Advice on dealing with home insurance and loss adjusters

CakeOrDeath

Hi everyone,

I just wanted to reach out and ask if anyone has experience/advice on dealing with a substantial home insurance claim as I am finding it difficult to make progress with it.

Like many folks my home got battered in the storm earlier this year which caused damage to my roof. This led to water getting in and quite a few rooms suffering water damage. I made a claim with my home insurance for the repairs and they said due to the high volume of claims at the time would I be interested in a settlement because they wouldn't have contractors available for some time. I agreed to the settlement.

Since I made the initial claim in January an assessor was sent out about late Feb who, quite bluntly, told me and my heavily pregnant partner nothing should be covered by insurance because the roof was already in a poor condition and that voided any cover for the internal damage. As you can imagine this caused massive stress and upset. Luckily I had the roof assessed just 8 months earlier because I had just moved in to the property. I had various repairs carried out and the roofing contractor stood by his word stating that no other major repairs were required and the roof was otherwise in good condition, so the insurance eventually agreed to cover the damage.  

Now the claim is with the loss adjuster and I submitted 4 quotes for the roof repairs and so far only two each for internal plastering repairs and painting/decorating, but the loss adjuster has rejected them all for being too expensive. The loss adjuster is claiming the roof work should be over £1000 less than the quotes that I got. I just don't understand how that can be allowed given that 3 of the roof quotes are in the same ball park and I would accept one was chancing their arm. Also, I don't think the loss adjuster has exact measurements of the roof to even make an estimate of their own to compare it with. They also keep drip feeding requests for information as if they are deliberately wanting this to drag on and for me to get worn down by it. 

Has anyone ever encountered tactics like this before? How did you go about resolving the issue? Do you think I would have enough of a complaint to go to the Financial Ombudsman?

pramsay13

Make a complaint to your home insurance company and ask them to recall the claim and deal with it. 
We had something similar for an escape of water claim and the loss adjuster wanted to give us £100 to hire a dehumidifier for a couple of days. 
We ended up with a cheque for £7000 which included a new floor and went towards a new kitchen. 

CakeOrDeath

Thanks pramsay13. I'm not familiar with asking the insurance to recall the claim. Is this basically saying I'm not willing to accept a cash settlement any more and I'm wanting the insurance to arrange and pay for all works themselves?

DullGreyGuy

CakeOrDeath said:

Thanks pramsay13. I'm not familiar with asking the insurance to recall the claim. Is this basically saying I'm not willing to accept a cash settlement any more and I'm wanting the insurance to arrange and pay for all works themselves?

They are proposing that you ask that they deal with the claim themselves rather than using a third party loss adjuster but that is on an assumption that it is an external firm. 

Ultimately you can ask but you cannot demand, insurers are entitled to set their claims handling processes including outsourcing arrangements. They may well be contractually obliged to pass all claims to the outsourcer and in exchange have a discounted fee structure. 

CakeOrDeath

Thanks for clarifying. I'll check whether they do their own internal loss adjustment. I think maybe they do and perhaps it's been outsourced due to the sudden high volume of storm claims. Definitely worth a try! 

I understand there are no guarantees by requesting this but to be fair they have been reasonable when I have spoken to them about elements of the claim. For example, when the assessor first said nothing should be covered, they did talk to me about it and give me a chance to present evidence that I had the roof inspected recently. At the time they were even saying they normally stick with the assessors opinion, but they thankfully changed their mind.

DullGreyGuy

There are lots of different strategies out there on how to use claims outsourcers (aka TPAs), some certainly use them on a surge basis only, some will use them exclusively for certain types of losses, some have a single provider and others have multiple firms. Fees for loss adjusters are not inconsequential and in most cases they will have to pay the TPA fee if they decide to bring it back in house and in some cases it will also make the fee subject to VAT (insurers cannot recover most VAT because they sell VAT exempt products). Ultimately if you dont ask you won't get so worst case is they simply say no. 

Again overruling the TPA or having to be referred to can add 20% to the bill hence they arent keen on doing it, though it depends a little on how the TPA interpret VAT rules.