Financial ombudsman - next step to the Ombudsman

20122013

I had reluctantly accepted my insurance company settlement amount, as it was not matching the full amount of the quote for the rework.

Over 18 months ago, the FO had accepted the case but not much movement. and now they are in a hurry to close the case, the new investigator had made their decisions without seeing either parties' supporting information and have It seems odd that they can make their decision without seeing supporting information.

However, if i wish they will put my case to the Ombudsman,  I would like to know whether the Ombudsman can ask me to pay back the settlement amount? and other possible outcomes?

MattMattMattUK

20122013 said:

I had reluctantly accepted my insurance company settlement amount, as it was not matching the full amount of the quote for the rework.

What do you mean by this, that they did not pay the full amount of the repair? Did they arrange the repair or did something else happen?

20122013 said:

Over 18 months ago, the FO had accepted the case but not much movement. and now they are in a hurry to close the case, the new investigator had made their decisions without seeing either parties' supporting information and have It seems odd that they can make their decision without seeing supporting information.

How did they not see any information? As part of your complaint you submit your evidence, what makes you think that they did not review that evidence, or were you expecting something else?

20122013 said:

However, if i wish they will put my case to the Ombudsman,  I would like to know whether the Ombudsman can ask me to pay back the settlement amount? and other possible outcomes?

They will not tell the insurance company to reclaim the original settlement, they can agree with the investigator, they can overrule the investigator or they can offer additional remedy. 

If you give some more information on what the actual issue was and what your complaint to the ombudsman was then we might be able to advise. 

MyRealNameToo

20122013 said:

I had reluctantly accepted my insurance company settlement amount, as it was not matching the full amount of the quote for the rework.

Over 18 months ago, the FO had accepted the case but not much movement. and now they are in a hurry to close the case, the new investigator had made their decisions without seeing either parties' supporting information and have It seems odd that they can make their decision without seeing supporting information.

However, if i wish they will put my case to the Ombudsman,  I would like to know whether the Ombudsman can ask me to pay back the settlement amount? and other possible outcomes?

You submit your evidence at the point of making the complaint so they should have all your supporting information unless you messed up. In the modern world they would normally once assigned to the case have a brief conversation with you and then go off to ask the firm for their statement and evidence. 

Why do you think they dont have the insurer's response? 

It's certainly possible for an Ombudsman to reverse an adjudicator's decision but normally the company won't have paid it until the complainant has accepted the decision. I dont recall any cases where the company paid too soon and the ombudsman then reversed the decision. 

Grey_Critic

Would be of help if NEW READERS were given some information on your original claim - For what reason did the insurers not settle in full?

20122013

MattMattMattUK said:

20122013 said:

I had reluctantly accepted my insurance company settlement amount, as it was not matching the full amount of the quote for the rework.

What do you mean by this, that they did not pay the full amount of the repair? Did they arrange the repair or did something else happen?

Please excuse my reply in CAPS ..
I HAD STOPPED THE REPAIR WORK AS SOON AS I NOTICE THE QUALITY IS NOT ACCEPTABLE. THE INSURER AGREED BUT DECLINED TO PAY THE FULL QUOTE, (THE QUOTE WAS TO MAKE GOOD AND FINISHED THE REST.) AS THEY CLAIM THEIR COBTRACTOR CHARGE LESS.

I HAD TO RELUCTANTLY ACCEPT THIS AMOUNT AS I HAD MY CONTRACTOR BOOKED AND THIS WAS HOLDING THINGS UP AND IF IVFONT GET THE MONEY I WILL NOT BE ABLE TO GET THE WORK DONE, ALREADY THREE MONTHS DELAY. 

I THEN MADE THIS COMPLAINT TO THE FO AS THE AMOUNT DID NOT INCLUDE THE BULDGE CAUSED BY THE WATER DAMAGE. IE UNEVEN SURFACES. BUT THE INSURER HAD SAID THAT IT WAS PRE EXISTING..

20122013 said:

Over 18 months ago, the FO had accepted the case but not much movement. and now they are in a hurry to close the case, the new investigator had made their decisions without seeing either parties' supporting information and have It seems odd that they can make their decision without seeing supporting information.

How did they not see any information? As part of your complaint you submit your evidence, what makes you think that they did not review that evidence, or were you expecting something else?

THE FO HAD THIS CASE FOR OVER 18 MONTHS AND. KEPT REFERRING ME TO LIASIE WITH THE INSURER AND THEY KEPT GETTING EXTENSIONS WITHOUT ANY PROGRESS. 

THIS INVESTIGATOR HAS SAID THAT THE INSURER HAD NOT REPLIED AND I WAS NOT ASKED TO SUBMIT ANY INFORMATION  ( for the bukdges, storage and removal costs etc) AND HAD MADE THEIR FINDINGS. EVEN AFTER RECEIVING INFORMATION FROM BOTH SIDES THE INVESTIGATOR IS STICKING TO THEIR FINDINGS.

20122013 said:

However, if i wish they will put my case to the Ombudsman,  I would like to know whether the Ombudsman can ask me to pay back the settlement amount? and other possible outcomes?

They will not tell the insurance company to reclaim the original settlement, they can agree with the investigator, they can overrule the investigator or they can offer additional remedy. 

If you give some more information on what the actual issue was and what your complaint to the ombudsman was then we might be able to advise. 

PLEASE LET ME KNOW IF YOU NEED MORE INFORMATION.

20122013

MyRealNameToo said:

20122013 said:

I had reluctantly accepted my insurance company settlement amount, as it was not matching the full amount of the quote for the rework.

Over 18 months ago, the FO had accepted the case but not much movement. and now they are in a hurry to close the case, the new investigator had made their decisions without seeing either parties' supporting information and have It seems odd that they can make their decision without seeing supporting information.

However, if i wish they will put my case to the Ombudsman,  I would like to know whether the Ombudsman can ask me to pay back the settlement amount? and other possible outcomes?

You submit your evidence at the point of making the complaint so they should have all your supporting information unless you messed up. In the modern world they would normally once assigned to the case have a brief conversation with you and then go off to ask the firm for their statement and evidence. 

Why do you think they dont have the insurer's response? 

It's certainly possible for an Ombudsman to reverse an adjudicator's decision but normally the company won't have paid it until the complainant has accepted the decision. I dont recall any cases where the company paid too soon and the ombudsman then reversed the decision. 

"In the modern world they would normally once assigned to the case have a brief conversation with you and then go off to ask the firm for their statement and evidence. "
I have asked to speak with them more than once but this had never happened. I wss told by the investigator 'we cannot keep the case open.. as we have deadlines' 
I find this odd. They had 18months but only started to look at it recently and trying to close it ASAP.

Why do you think they dont have the insurer's response? 
- As it was stated in the investigator' s email.

It's certainly possible for an Ombudsman to reverse an adjudicator's decision but normally the company won't have paid it until the complainant has accepted the decision. I dont recall any cases where the company paid too soon and the ombudsman then reversed the decision. 

- The original investigator ( no longer dealing with my case) had told me to open this complaint which is separate to the original claim.   I see this as a separate claim but I think the current investigator sees it as the same complaint.

MyRealNameToo

They are allowed to bundle complaints where there are related parties and so efficiently can deal with both hand in hand however if they are discrete they are supposed to issue seperate decisions for each complaint. Obviously in some cases it is just the same complaint and I suspect they can fully roll them up if thats the case but it's been a good few years since I last read their rules. 

20122013

In summary, this complaint is about making good ofctge bulges caused by the water damage which the insurer kept saying it is pre existing, they did not notice it until they had painted over the areas without sanding down. They now says it us included in the settlement but the contractors I have spoken with said needs replastering .. I am wondering what I can do. Ad initially the insurers  contractors had their own manager yo check their and said high standard. Then I disagreed and insurers had their own technical manager but I do not know their findings but it seems they are saying is pre existing or it can be painted over.. painting over does not mean it had been returned to predamaged condition ..

sheramber

What was damaged?
 

Are you saying you were not happy with the work done but accepted the insurance company’s offer? 

After you accepted the settlement you referred the case to the ombudsnan?

20122013

sheramber said:

What was damaged?
 -the walls and ceilings.

Are you saying you were not happy with the work done but accepted the insurance company’s offer? 

- Yes, if additional work is require to get them know. 

After you accepted the settlement you referred the case to the ombudsnan?

- No, the original investigator had told me that this is a separate issue,  so i had opened a new complsint. 

It was water damage. My complaint was that their contractors poor quality of work, the area they have stain blocked but the water damage (bulge) are still showing. They say the paint 
used was not Matt paint, so it "shows all imperfections..' they did not sand down or replastered the bulge areas. I believe if they have replastered the area to even surfaces, using non matt paint the bulge will not show through and it is not ore existing. Aldo, their contractors had told me that their job is to paint not plastering. 

From the replies, there is no harm going to the Ombudsnan abd let them review my case. 

MattMattMattUK

You have now mentioned replastering, so that would indicate this is not a car?

It might well depend on the timeframe as you should have given them time to rectify rather than jumping the gun and employing additional contractors.

You can take it to the ombudsman, it does not cost you anything, but your posts are far from clear so you will really need to get your ducks in a row, coherently, before you do so.