Help and advice needed

pinnaclepain

Hi .. Sorry this is a long one .. but wanted to give the FULL facts

I am writing this on behalf of my brother, so I hope I give as much information as possible, and would greatly appreciate any assistance.

My brother was employed as a welder and his wife owns a shop, the shop is a LTD company and he was also employed there, well not employed just taking a nominal salary for tax reasons.

Anyway, in March this year he was made redundant from his real job as a welder and the shop was running into hard times so they made him redundant also, not so concerned about the shop as it was a tax thing, but the welder was his main job.

He has a policy with Pinnacle, he made a claim and for the last 4months they have paid out.

Then out of the blue they send an agent from a 3rd party company to see if he is genuinely looking for work, get copy of his CV etc..

Well they also wanted a to see his bank statements, he had nothing to hide so showed them and the 'agent' saw £2000 being paid in cash and then £2000 going out to his wifes shop - he stated this was normal as his wifes bank HSBC charged 35p per £100 going in to a business account - so they pay weekly cash into the personal account and then do an internet transfer to the business account - thereby paying 30p for the internet transfer instead of £7.00 for paying the cash in.

The agent seemed OK with this, then 3 weeks ago he had a phone call stating they had stopped his claim as on the website for the shop it says "Paul and Andrea have owned the shop since 2000" - and as a result he was still running a business and demanded the 4payments back.

He explained that it is a LTD company, his wife is a director and he plays NO part in the business (the books will show last years loss also).

They explained a clause in the contract that states "Unemployment means being entirely without gainful employment (which includes the assisting, managing and/or the carrying on of any part of the day to day running of a business)".

He stated he does not, his wife is the director and he plays no part in it, companies house shows his wife as the director since 2000 and he is the secretary only.

He genuinely does not work there.

A few days ago the insurance company send him a letter demanding 3yrs P60 and Bank statements relating to the business and personal accounts since December 2006.

My questions are (amongst many).

If the insurance company accepted his claim, and he has been complying with the terms (sending in job apps etc/signing on) - if they stop his claim later on does he have to do anything or is the responsibility on the insurance company to show why they have stopped the claim ?

Can they demand bank statements from a person who is not a director/working for a company - surely they would have to write to the company as its a seperate legal entity and they would be under NO obligation to send them (they have nothing to hide, but its priciple) - without a court order.

The claim started in April 2007, why they want bank statements from December 2006 I am confused by, but can they ask for them ?? - the policy conditions do not state they can have them ... as its a joint account with his wife and he is the only claimant - she is entitled to her human rights (privacy etc..) and to just send bank statements with all her personal stuff on she thinks is wrong.

He asked for a SAR .. and sent off the £10.00

Pinnacle have replied with a massive bundle of docuemnts under the freedom of information act etc..

In there is a copy of the report from the "investigator" who actually states "there is no evidence of mr xxx working, as a result i have closed my file".

They seemed to have picked up on the wording of a website ONLY that reads "Paul and Andrea have owned the shop since 2000" and on this basis alone cancelled the claim.

He actually starts work in 2 weeks time and when he goes to the job centre to sign off will send in the final claim form to the insurance company.

We have also found out that the letter pinnacle sent to him as part of their appeal (worded "so we can consider your appeal") was actually send as a result of request made by someone in their legal department to assist in their case against him .. so the letter sent, we feel was sent to try and trick him.

We feel the decision to cancel his claim is very dubious - is he within his rights to send his final ABI1 from the jobcentre and state "you owe me £xxxx.xx from date to date" - unless the payment is made within 28days I will commence proceedings against you in the county court ??

Or does he have to go through a pointess appeals process/refer to the ombudsman .. I would have thought they have creached teir contract and he feels they owe him money so he can go straight to the smal claims court after giving them a letter before action.

Your comments very much appreciated