time as it has been nearly 2 months since the issue was reported and latest delay tactic being delay in payment once everything was agreed.

I have few questions:

• Shall I do a subject access request (SAR) to retrieve records of my phone calls as they are evidence in this? or ask insurers to listen to the calls themselves?
• Shall I copy the claim management company in the official complaint?
• Can I request the complaint procedure to be expedited given the state of floors? Also in the complaint shall I mention that an alternate housing is provided given the H&S risks and damage to the kitchen/bathroom?
• Can I ask the insurer to expedite the complaint process?
• Can I start the Financial Ombudsman process parallel to the complaints process?
• What other options, if any, do I have to expedite this? 

Thanks for suggestions in advance 

DullGreyGuy

No, it means you have a backstop of 8 weeks at which point you can go to the Financial Ombudsman but the vast majority are answered well before that.  

knowledgeseeker365 said:
I have few questions:

1. Shall I do a subject access request (SAR) to retrieve records of my phone calls as they are evidence in this? or ask insurers to listen to the calls themselves?
2. Shall I copy the claim management company in the official complaint?
3. Can I request the complaint procedure to be expedited given the state of floors? Also in the complaint shall I mention that an alternate housing is provided given the H&S risks and damage to the kitchen/bathroom?
4. Can I ask the insurer to expedite the complaint process?
5. Can I start the Financial Ombudsman process parallel to the complaints process?
6. What other options, if any, do I have to expedite this? 

Thanks for suggestions in advance 

1. you can do either, depends if you want a copy of them or not. The Ombudsman will ask for copies/transcripts if it gets that far

2. follow the policy book, there is no need to CC in the TPA if the policy book says to complain to the insurer or seller instead 

3. Everyone wants their complaint expedited, you would need to identify legitimate reasons why the issue is causing you more issues than the next customer thats not happy with their kitchen claim... generally that would mean identifying there are vulnerable people being disproportionately disadvantaged than other customers

4. You can ask, but per 3 above, everyone wants theirs prioritised

5. No, the insurer has the right to respond to the complaint first. It's only if they exceed 8 weeks that you can escalate without their response. If you try to register it too early a call centre agent will try to summarise your complaint into 2 lines whilst speaking to the next caller... it can send things down totally the wrong path

6. Not realistically... things take time. That said if you have no working bathroom and no working kitchen then speak to the claims handlers about alternative accommodation. 

knowledgeseeker365

Since the last message on MSE:

• I raised a formal complaint — they acknowledged it, promising a final response within 10 working days. They also promised if they cannot give final response in 10 working days they would inform me of a new date.

• That deadline passed and I received neither the final response nor a new date. So I sent a follow-up complaint few days after the deadline, again setting a new deadline to give me a final response. 

• That too has been ignored — no reply at all since. Making it a pattern of ignoring communication and delaying the process from the time claim started nearly 3 months ago.

My question:

Given that I’ve been completely ghosted, both after agreeing a settlement and after raising two written complaints, is there anything I can do before the 8-week Ombudsman window ends?

Also — can I now raise a second complaint specifically for them failing to respond to the first complaint and the follow up complaint?

Would appreciate any advice on next steps.

Thanks! 

DullGreyGuy

knowledgeseeker365 said:

Since the last message on MSE:

• I raised a formal complaint — they acknowledged it, promising a final response within 10 working days. They also promised if they cannot give final response in 10 working days they would inform me of a new date.

• That deadline passed and I received neither the final response nor a new date. So I sent a follow-up complaint few days after the deadline, again setting a new deadline to give me a final response. 

• That too has been ignored — no reply at all since. Making it a pattern of ignoring communication and delaying the process from the time claim started nearly 3 months ago.

My question:

Given that I’ve been completely ghosted, both after agreeing a settlement and after raising two written complaints, is there anything I can do before the 8-week Ombudsman window ends?

Also — can I now raise a second complaint specifically for them failing to respond to the first complaint and the follow up complaint?

Would appreciate any advice on next steps.

Thanks! 

No, the rules give a financial services company up to 8 weeks to respond to any complaint anything sent to the FOS before that just gets forwarded to the FS firm with a coversheet asking them to respond directly to the customer. It is however unusual for a complaint to get to close to 8 weeks even if they've missed the 2 week window they originally gave themselves. 

Its unlikely that they would treat a complaint on the second complaint as a third as its the same as the second so likely to be merged into it/considered a continuation of it.

knowledgeseeker365

DullGreyGuy said:

knowledgeseeker365 said:

Since the last message on MSE:

• I raised a formal complaint — they acknowledged it, promising a final response within 10 working days. They also promised if they cannot give final response in 10 working days they would inform me of a new date.

• That deadline passed and I received neither the final response nor a new date. So I sent a follow-up complaint few days after the deadline, again setting a new deadline to give me a final response. 

• That too has been ignored — no reply at all since. Making it a pattern of ignoring communication and delaying the process from the time claim started nearly 3 months ago.

My question:

Given that I’ve been completely ghosted, both after agreeing a settlement and after raising two written complaints, is there anything I can do before the 8-week Ombudsman window ends?

Also — can I now raise a second complaint specifically for them failing to respond to the first complaint and the follow up complaint?

Would appreciate any advice on next steps.

Thanks! 

No, the rules give a financial services company up to 8 weeks to respond to any complaint anything sent to the FOS before that just gets forwarded to the FS firm with a coversheet asking them to respond directly to the customer. It is however unusual for a complaint to get to close to 8 weeks even if they've missed the 2 week window they originally gave themselves. 

Its unlikely that they would treat a complaint on the second complaint as a third as its the same as the second so likely to be merged into it/considered a continuation of it.

Thanks for the advice!!!
 
It is pathetic how insurers can delay the matter all the way up to 8 extra weeks after agreeing full and final settlement whereas all I can do is to suffer and put my and my families H&S at risk utilising kitchen and bath with broken floor while I wait for them to take their sweet time to respond.

The reason I asked for second complaint was to help build my case that shows persistent unacceptable behaviour of insurers while dealing with my case. Missing deadlines, even those that they voluntarily gave me to resolve this issue and continuing pattern of ignoring communication when their job is to deal with claims in concerning, prompt and fair manner. I thought having this complaint would assist me showing this unprofessional behaviour to Ombudsman unless they would already pick up on these without me complaining?