CIS refuse to pay insurance claim

[kcherryhead]

I need help and advice! I was decorating the house and I knocked the tin of paint off the stepladder, by accident. As it dropped from a height it has splashed accross my living room carpet couch and table. CIS's loss adjusters CONVERSANT CLAIMS have rejected my claim on the basis that the swirls of paint at the end of the main splash do not coincide with the whole thing?????? How is paint supposed to splash - in a staight line??!!They have also wrongly said that I have changed my statement several times, WHICH is UNTRUE. They asked me what I done with lid from the tin and I said I couldn't remember, Sally from conversant claims persisted in the fact that she wanted an answer to this as there was another smaller circle of paint by the main splash, I still said I couldn't remember but she made me feel like if I didn't answer her that I would be wrong and she would reject the claim, (basically she is a bully) I said I must have put it on the windowsill (this is all on the telephone). I later had to do a written statement, Sally had told me that if I didn't provide her with more info than what i could remember she would reject the claim?? So on further discussions with my husband he told me it was him who took the lid off and he put it next to the tin on the stepladder so that must have been what made the smaller circle, that's why I couldn't remember doing it. I explained all this in my statement.

So now they have rejected the claim on that I have changed my story several times! By the way i moved into a new house 2 years ago so the carpet was brand new then and my couch is only 3 years old, neither needed replacing as they were both still in great condition and went with the decoration I was doing.

I have wrote to the claims manager at CIS stating my utter disgust at being treated in this manner, (I was actually crying twice after a telephone calls from Sally).

They have wrote back to me today and said that they have listened to the tapes of my discussions with Sally at conversant claims and are happy that they were handled in a proffessional and courteous manner. But they have offered "As a reasonable insurer" to refer the dispute to the loss adjusters, Cunningham Lindsey UK for a fresh look at the claim.

What should I do? Should I say ok or should I go the the financial ombudsman now??

[bed32]

You cannot go to the ombudsman until you have exhausted the Ins Co's formal complaints process (or waited 8 weeks from raising the complaint).

If CIS haven't sent you anything acknowledging that they are treating this as a complaint then it is probably worth writing to them just to confirm that you want this to be treated as a complaint (thereby starting the clock on when you can take it to FOS).

Other than that you just have to sit back and wait.

Maybe worth making an S.A.R. to see what details they have on the claim (particularly where they say you have changed your statement). If the details are inaccurate then you can also try a Data Protection Act approach

[kcherryhead]

Thanks, at the risk of sounding totally thick what is a S.A.R.?

This claim has been going on since february, I have made a complaint and they said they agreed with conversant claims decision, I then wrote a letter of complaint to the big boss complaining that the home liason girl who was looking into my complaint was a nightmare. (I couldn't get through to her and when I did she wouldn't know who i was etc, she would say that she had that many claims going on that she'd have to read her files and call me back!) They have just wrote back after looking into the claim once again to say that they can refer it to another loss adjuster as a fresh claim or I can proceed with the ombudsman, within 6 months of this letter.

I have instructed them to proceed with the new loss adjusters? They said I can still go to the ombudsman if I am still not happy with the outcome after that.

Bearing in mind its now June and this happened in Feb!

[bed32]

S.A.R. is a Subject Access Request - exercising your rights under S.7 of the Data Protection Act 1998. They must respond by sending you copies of all the information they hold on you which will enable to see why they are claiming that you changed your story. That will also include copies of the recordings of the telephone conversations (but worth asking for them explicitly).

If you have already got a "final letter" then I would take it straight to the FOS. It will take some time for that to kick into action and if the new loss adjusters come back with a positive result then you can always tell FOS that you've settled.

[kcherryhead]

Thanks for your help, I will do that. Will update with anything new.

[Beanie1]

A few threads on here about CIS, seems to me like they dont like anyone claiming !!!

Whatever happened to "utmost good faith?". Sounds like you had a reasonable cause for claim and regardless of how the "Swirls" got there it was still an accident and another of the less known principles of insurance kicks in. Proximate cause. The paint fell off the stepladder due to an accident so regardless of how the "swirls" got there it was the result of an accident.

As prev post said, If you had their decision letter then get on to the FOS straight away and send it recorded delivery as proof of date sent. Ask CIS for the Data Protection Act request and yes you do have to ask for transcripts of calls as a seperate issue and keep them for future ref if the FOS ask you for further details. You can download a complaint form from the FOS site. Will search my threads for the link and post it here for you. Good luck

[Beanie1]

heres the link for FOS as promised

our complaints procedure and how to complain

[kcherryhead]

thanks!!

[bed32]

Originally Posted by Beanie1

Whatever happened to "utmost good faith?". Sounds like you had a reasonable cause for claim and regardless of how the "Swirls" got there it was still an accident and another of the less known principles of insurance kicks in. Proximate cause. The paint fell off the stepladder due to an accident so regardless of how the "swirls" got there it was the result of an accident.

Unfortunately Utmost Good Faith does nothing for the insured - it enables the Ins Co to wiggle out of lots of things they shouldn't but is of no use at all to the insured.

I presume what CIS are getting at is that this may be a fraudulent claim - which appears to be an increasingly common problem with insurance claims.

[kcherryhead]

It seems to me that they are just waiting for anything to reject the claim, I did speak to a customer services guy at CIS who read through the notes and he couldn't understand really why its been rejected. He said that he could understand if my couch and carpet were 15 years old and they needed replacing, but you can tell by the photos i took that they were still as new so why would I want to go through the hassle of damaging a new carpet and couch when I don't need one???

[patian47]

I am having a Car claim issue with CIS, they refused our claim on a technacality and it was passed over to CUNNINGHAM AND LINDSEY, who asked the most stupid questions over and over. It has been passed back to CIS to reveiw, needless to say it was again rejected. We have sent everything to FSO london. These insurers are quick to take your premiums but try and find any loophole they can. Our claim began March 2007. After2 requests to the broker , they have told me they will check their calls and it will take upto 2 months, they have a backlog, I WONDER WHY? or 40 working days.

[kcherryhead]

It's a nightmare. I'll update you when I have any news. Still haven't heard from Cunningham Lindsey though?

[patian47]

Cunningham Lindsey I believe do the donkey work for CIS, so basically if they say NO, CIs , simply review and then agree with them. I had to chase both of them up, without being pushy, as they could not apprehend that our car was stolen, and we did not lose it! The police provided a crime report number and attended the vehicle when it was first found. However Cunningham and Lindsey, persistently asked, were you driving the vehicle ? who used it last ? WEll the blooming thief obviously. They are like robots, they repeat everything over and over, as if they are talking to somebody beneath them, they do not realize that this is a stress fulltime for the victim. To date, the car is un recovered stolen, they didnt even believe that, and that was what the police stated!. So thay are not trying to assist you as the paying customer, but to find any way out of the insurer paying up. Keep copies of everything, do not send your cover policy back if they request. Refer to FOS , SOUTH QUAY PLAZA 183 MARSH WALL LONDON E14 9SR, if you receive a final letter of refused claim from CIS. Then contact FOS, who can send application form to begin review, or you can complete online.Lets hope your paint saga does not come to this.

[Duffers Mum]

We had a similar problem with Direct Line in that they accused us of lying about how we damaged our bath and sink, we sent an Subject Access Request and the report from the assessor was interesting to say the least, he definately didn't believe us. They paid out, however they have now written saying they don't want to renew our cover, which doesn't bother us as we had already sorted out new insurance for this coming year anyway. So if you do get them to pay out, might be worth changing companies shortly afterwards, just to ensure you get in first! I'm so incensed with Direct Line that I will be moving my motor insurance as well when its due for renewal.

Hope you get a good outcome