Financial ombudsman - next step to the Ombudsman

20122013

MattMattMattUK said:

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. 

The disagreement is the bulges which is caused by water damage and their contractor had commented that they had said that it needs replastering but their work is to paint.

Hence, I have asked them to stop work as I want the damage to be repaired and not just painted over

My case is being looked into by the Financial Ombudsman and the Investigator had issued their findings, and I am asking whether it is worth going to the next stage which is the 'Ombudsman'. 

MattMattMattUK

20122013 said:

MattMattMattUK said:

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. 

The disagreement is the bulges which is caused by water damage and their contractor had commented that they had said that it needs replastering but their work is to paint.

So asking again for clarity, as you have posted this in Motoring but are talking about plastering, what does this actually relate to?

20122013 said:

Hence, I have asked them to stop work as I want the damage to be repaired and not just painted over

In one post you mention having brought in your own people, now you are saying you asked the insurer's contractors to stop work, what actually happened?

20122013 said:

My case is being looked into by the Financial Ombudsman and the Investigator had issued their findings, and I am asking whether it is worth going to the next stage which is the 'Ombudsman'. 

No one can say because there is far to little detail in your posts. If you presented evidence to the Ombudsman in the same way you are posting on here then I can see things will be a real struggle to get anywhere.

You may or may not have a valid case, but unless you coherently get your complaint across then that is irrelevant, the ombudsman (or investigator) can only base their decision on the facts presented to them and based on what you have written here I suspect they have very little idea what your actual complaint is about.

MyRealNameToo

It seems that the OP has had some Home related claim for either flood, storm or escape of water. The insurer appointed contractors didnt do a great job, which the insurer has accepted and the OP has submitted their own quote for rectification work. 

The insurer has reviewed the quote, deemed it to be excessive and including pre-existing damage therefore has made what it considers a fairer settlement offer. The OP isnt happy with the offer, has gone to the FOS.

Whilst the OP hasn't said the outcome in detail it sounds like the Investigator has partially upheld the complaint saying the insurer should pay more than they'd offered but not the full amount the OP has asked for. Hence they've asked about the next step, which would be to escalate to an ombudsman but they are concerned that the ombudsman disagrees with the investigator and decides the original amount offered was sufficient thus reversing the gain they've had. 

They key to it comes down to two things:

1) What the policy book states about settlement - most wordings do allow an insurer to settle inline with what their contractor would have charged when the insured doesnt want to use them

2) Any evidence from either side that the disputed damage was pre-existing or not 

I'm speculating a little that the investigator has increased the settlement from the original offer but its unclear as to why... was it they disagreed on the pre-existing or think the quote was reasonable or is it nothing to do with either and its an award for poor claims handling/something not directly related. This will impact the probability of the ombudsman reversing it.

I can't explain why they started a thread about a home claim in the section on Motoring though. 

20122013

Sorry for the confusion I thought I had posted under insurance. 


Myrealnametoo, thanks for summarising my posts.

The investigator had asked the insurers to reimburse me for the cleaning costs.

The investigatie had agreed with the insurer about the bulges are pre existing. But I will get the ombudsman to review it as the bulges are not pre existing. 

Isthisforreal99

20122013 said:

Sorry for the confusion I thought I had posted under insurance. 


Myrealnametoo, thanks for summarising my posts.

The investigator had asked the insurers to reimburse me for the cleaning costs.

The investigatie had agreed with the insurer about the bulges are pre existing. But I will get the ombudsman to review it as the bulges are not pre existing. 

So, other than your statement that they are not pre-existing what actual evidence do you have? Going back to your first post you said the Ombudsman was wanting to close the case due to a lack of information? 

What it looks like to me is that we have an investigator (were they independent) confirming the insurers view that they were pre-existing so some tangible evidence. On what basis do you think an Ombudsman would ignore such a report?

20122013

Isthisforreal99 said:

20122013 said:

Sorry for the confusion I thought I had posted under insurance. 


Myrealnametoo, thanks for summarising my posts.

The investigator had asked the insurers to reimburse me for the cleaning costs.

The investigatie had agreed with the insurer about the bulges are pre existing. But I will get the ombudsman to review it as the bulges are not pre existing. 

So, other than your statement that they are not pre-existing what actual evidence do you have? Going back to your first post you said the Ombudsman was wanting to close the case due to a lack of information? 

What it looks like to me is that we have an investigator (were they independent) confirming the insurers view that they were pre-existing so some tangible evidence. On what basis do you think an Ombudsman would ignore such a report?

When i was getting quotes, it was stated that it needs  replastering. 

The FO wanted to close the case as it has been  18months old. This delay is because they kept allowing extensions to the insurer.

The current investigator had said that although  the insurer had missed their deadline. The investigator had made their findings ie they agree that it is pre existing condition.

I think the second and the current investigator goal are to close the case ASAP. As it is the first statement they make in their replies. 

As the investigator was not going to look into my case for a couple of weeks. I had asked abd was told no extension. I asked again then I was told that I can, as they will not be looking at case during that time. (I find this odd, why not agree to it when I  first asked?)

From my experience so far, 
- I do not know what information the insurer had submitted,

- I have asked but had never spoke with the investigator, especially,  the investigator had made some assumptions .. in their findings. 'that's their personal choice'..thus statenent was made before I had submitted my information. Even after I had submitted my information.  They have issued and updated finding and there is no mention of my submitted information etc. And same findings.

They have passed on my case to next abd final level, the Ombudsman 

MyRealNameToo

20122013 said:

From my experience so far, 
- I do not know what information the insurer had submitted,

- I have asked but had never spoke with the investigator, especially,  the investigator had made some assumptions .. in their findings. 'that's their personal choice'..thus statenent was made before I had submitted my information. Even after I had submitted my information.  They have issued and updated finding and there is no mention of my submitted information etc. And same findings.

They have passed on my case to next abd final level, the Ombudsman 

You rarely get to see exactly what the other side has submitted, normally its at the discretion of the ombudsman but the rules also allow the firm to submit information "in confidence" which the ombudsman isnt allowed to share... I've only seen it in relations to issues of fraud and pricing but the rules dont restrict it to that. 

In the old days you never got to speak to anyone involved in the case, communication was always done in writing. In recent years as a the complainer in 3 cases the investigator has called me to discuss; the last case it almost became excessive with them explaining each response they'd gotten and me poking holes in the response.

Good luck with the Ombudsman - I've never spoken to one as a complainer... I have within a professional capacity and even hired one to help me on a project.

20122013

MyRealNameToo said:

20122013 said:

From my experience so far, 
- I do not know what information the insurer had submitted,

- I have asked but had never spoke with the investigator, especially,  the investigator had made some assumptions .. in their findings. 'that's their personal choice'..thus statenent was made before I had submitted my information. Even after I had submitted my information.  They have issued and updated finding and there is no mention of my submitted information etc. And same findings.

They have passed on my case to next abd final level, the Ombudsman 

You rarely get to see exactly what the other side has submitted, normally its at the discretion of the ombudsman but the rules also allow the firm to submit information "in confidence" which the ombudsman isnt allowed to share... I've only seen it in relations to issues of fraud and pricing but the rules dont restrict it to that. 

In the old days you never got to speak to anyone involved in the case, communication was always done in writing. In recent years as a the complainer in 3 cases the investigator has called me to discuss; the last case it almost became excessive with them explaining each response they'd gotten and me poking holes in the response.

Good luck with the Ombudsman - I've never spoken to one as a complainer... I have within a professional capacity and even hired one to help me on a project.

Appreciate this, help me to understand what to expect. I will wait and see the outcome. 

thanks to everyone who have taken the time to post.