Contents Claim With Esure

[Hadituptohere]

Hi
Hope im posting in the right place here, I've recently been unfortunate enough to get my Garage broken into and the ar**holes took my carp fishing equipment that I had put toghether over the last 10 years.
I rang esure to report the theft and they sent out a loss assesor from a manchester firm to validate my claim, the loss assesor came and went through a full insurance valuation of my contents (fairly degrading pulling the cost of your contents to pieces) and calculated that I was insured as the goods were stated as HIGH RISK ITEMS in the esure home insurance policy booklet, he went on to contact a firm that would quote for the replacement of my goods which worked out at 7200.00 but with their discount I was looking at a 5650.00 cash payment, I also notifed him I was hoping for a qick settlement as I have a fishing trip to france booked in few weeks time and no fishing equipment to go with.
The loss assesor refered his findings back to esure who have now turned round and stated that there is a policy limit of 2000.00 Contents Of Outbuildings within my schedule and have stuck to that limit.
On refering to the Policy Booklet it clearly states that High Risk Items include Portable Sports Equipment and the definition of High Risk Items is:
Items that are particulary exposed to the risk of theft, which belong to your household or which any member of your hosehold is legally responsible for and are kept in the home.

The Definition of HOME:
Your house and the fixtures and fittings, sheds, summer houses, garages and greenhouses which are designed only for domestic purposes.

With that im sure Esure are trying it on
any advise would be appreciated as my trip to france is only two weeks away and im totally frustrated as Esure have now passed the matter to their complaints department

Hadituptohere

[Bernie_the_Bolt]

OK,

I had a look at the esure terms on the web and if they are the ones that apply my view if this applied to me would be the following

The sublimit is as follows:

Contents in your outbuildings £2,000

Relevant definitions are as follows, note that there is no definition of "outbuilding(s)" or "out-building(s)":

Buildings/home
Your house and the fixtures and fittings, sheds, summer houses, garages and
greenhouses, which are all designed and only used for domestic purposes. Your buildings
also include swimming pools, hot tubs, hard tennis courts, terraces, patios, driveways,
footpaths, walls, gates, hedges and fences all within the same site at the insured
address shown in your Schedule.


High risk items
Items that are particularly exposed to the risk of theft, which belong to your household or
which any member of your household is legally responsible for and are kept in the home,
including but not limited to:
. . .
• portable sports equipment
. . .

House
The house, self-contained flat or other structure you or your family live in at the address
shown in your Schedule. This does not include fixtures and fittings, sheds, summer
houses, garages, greenhouses, swimming pools, hot tubs, hard tennis courts, terraces,
patios, driveways, footpaths, walls, gates, hedges and fences or any part of your home.
Unless described differently by endorsement, the house must be built of brick, stone or
concrete, and roofed with slate, tile, asphalt or concrete.

So, your garage is part of your "Buildings/home" but not part of your "House". High risk items are items kept in your home (including garage in the definitions) and include portable sports equipment which I guess no argument includes fishing gear.

Out-buildings are not defined but note the following exclusion which is the only reference to out-buildings in the policy.

Damage to boundary walls, gates,
hedges or fences and any damage
to garages or out-buildings

This clearly shows that garages are considered separately to out-buildings and garages are therefore not an out-building.

Further if e-sure had meant high risk items to be kept in the "house" rather than the "home" they would have said so.

I think it is clear, your stuff should be covered (in the absence of any other limitation). At worst it may be ambiguous in which event it would be ruled in your favour under the contra proferentum rule.

In your shoes, bearing in mind your trip, I would write to e-sure and ask them to settle the £2,000 as an interim amount pending resolution of your dispute with them. If they refuse tell them that you will replace the equipment and add the credit-card interest as damages for their failure to adhere to the terms of the policy and their failure to treat you fairly as required by the FSA.

If you spend more than £2,000 you are at risk if I missed something (quick look) or my view is found to be incorrect.

Good luck!

[Hadituptohere]

Thanks for your reply BtB, glad to see you have the same opinion as myself, as for the fishing trip which is a week long trip im not going to be as comfortable as I would with my goods and even the two grand wont kit me out well enough to enjoy the trip which puts me off going. thanks again for the advise

Hadituptohere

[vusys1]

did you have personal possesions cover for items outside the home etc and so was the fishing equipment specified under this section?

[Hadituptohere]

Hi
Funny you should say that.... when I took out the policy which I bought online I got the quote and rang esure to verify that if I bumped my personal possesions up to 5000.00 would it cover my fishing equipment, I was told that as long as each individual item cost less than 1500.00 each it would be covered, I have put this to Esure and because this was a general enquiry there would be no recorded conversation to verify this and that personal possesions are 'Any item that is worn or carried ' which means the likes of jewellery, although jewellery are under high risk items. I have also been paying the extra 30 odd pounds for that cover for the last two two and a half years.
Hadituptohere

[Hadituptohere]

Is it right that insurance companys dont legally have the right to use there suppliers to replace goods in a claim or if they offer you a cash settlement it shouldnt include any discount they would recieve if they were to replace your goods from one of their suppliers?
Or have I got that wrong?

Hadituptohere

[Hadituptohere]

Had a letter from Esure today after discussing my claim yesturday, they agree that on the definition of home and the definition of house but draw my attention to: Policy booklet - section - contents - making a claim
For loss or damage caused by theft or attempted theft from your domestic sheds, summerhouses, greenhouses or garages we will pay up to the policy limit shown in your latest schedule.

Any advise on this would again be appreciated

Hadituptohere

[Bernie_the_Bolt]

To which I say so what!

Crucially what e-sure don't say is:

For loss or damage caused by theft or attempted theft from your domestic sheds, summerhouses, greenhouses or garages we will pay up to the policy limit for outbuildings shown in your latest schedule.

If that's what they meant that's what they should have said.

The "policy limit shown in your latest schedule" could be any one that applies.

I would go back to e-sure and say "you have created an ambiguity and under the contra proferentum rule of policy construction such ambiguity will be construed against you."

Regarding the question you sent by pm, I found the exclusion when I did a search on the document on line for "out-building". It's on page 53, I didn't check into which section or relevance.

[Hadituptohere]

Thanks again BtB, ive found the quote and can now present that to esure along with everything else. Lets see what they come with next?
Hadituptohere

[Hadituptohere]

Just a quick update, been onto Esure today as they recieved my email on monday and theve informed me that they have handed it to their technical adviser and I should have a decision by tomorrow.
I cant wait....

[Hadituptohere]

Well just got off the phone with Esure and after passing it to there Technical Advisers there sticking to there Outbuildings Limit within my Schedule..........(i have asked for written conformation on there decision a.s.a.p)
I cant believe it and its left me wondering where to go from here, any advise/thoughts.......

Hadituptohere

[mooreda]

Formal complaints procedure then and ultimately the Ombudsman - if you do go to the Ombudsman it is likely to take them six months to deal with your case - I have had a legal expenses complaint with them since January and it has only just been looked at!

[Hadituptohere]

Hi all had the final responce today from Esure:

Customer Relations Department

Office Hours
Monday-Friday 9am-5pm

01737 641 055
Mr
Lancashire
25th July 2008

Dear Mr
Claim Number
complaint number
Thank you for taking the time to speak to me about your complaint. I understand that you are still unhappy with our payment of £2,000 following the theft of your fishing tackle from your garage on 2nd May 2008.
Both you and your Loss Adjuster have said that the construction of our policy wording is ambiguous and you are seeking the full replacement cost of the equipment, which amounts to £5,560. I understand you have not yet replaced the stolen items.
I understand that when our Loss Adjusters, Cunningham Lindsey, visited you to discuss your claim your own Loss Adjuster was present. At the end of the meeting, and after much discussion about the policy wording and associated limits, Cunningham Lindsey felt the claim should be settled for the amount you were claiming.
Cunningham Lindsay submitted their report to us recommending we make a payment of £5,560 to settle your claim. However, we pointed out to them that the policy limit for contents in outbuildings is £2,000 and asked them to contact you to explain this.
I should like you to know that we have raised this matter with Cunningham Lindsey and the Loss Adjuster concerned so that they are aware of the impact this matter has had on you and the inconvenience you have been caused.
As I told you during our telephone conversation, and in my e-mail of 23rd July, I have discussed the matter with our Senior Claims Manager and the Manager of our Technical Claims Department as well as our Senior Underwriters. As you know, the outcome of my discussions is that we will not be increasing the payment under your claim beyond the £2,000 we have already paid you and I will now go on to explain the reasons why.
Firstly though I should just like to confirm, as you requested, that by accepting and banking our cheque for £2,000 it does not prejudice your right to continue to dispute the amount we have paid you.
For the purpose of your buildings insurance we define buildings, on page 4 of the policy booklet, to be your house and the fixtures and fittings, sheds, summerhouses, garages and greenhouses. For the purposes of your contents insurance page 6 of the policy booklet then goes on the define your house, self contained flat or other structure you or your family live in at the address shown in your schedule. This does not include fixtures and fittings, sheds, summerhouses, garages and greenhouses etc.



Your garage is a detached garage and as such does not form an integral part of your home and is therefore classed as an outbuilding. Page 31 of the enclosed policy booklet headed “Contents – making a claim” states “The most we will pay under this section: ….. For loss or damage caused by theft or attempted theft from your domestic sheds, summerhouses, greenhouses or garages we will pay up to the policy limit shown in your latest schedule”. I have also enclosed a copy of your policy schedule, which shows the maximum amount we will pay for contents in your outbuildings is £2,000.
I see that you have said your fishing tackle falls within the definition of high-risk items within the home. The fishing tackle is covered in the home subject to the policy limits but, as the equipment was in the garage at the time of the theft, this is specifically limited to £2,000 as detailed on the policy schedule. The cover for items contained in outbuildings is more restricted because they are more vulnerable to loss.
It is not possible to provide extensive definitions of all words within the policy and whilst you state we should define outbuildings, we feel that this term speaks for itself.
Mr , I am sorry you have found it necessary to complain and I do appreciate that this was not the response you were hoping for but I hope you will find my explanation useful.
I understand you now wish to refer this matter to the Financial Ombudsman Service and I would like you to know that I will be happy to send my file to them, if asked. I have enclosed a leaflet about the Financial Ombudsman Service and how you can make your complaint to them. Please note that you can do this within six months of the date of this letter.
In closing, I would like to thank you for taking the time to bring this matter to my attention and for the opportunity to review it for you.
Yours sincerely


On behalf of the Customer Relations Manager
Enc: FOS leaflet
Home policy booklet
Policy schedule


Any thoughts would be appreciated again Guys

Thanks
Hadituptohere