PPI Reclaiming discussion Part II

di3004

marshallka wrote: »

I take it the HBOS have been advised to pay you back in 6 weeks???

Its so annoying that you cannot make another complaint about this and that FOS does not have any clout in making them pay up....I think they should do...

If this is the case, I would now suggest a LBA (letter before action), if the FOS is involved I know they do like to know this is being done, and they normally a request a copy of the LBA for their records.

I did send one to NEMO, it worked.

Will have to see if I still have this, I am not sure, but its worth it.

marshallka

pinknico wrote: »

My head hurts! There are so many different aspects to take into consideration for each complaint.

And why now are the FOS able to get a result on somecases dated 2000?

Because before the FOS was the Banking Ombudsman Scheme which if it were a bank then they can take certain rules from this scheme and apply them to here. There were some other schemes too like GISC for instance and they can also apply the same thing from section 32 of the limitations act in that if the complainant only just became aware (or did so within 3 years) then the complaint can be looked at...

The Ombudsman Service as we know it consists of these put together...

The new Financial Services Ombudsman Scheme will bring together The Banking Ombudsman; The Building Societies Ombudsman; The Investment Ombudsman; The Insurance Ombudsman; The PIA Ombudsman Bureau; The Personal Insurance Arbitration Service; The SFA Complaints Bureau and Arbitration Service; The FSA Independent Investigator.

pinknico

marshallka wrote: »

No-one had to be regulated to sell insurance in 2000 though... I would think the "record a default" complaint would be a banking type complaint and again they would only be able to look into this if they authorised by the FSA at the time of when they recorded the default which I take it they were...

Yes this was 2008. And yes I know that they didnt have to be regulated but I think they want to make the point that people have been missold for years and people cant claim as easily .

marshallka

The Ombudsman works from the FInancial Services and Markets Act which was made in 2000 and came into force in 2001

They can look at complaints and apply rules from this act

On section 3 of the act is this

3. - (1) Subject to the provisions of this Order, the compulsory jurisdiction resulting from section 226 applies to a complaint referred to the new scheme after commencement which relates to an act or omission occurring before commencement, if the conditions mentioned in paragraph (2) are satisfied (notwithstanding that the conditions in subsection (2)(b) and (c) of that section are not met).

(2) The conditions are that -

• (a) the act or omission is that of a person who was, immediately before commencement, subject to a former scheme;
  
  (b) the act or omission occurred in the carrying on by that person of an activity to which that former scheme applied; and
  
  (c) the complainant is eligible and wishes to have the complaint dealt with under the new scheme.

http://www.opsi.gov.uk/si/si2001/20012326.htm#3

This FSMA did not come into force until the new Ombudsman Scheme in 2001 so it means that any complaint prior to that must have come under jurisdiction of one of the other schemes that were all voluntary...

It is maddening but its the law..

Complaints before this can be looked into but by the courts only if they were not part of any of the schemes and this is where the Limitations act comes in..so you have to act quick..

In the courts any laws can be applied dating back to whenever...


A little bit of info as to where GISC comes into the complaints procedures

general insurance regulation
The conduct of general insurance business is regulated by a new organisation, the General Insurance Standards Council (GISC). We have worked closely with GISC during the year to help it develop its rules and, in particular, its new Code for Private Customers. This code will in due course replace the Association of British Insurers’ (ABI) Code as a statement of the obligations of the industry when selling general insurance products. As the membership of GISC grows, the new code will play an important part in our consideration of many disputes.

[FONT=Verdana, Arial, Helvetica, sans-serif]We also commented on the new ABI Claims Code. This provides for standards to be maintained by firms when handling claims. Particularly welcome was the inclusion of obligations towards third party claimants. In due course it would seem sensible for the Claims Code to come under the scope of GISC. [/FONT]

dreamer33

marshallka wrote: »

You could always try but bear in mind what I have said... they may not even reply to it and you are losing time again here...

I know your right, I got a contact from the CAB for a legal person whom deals with disputes with creditors, but when I called this person they were on long term sick (they were the only person there whom deals with these things) felt like I had no where to go and was losing.

I shall give them another try but have kids myself and its very time consuming, but worth another try. x

di3004

Increase in ppi complaints updated 10 October.

http://www.themoneystop.co.uk/102008/increase-in-ppi-complaints-results-in-further-investigation.html

marshallka

Right folks here is an extract from the Ombudsman about "insurance complaints" and this is to the insurers and dates back to 2001 so maybe anyone not being able to take complaints to the FOS about the misselling can do like me and make a complaint about the insurer and the underwriters of the insurance.

[FONT=Verdana, Arial, Helvetica, sans-serif]Welcome to the second insurance issue of ombudsman news. We were delighted to receive such a positive reaction to our January issue. Do please continue to send us your comments and suggestions. [/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]ombudsman news covers a wide range of topics this month, starting with loan protection insurance. Complaints reaching us show that sufficient care is not always taken to ensure the suitability of policies for prospective policyholders. Restrictions which significantly limit the cover available are not always made clear before purchase, and the exclusion of claims for mental illness is something that causes us particular concern in this regard. [/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]We also look at some of the problems caused by lack of clarity in insurers’ documents. In recent years there have been considerable improvements to policies and other literature. However, even when insurers use simple, everyday terms, they can still sometimes fail to communicate as clearly as they should do. [/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]Other issues we discuss this month include: [/FONT]

• [FONT=Verdana, Arial, Helvetica, sans-serif]legal expenses insurance [/FONT]
• [FONT=Verdana, Arial, Helvetica, sans-serif]the ‘sum insured’ and problems arising when claims exceed this amount [/FONT]
• [FONT=Verdana, Arial, Helvetica, sans-serif]minimum security requirements[/FONT][FONT=Verdana, Arial, Helvetica, sans-serif] in household and caravan policies [/FONT]
• [FONT=Verdana, Arial, Helvetica, sans-serif]keys left on or in cars, a topic revisited in the light of a recent Court of Appeal decision; and [/FONT]
• [FONT=Verdana, Arial, Helvetica, sans-serif]a summary of our complaints-handling procedures.[/FONT]

loan payment protection insurance
[FONT=Verdana, Arial, Helvetica, sans-serif]ensuring suitability[/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]Most borrowers are urged to protect their loans by taking out insurance to meet the repayments if they become unable to work. But the people who sell this type of insurance are often not specialists in this field and some have little or no knowledge of the policy terms. Their ‘advice’ will therefore not be of great assistance to borrowers, who may be uncertain what they are paying for and unable to judge whether it is suitable for them. [/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]The Code of the Association of British Insurers (ABI) – shortly to be replaced by the Code of the General Insurance Standards Council (GISC) – requires the seller to ‘ensure as far as possible that the policy proposed is suitable to the needs and resources of the prospective policyholder’. But many of the complaints we receive indicate this has not happened. [/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]When determining whether a policy is suitable, a seller – whether a lender or an agent for the insurer – must obviously take into consideration any information the prospective policyholder volunteers. However, we do not consider the seller’s duty is limited simply to recording what the borrower discloses. It is only by asking questions that the seller can properly determine suitability. These questions cannot cover every aspect of a borrower’s personal position and should not be expected to do so. To paraphrase the ABI Statement, only those matters deemed to be relevant by the insurer should be the subject of questions. [/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]eligibility [/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]If sufficient care were being taken to ensure suitability, we would not be continuing to see complaints from borrowers who have been sold insurance for which they were clearly not eligible. For example, most policies exclude from cover anyone who is not ‘actively working’ on the date of the sale. Take the case of a borrower who is incorrectly sold a policy while on sick leave and later submits a claim, which the insurer refuses to meet. The insurer can leave the borrower in a serious financial predicament if, acknowledging the unsuitable sale, it refunds the premiums. The borrower’s predicament will, of course, be even more serious if his house is at risk. We generally take the view that insurers should meet claims in circumstances. [/FONT]



[FONT=Verdana, Arial, Helvetica, sans-serif]It is also common for policies to include additional eligibility requirements concerning the insured person’s age and number of hours worked each week. Some policies exclude from cover anyone who is self-employed or employed on a short-term contract. Other insurers deem such borrowers eligible for cover, but restrict the benefits available to them under the policy. The ABI Statement on Payment Protection Insurance requires that [/FONT]

[FONT=Verdana, Arial, Helvetica, sans-serif]‘details of the main features of the cover as well as important and relevant restrictions will be made available and highlighted at the time the insurance is taken out with full details being sent afterwards’ (our emphasis). [/FONT]

[FONT=Verdana, Arial, Helvetica, sans-serif]If the insurer fails to ensure sellers meet these requirements, we regard this as indicating that it waives any right it might have to avoid giving effect to the insurance. [/FONT]

[FONT=Verdana, Arial, Helvetica, sans-serif]extending the debt[/FONT]

[FONT=Verdana, Arial, Helvetica, sans-serif]When existing borrowers extend their debt, it is common for the lender to issue a new loan incorporating all the borrower’s liabilities. This will result in the sale of a new insurance policy, but it can leave the borrower unprotected, at least for part of the loan. For example, if a borrower has consulted a doctor before the new policy comes into force, any illness that is later diagnosed as being related to the symptoms for which the borrower saw the doctor is unlikely to be covered. And if the borrower then becomes unemployed, he or she will not be able to claim during the initial period excluded by the policy – often the first 90 days. [/FONT]

[FONT=Verdana, Arial, Helvetica, sans-serif]Insurers have generally accepted liability for such claims under the borrower’s previous policy (if there was one). However, where the new loan is significantly larger than the old one, the borrower could be left without protection for the balance of the repayments. In such cases, we need to satisfy ourselves that the borrower was told of the effect of the new policy provisions or, at the very least, that the borrower would have acted in the same way if he or she had been told of them, and that the borrower has not therefore been prejudiced by the seller’s failure to highlight these restrictions.[/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]claims for mental illness [/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]Another type of claim has caused us real concern. Almost all policies exclude claims which arise from stress or other forms of mental illness. We have seen a number of complaints recently where this restriction has meant an unemployed claimant has been left with no recourse. [/FONT]

[FONT=Verdana, Arial, Helvetica, sans-serif]It seems to us that the clear distinction that was once made between physical and mental illnesses has largely disappeared. Illness (or for that matter disability) is generally understood to cover a range of medical conditions with both physical and mental symptoms and causes. Media reports suggest that some 50% of all illness may be due to mental causes. Excluding claims for all mental illnesses is therefore a significant limitation of cover, and should be made clear to purchasers before the policy sale is completed. An example of such an exclusion states: [/FONT]

[FONT=Verdana, Arial, Helvetica, sans-serif]‘No claim shall be payable hereunder if … caused or aggravated by any psychiatric illness or any mental or nervous disorder.’ [/FONT]

[FONT=Verdana, Arial, Helvetica, sans-serif]Clearly, mental or nervous disorders, such as stress or depression, can be difficult to verify and diagnose with confidence – and insurers are concerned about the potential for numerous claims where it would be difficult to assess claimants’ fitness to work. Some insurers have addressed this by excluding mental illness only where the claimant has not received treatment or been referred to a consultant. These insurers will accept claims where the insured person is receiving treatment or seeing a consultant for their condition. [/FONT]

[FONT=Verdana, Arial, Helvetica, sans-serif]For insured persons who are made redundant and then suffer from depression, the situation is more complicated; they will generally be unable to claim for either unemployment or disability. Unemployment claims are subject to proof that the claimant is seeking work, but a sick claimant will not be in a position to sign on. [/FONT]

[FONT=Verdana, Arial, Helvetica, sans-serif]Thus, the mental illness exclusion will defeat a disability claim and the effect of the redundancy exclusions means that the unemployment claim will also fail. Neither of these exclusions is generally unreasonable, but we are concerned about their combined impact. Redundancy is likely to be a difficult time and symptoms related to stress and/or depression must be common in such cases. When someone’s sole reason for not looking for work is that they are sick, we consider it unreasonable for an insurer to reject an otherwise justified claim by relying on the largely procedural requirement that a claimant be registered as unemployed and actively seeking work. [/FONT]

[FONT=Verdana, Arial, Helvetica, sans-serif]It is relevant to contrast this situation with that of someone who is made redundant and then suffers an illness which, if it had arisen before the redundancy, would have given rise to a successful claim under the policy’s disability section. At face value, both claimants would be in a similar position. The wording of the redundancy provision which requires a person to look for work would apply and, generally, policies of this type require the claimant to be in employment on the day the disability started. Despite the wording of these policies, in a number of cases we have concluded the insurer should pay benefits in such circumstances. In essence this is because either the redundancy claim would be valid were it not for the disability or the disability claim would be valid were it not for the previous redundancy. [/FONT]

[FONT=Verdana, Arial, Helvetica, sans-serif]Of course, where an insurer offers on-going payments in the case of redundancy, it is not unreasonable that it wishes to confirm that a claimant is seeking new employment. But it is also not unreasonable for it to accept that people made redundant may sometimes suffer periods of ill-health which prevent them seeking work for a time but have little, if any, impact on their prospects for re-employment. [/FONT]

[FONT=Verdana, Arial, Helvetica, sans-serif]When looking at individual cases, we therefore need to consider whether the illness was so severe that it would have prevented the person from working. We also need to consider the extent of any prejudice to the insurer’s position (that is, how likely it is that the insured person would have found work were it not for the illness). [/FONT]

http://www.financial-ombudsman.org.uk/publications/ombudsman-news/4/on-loan1.htm

Complaints against the insurers come under Compulsary Jurisdiction...

dreamer33

I found the below info interesting:

If you are having difficultly deciding which products are best for your needs,
you may want to consider using an Independent Financial Adviser or an
insurance broker.(ha ha they are the ones thats ripped us all off)

When taking out any of these insurance products it is essential that you
answer all the questions in the application about your medical history
carefully, accurately and to the best of your knowledge and belief. (no medical questions asked)

Nondisclosure (What about if none are asked)
of medical details that are relevant to the application could lead to
a reduced payout or, in extreme circumstances, a claim being turned down.

Application forms have recently been made easier for customers to complete
so that they capture the right medical information.

The ABI recently announced that insurance companies will pay more claims
for Critical Illness, Income Protection and life insurance where medical
information has not been disclosed, unless the customer deliberately withheld
it. This important new commitment will lead to a further fall in the number of
declined claims.

Where relevant information has not been provided, insurers will pay
customers a fair sum, reflecting risk and premiums paid.

In a small number of
exceptional cases, premiums will be refunded if the insurer would not have
taken on the policy if they had known the full facts. Fraudulent non-disclosure (does this mean by way of booklets or verbal communication)
will always lead to a claim being turned down, and could lead to prosecution.
For more information and advice on insurance products, visit the ABI web site
at www.abi.org.uk.

ABI, January 2008

marshallka

Case studies of Insurance complaints

http://www.financial-ombudsman.org.uk/publications/ombudsman-news/4/loanpayment-case-studies.htm

Look at this reason why a complaint was upheld here

[FONT=Verdana, Arial, Helvetica, sans-serif]complaint upheld
It was up to the insurer to prove that the policy had been properly sold and that the sale complied with the provisions of the ABI Code. The insurer was clearly aware that Mrs M was both self-employed and on ‘maternity leave’. Since she was not ‘actively working at her business’ she was not eligible for the policy. However, we did not consider that the insurer’s refunding the premium constituted an appropriate resolution of the dispute. [/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]We accepted the insurer’s contention that the policy could have been transferred into the husband’s name at Mrs M’s request. However, we did not agree that her failure to make such a request meant she had deliberately chosen not to take out cover for her husband. We were satisfied that the policy had not been properly explained at the time of the sale. [/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]The appropriate outcome was for the insurer to amend its records to include the name of the husband on the policy and to meet his disability claim. [/FONT]

marshallka

dreamer33 wrote: »

I found the below info interesting:

If you are having difficultly deciding which products are best for your needs,
you may want to consider using an Independent Financial Adviser or an
insurance broker.(ha ha they are the ones thats ripped us all off)

When taking out any of these insurance products it is essential that you
answer all the questions in the application about your medical history
carefully, accurately and to the best of your knowledge and belief. (no medical questions asked)

Nondisclosure (What about if none are asked)
of medical details that are relevant to the application could lead to
a reduced payout or, in extreme circumstances, a claim being turned down.

Application forms have recently been made easier for customers to complete
so that they capture the right medical information.

The ABI recently announced that insurance companies will pay more claims
for Critical Illness, Income Protection and life insurance where medical
information has not been disclosed, unless the customer deliberately withheld
it. This important new commitment will lead to a further fall in the number of
declined claims.

Where relevant information has not been provided, insurers will pay
customers a fair sum, reflecting risk and premiums paid.

In a small number of
exceptional cases, premiums will be refunded if the insurer would not have
taken on the policy if they had known the full facts. Fraudulent non-disclosure (does this mean by way of booklets or verbal communication)
will always lead to a claim being turned down, and could lead to prosecution.
For more information and advice on insurance products, visit the ABI web site
at www.abi.org.uk.

ABI, January 2008

Dreamer, I would now ask for a copy of your insurance document and make a complaint to the actual INSURERS here.... please read the above... so exicited for you... complaints against insurers come under compulsary jurisidiction...
complaint upheld
It was up to the insurer to prove that the policy had been properly sold and that the sale complied with the provisions of the ABI Code.


It may be your breakthrough here...