Hi

I have been asked by my sister to help her out with a home insurance claim which has turned into something of a nightmare.

It seems that the insurers have tried systematically to squirm out of the claim, and to completely wear her down in the process and now she is in a bit of a state about it all.

I will be posting more on this as I get the full details, but I just wanted to ask a quick question in the hope that someone will know how to proceed with this particular bit of the mess!

My sis is convinced that the surveyors that are being sent round by the insurance company to assess the damage to her property are in cahoots with them and therefore deliberately playing down or trying to obscure the real extent of the problems that have arisen since the claim arose (her property was flooded)

My question is; would my sister be within her rights to expect the insurers to take an independent report into consideration, i.e. one that had been prepared by a trusted and impartial expert.

Of course she can commission this report but can she get them to take any notice of it?

Judging by what she has been telling me about their behaviour so far, I find it unlikely that they will do anything that might actually hinder their efforts to wriggle out of their liabilities.

This one may run and run!

All advice, as ever, gratefully received.

H

I am not an expert on insurance but I do know that the insurancecompany will try everything to try and keep the claim as low as possible . In the insurance policy the complaints proceedure should be explained and the first move would be to register a complaint about why your sister feels that the sum offered is not sufficient.

Why does she feel that she is not being treated fairly ? Does she have any specific complaints?

She is coming over soon to go through it all and when I have all the relevant info I'm going to post it here in the hope that someone will be able to advise as to the best plan of action

Until then - Happy New Year!!!

Watch this space :o)

This is a common concern regarding ethics in insurance: if a contractor handling a claim is appointed and paid for by an insurer, does it make them inherently biased towards the insurer? If contractors follow professional/ethical standards, then there shouldn't be any bias, although it wouldn't surprise me if there are some corrupt contractors around.

On the other hand, if a policyholder was allowed to select their own contractors, there is a risk that they could choose someone who isn't qualified to do the job and makes a mess of it. So that is one of the reasons why insurers usually have a panel of authorised contractors which have been vetted and who should hopefully be trustworthy.

From what you've said above, I assume this is quite a substantial claim? If so, then chances are there are several parties involved in the handling of the claim. With large, complex claims, it is common for a loss adjuster to be appointed, who is responsible for project managing the claim from start to finish. Although the loss adjuster is appointed and paid for by the insurer, they are supposed to be impartial and recommend a settlement which is acceptable to both parties (insurer and policyholder).

If you don't agree with the findings of the appointed surveyors then you could ask for them to be taken off the job and different ones to be appointed. Alternatively, I see no reason why you couldn't commission an independent report, and the insurer/loss adjuster would take this into consideration when reaching their conclusion about the settlement. There is no guarantee that they would agree with the findings of the independent report, but if it is favourable it should add weight to the claim. However, if you commissioned your own report I think you would have to pay for it yourself; I don't think you would be able to recover this as part of the settlement figure.

We need more clarity around which aspects of the surveyor's findings you are disputing and then we would be able to help you in more detail.

An insurance company is correct to try and keep the claim cost as low as possible, but at the same time they must ensure that the claimant is put back into the same position that they were in immediately before the loss occurred, as that is the principle of indemnity. Also they should ensure that the restoration/repair work is of good quality, otherwise there is a risk that the problems would manifest themselves again in the future and the claim would have to be re-opened.

I can't believe I'm sitting here typing all this on New Year's Eve - I guess I'm bored! (I'm not in the mood for going out tonight).

Anyway, Happy New Year for 2009 and I hope this situation will be resolved to everyone's satisfaction!

Hi Thanks very much for that info, it's much appreciated! BTW I didn't go out either!!!

I will get some more details in the next few days and post them here - and Happy New Year to you too!

H

Hi again

Does anyone know whether, on home and contents insurance, there is supposed to be a contract drawn up by the insurers setting out the full terms of the insurance, a copy of which is made available to the insured?

My sister just did a SAR to her insurers aking for a copy of this document (if it exists) but she has been sent a copy of the general terms of the policy and told that 'this is all there is'.

Does this sound right?

All advice gratefully received

H

We need more clarity around which aspects of the surveyor's findings you are disputing and then we would be able to help you in more detail.

 

The main problem is that her property was flooded by a blocked drain and some effluent from the drain seeped into the area beneath the house.

My sister wants the floor lifted so that the damage can be assessed and the area can be properly cleaned/disinfected but the surveyors/builders sent by the insurance co are saying that this won't be necessary.

She is getting an independent builder to make a report but she is so incensed by the way the ins co are treating her that she is considering legal action, part of which might be based on damages caused by their non-compliance with the SAR (hence the previous question!)

Cheers for any advice

H

When you take out the insurance you should have a copy of the insurance policy. Normally this is fairly comprehensive in that it will explain all the insurance terms / conditions and exclusions. As to what would happen in the event of a claim I think in general it would say something like to restore the property to state before claim - So there should be details of their obligations and also a copy of the complaints proceedure. There will obviously not be wording that covers every eventuality of course as you can imagine there are MANY different types of claim.

If your sister is not happy she must follow the complaints proceedurethat should be in the policy or she can ask for it to be sent to her and make an official complaint in writing.Then when she has had a reply she can go to the insurance ombudsman - legal action should not be the first action.

I know it is time consuming but certain proceedure must be followed.

Keep the letter firm but polite and send any extra reports she has and add that if they agree with her she will expect to be re-imbursed for any cost of the report.

A couple of questions

Who was responsible for the drain where there was a problem

What is the area under the house that has been affected - a cellar? or just the foundations?

Also I would add you will not get an answer of who is right or wrong here - but just a guide about how to proceed if not happy.

Jan

Hi Jansus

Thanks for your response and for your advice which I have taken on board.

I spoke to my sister and she said that she has already exhausted their internal complaint procedures and the ins co are now refusing to enter into further dialogue with her other than offering a derisory figure in full and final settlement.

The loss adjuster has also closed their files after my sis got annoyed with them after they had reneged on verbal agreements regarding what they were willing to recommend to remedy the damage to the property. When she asked for written confirmation of their recommendations, which they refused to provide. She then refused them access to her property until they complied with her request. Their response was to turf her out of the temporary accommodation she had been allocated, saying that she was being 'obstructive'.

She is now back in the house which she feels is still potentially contaminated with effluent.

To answer your specific questions, the water went under a kitchen floor and under the floor in the dining room into the foundations. They have lifted the kitchen floor, but are refusing to lift the dining room floor as they say it won't be necessary, but this is more likely to be because this would be a lot more involved and therefore costly than the kitchen floor was.

Naturally this is causing her a great deal of distress and upset, which is impeding her ability to take on the task of dealing with the ins co and the loss adjusters. She feels that they are playing on this and that when she speaks to them they often deliberately try to antagonise her, in order to impede her ability to deal with the situation effectively.

It's all a bit of a mess as you can probably tell.

She has already contacted the Ombudsman over the phone but the problem is that it may have gone way beyond what the Ombudsman can deal with, given that they can't order the ins co to pay compensation which my sister feels she is entitled to given the way they have behaved and the amount of stress and upheaval that she has had to go through because of their mis-management of this claim. She is at the moment contemplating legal action to try to move things along more quickly, as naturally she wants an end to this nightmare asap.

From what she has told me it seems that they are just behaving like a bunch of crooks, telling lies and behaving in a completely dishonest and devious manner.

Any comments gratefully received as ever - will keep you posted as to the outcome.

Cheers

H

The only thing I am surprised about is that you are saying the ombudsman can not offer compensation - in that I would have thought they could ask the insurance company to increase the offer if they feel that they have not acted correctly - surely that is what they are there for? And also I would have thought they couls make them have the additional work done if they agree with your Sister.

IMO I would still make an official complaint to the INS ombudsman(NOW FOS) and wait for their reply as I am not sure how the courts would help.

However if she is willing to pay for an independant report and take it to a "specialist" solicitor for an initial consultation then she should really take their advice. I am not a legal expert so I can not really comment on that.

I can see your sisters point of view and if she feels she has a case and sufficient evidence in WRITING - then the next move is really up to her.

I have heard of insurance companies needing pushing before increasing final pay outs (protecting the shareholders funds) but her experience does sound extremely frustrating.

From the FOS site

how does the Financial Ombudsman Service help?

We aim to settle complaints as fairly and as quickly as we can. There are always two sides to any complaint, so we'll look carefully at both sides of the story and weigh up all the facts.

If we decide the business you are complaining about has treated you fairly, we will tell you why.

If we decide the business has acted wrongly and you've lost out as a result, we can order the business to put things right for you. Generally, the aim is to put you in the position you'd be in if things hadn't gone wrong.

This can include telling the business to compensate you for losses of up to £100,000 - but most complaints involve much smaller amounts than this.

Hi Jansus

Thanks for your reply

I think we are now looking to get the Ombudsman involved in order to get the house repaired and back into a habitable condition, but I think the compensation they can arrange is more for material losses rather than or the distress or anxiety that may have been caused by the malpractice of the ins co.

We got a builder friend in and he has suggested that we call in a building surveyor to schedule works to get the property sorted out, so we will put this to the Ombudsman as a proposed course of action and see what he has to say.

Will keep you posted

H

Hi again

I understand what you are saying but if they eventually agree to the works I think your sister would be entitled to ask for some compensation as well for the stress and inconvenience. If you had to do that in a court of law - much harder to prove IMO

Court may still be an option if the correct proceedures nhave been exhausted - but I hope it does not come to that.But make sure that it is a sol that specialises in that area.

All my posts are my opinion only I am not an expert by any means!

Hope there is some good news soon.

Thanks very much for the advice I think you are right about the legal proceedings, I'm trying to make her see sense on that one but I think at the moment all she can see is the 'red mist'!

Will call the Ombudsman on Monday and see what he says.

Watch this space!

H

Have only had a brief scan of this thread so apologies if already mentioned, but you can always get your own loss assessor to dispute the finding of the insurer's adjuster.

As an aside to the title of the post, I was told he easiest way to remember the difference between assessors and adjusters is this:

An assessor is an ass because he works for the insured.

I'm sure it is a jest, but do wonder about the general attitude.

Hi Gyzmo

Our friend the builder suggested that we employ a building surveyor to assess the damage and schedule works to put it right and put that to the Ins co via the Ombudsman

The other issue is compensation that my sister feels she is entitled to for all the distress and upheaval - not sure if the Ombudsman can help with this but we shall see!

H