It is not often that you come across a crime the nobody will investigate.

But I have 1 for you.

Business Insurance fraud.

While individuals can be arrested for false Insurance claims of a few hundred,

Insurance company’s & the representatives can do & say anything they want without recourse.

2 examples:

I had an Nissan X-Trail that someone used instead of their brakes.

It was written off.

The insurer’s first offer to was £3,123.

Then £4,000 eventually an agreed settlement of £6,421.

More than twice the original.

An X-Trail is not a difficult car to value so how can insurers or their representatives make such low ball offers?

The second is that our home was seriously damaged due to vehicular impact.

The insurer & their representatives have been a nightmare.

Initially they said there was no damage, then it could be fixed for £200 …. £10,000 …. £40,000 … £140,000 … £200,000+.

In this instance the insurer or their representatives undervalued a claim by over £200,000 or more than 1000 times.

Individuals can be arrested for dodgy insurance claims of a few hundred pounds.

But who is there to protect the consumer?

The Financial Services and Markets Act 2000 (there to promote consumer protection & reduction of financial crime)

created the Financial Services Authority (FSA)

now the FCA as a regulator

and the FOS,

however neither will investigate an allegation of Business fraud.

The FCA told me to seek legal advice.

The FOS advertises that it investigates Fraud but in 14 years has NEVER investigated a Business for fraud or deception.

For those unaware, the FOS chairman is the Chairman of Aviva, I guess impartiality cannot be expected.

I contacted the Police, to find out that the Insurance Fraud Enforcement Department (IFED)

is funded by the Association of British Insurers at a cost of £9,000,000.

Action Fraud is run by the City of London Police.

Clearly they will not bite of the hand that feeds them.

The Insurance Fraud Bureau (IFB) has been set up by Insurers to protect themselves.

It would seem that the Insurance industry has this well & truly sewn up.

The only option open to the private individual is to take legal action at their own cost, as advised by the FCA.

UK consumer protection at its best.

I'm struggling to see the "fraud" if I'm honest.

Thread moved to the appropriate forum.

Andy

I'm struggling to see the "fraud" if I'm honest.

Well it could be considered attempted fraud ? If there has been a deliberate attempt to gain a financial benefit in the way that it is alleged, then in any other walk of life, it would be considered a fraud.

This is something that the FCA should be willing to investigate as unfair trading. Of course if you allege that fraud has been committed they won't get involved, as that would be down to the Police. But the Police won't often investigate large businesses in relation to fraud. Don't ask me why, as I don't understand it, other than it would be very costly to investigate and no doubt the Insurers legal people would be all over it like a rash. The CEO of the Insurance company would no doubt contact friends in high places and any investigation would be dropped pretty quickly.

I used to believe that conspiracy theories involving powerful interest groups was a bit exaggerated. But now I am not so sure, as I believe that very little protection is offered to ordinary citizens, who don't have the resources or contacts to be able to take relevant actions including using the courts if necessary.

Your route of complaint is definitely the FCA re unfair trading.

Where did you get that the Aviva Chairman is Chairman of the FOS?

Who do you expect to fund an industry organisation to deal fraudulent claims against Insurers?

Where did you get that the Aviva Chairman is Chairman of the FOS?

 

Who do you expect to fund an industry organisation to deal fraudulent claims against Insurers?

Sir Nicholas Monatgue is Chairman of FOS.

John McFarlane is Chairman of Aviva.

I'm struggling to see the "fraud" if I'm honest.

The legal definition of fraud comes from Derry v Peek [1889] 14 AC 337:

“Fraud is proved when it is shown that a false representation has been made:

● knowingly, or

● without belief in its truth, or

● recklessly, without caring whether it be true or false.”

I assume Ganymede you are either an Insurance seller or Chairman or possibly a loss adjuster.

Insurance is taken out to transfer the possibility of a loss to an insurance company, which in turn spreads out the costs of unexpected losses to many individuals hence the premiums.

What you are saying is that you cannot understand that an insurance company that leaves an individual short of the required sum to ensure they do not suffer loss, by thousands or hundreds of thousands is not committing fraud?

Insurers & their representatives are getting away with this daily. Is it costing individuals £billions every year while the insurance industry profits soar!

Sir Nicholas Monatgue is Chairman of FOS.

John McFarlane is Chairman of Aviva.

Who is chairman of the FOS Board:

http://www.ftadviser.com/2011/11/23/regulation/regulators/fsa-appoints-sir-nicholas-montagu-as-fos-chairman-6zlR8FuVplnkOXwQeCKxAK/article.html

Sir Nicholas Montagu current chairman of the Aviva UK

Aviva heads the FOS, dictates how the FOS will operate, appoints the 'overseer' the Independent Assessor's (IA's) authority and this is considered independent?

The IA's terms of reference remained unchanged for many years, but in late 2010, the FOS revised them. This re-editing of the rules spell out more clearly what the IA cannot do. Is this further restriction on the IA what Parliament envisaged? The Board have specified certain important items the IA may not even comment on. So if the IA should find that poor service standards have affected the outcome of a case, for instance if the Ombudsman has ignored FOS published guidelines, the Law, relevant rules, principles or deliberately ignored some crucial evidence, ... whatever, the IA is not permitted to even comment on this so the wrong decision still stands even though the IA knows it is wrong. I am surprised IA's are prepared to accept a position of such a restriction, then again £112,000 pro rata for 3 days a week!

FYI may of the Ombudsman earn more than the Prime Minister. Consumer non-protection is very well paid.

Fraud by false representation

(1)A person is in breach of this section if he—

(a)dishonestly makes a false representation, and

(b)intends, by making the representation—

(i)to make a gain for himself or another, or

(ii)to cause loss to another or to expose another to a risk of loss

(2)A representation is false if—

(a)it is untrue or misleading, and

(b)the person making it knows that it is, or might be, untrue or misleading.

Where did you get that the Aviva Chairman is Chairman of the FOS?

 

Who do you expect to fund an industry organisation to deal fraudulent claims against Insurers?

Google Sir Nicholas Monatgue appointed Chairman of FOS by the FSA.

He is Current chairman of the Aviva UK.

The funding is already there. The FOS has the authority to instruct a business to fund legal cases. But in 14 years has not once investigated a business for fraud or deception. Does that sound independent?

But they do & will investigate individuals. The FOS where business win every time?

The FSMA there to promote consumer protection, exploited by the FCA FOS for personal benefit? Who looses the consumer.

Who is chairman of the FOS Board:

http://www.ftadviser.com/2011/11/23/regulation/regulators/fsa-appoints-sir-nicholas-montagu-as-fos-chairman-6zlR8FuVplnkOXwQeCKxAK/article.html

Sir Nicholas Montagu current chairman of the Aviva UK

 

Aviva heads the FOS, dictates how the FOS will operate, appoints the 'overseer' the Independent Assessor's (IA's) authority and this is considered independent?

 

The IA's terms of reference remained unchanged for many years, but in late 2010, the FOS revised them. This re-editing of the rules spell out more clearly what the IA cannot do. Is this further restriction on the IA what Parliament envisaged? The Board have specified certain important items the IA may not even comment on. So if the IA should find that poor service standards have affected the outcome of a case, for instance if the Ombudsman has ignored FOS published guidelines, the Law, relevant rules, principles or deliberately ignored some crucial evidence, ... whatever, the IA is not permitted to even comment on this so the wrong decision still stands even though the IA knows it is wrong. I am surprised IA's are prepared to accept a position of such a restriction, then again £112,000 pro rata for 3 days a week!

 

FYI may of the Ombudsman earn more than the Prime Minister. Consumer non-protection is very well paid.

The link is to an article published in 2011.

John McFarlane is Chairman of Aviva. Appointed Jan 2013

The link is to an article published in 2011.

John McFarlane is Chairman of Aviva. Appointed Jan 2013

I don't think you are disagreeing that Sir Nicholas Monatgue was appointed Chairman of FOS by the FSA while being chairman of the Aviva UK.

And held both roles for a considerable time.

Hence the point, how can the FOS board be independent?

What relationship is there between Aviva & the FCA or the FOS?

How many employees of the FCA/FOS does Aviva pay?

Does Sir Nicholas Montagu receive continued benefits ie pension or salary from Aviva? Is that linked to performance? How can someone be independent hold both roles?

I don't think you are disagreeing that Sir Nicholas Monatgue was appointed Chairman of FOS by the FSA while being chairman of the Aviva UK.

 

And held both roles for a considerable time.

 

Hence the point, how can the FOS board be independent?

 

 

How would one be able to appoint a person with sufficient knowledge experience and ability to a public roll if you did not look to

in this case a person with vast experience in the financial arena.

 

What relationship is there between Aviva & the FCA or the FOS? **** THERE IS NONE****

 

How many employees of the FCA/FOS does Aviva pay? **** NONE*******

 

Does Sir Nicholas Montagu receive continued benefits ie pension or salary from Aviva? Is that linked to performance? How can someone be independent hold both roles?

This conspiracy theory I think has no merit.

You would need to focus your attention on the companies, their agents or employees involved in your particular case.

This conspiracy theory I think has no merit.

This is no theory, it is real life & going on.

ANSWER 1 QUESTION: Who will investigate Insurance Fraud committed by the Insurer or their agents?

If you can answer that, I will be impressed.

This is no theory, it is real life & going on.

 

ANSWER 1 QUESTION: Who will investigate Insurance Fraud committed by the Insurer or their agents?

 

If you can answer that, I will be impressed.

The Financial Ombudsman Service Will and Does investigate as will the FCA IF there is significant proof, one contested case I not sufficient.

As said your complaint is with the insurer (s) in your particular case.

Insurer and Insured must make the best efforts to mitigate losses hence the "negotiations" on "pay outs ".

The Financial Ombudsman Service Will and Does investigate as will the FCA IF there is significant proof, one contested case I not sufficient.

As said your complaint is with the insurer (s) in your particular case.

 

 

Insurer and Insured must make the best efforts to mitigate losses hence the "negotiations" on "pay outs ".

NO THEY DON'T investigate businesses. Just individuals.

IN 14 YEARS THEY HAVE NEVER. NOT ONCE INVESTIGATED A BUSINESS FOR FRAUD OR DECEPTION. I did a FOIA request. I have the info. Please do not make statements you cannot back up.

Negotiations, ie at 50% of actual is that fair or reasonable or fraud? or what about 0.1%?

Insurers are supposed to employ impartial professionals that you can rely on.

You sound very much like an insurance employee.

NO THEY DON'T investigate businesses. Just individuals.

 

IN 14 YEARS THEY HAVE NEVER. NOT ONCE INVESTIGATED A BUSINESS FOR FRAUD OR DECEPTION. I did a FOIA request. I have the info. Please do not make statements you cannot back up.

 

 

Negotiations, ie at 50% of actual is that fair or reasonable or fraud? or what about 0.1%?

Insurers are supposed to employ impartial professionals that you can rely on.

 

You sound very much like an insurance employee.

I will not enter into a pointless argument with someone who cannot understand what the regulatory authorities do.

Could your supposed results mean there has been no institutional fraud most likely I think.

What you consider is fair and reasonable may not be so in the view of others.

I am not trying to have an argument & don't want 1. Shame on you for engaging such.

I suppose any insurance employee retired or not would think settlements offered at 50% & 0.1% was not fraud!

What I am trying to highlight is that Insurers are using deception & professional enablers to get away with fraud on a much greater scale than any bogus claim against them. This is not an isolated incident, I have many others, ie £500 offered £40,000+ settlement, £2,000 offered over £100,000.

It is such a shame that the protection set up with the FSMA has been exploited by the companies set up to protect us for their own benefit, proven by the exponential growth of the FOS.

I am sad that anyone could be so naive to believe that 'your supposed results mean there has been no institutional fraud most likely I think'.

I am not trying to have an argument & don't want 1. Shame on you for engaging such.

 

I suppose any insurance employee retired or not would think settlements offered at 50% & 0.1% was not fraud!

 

What I am trying to highlight is that Insurers are using deception & professional enablers to get away with fraud on a much greater scale than any bogus claim against them. This is not an isolated incident, I have many others, ie £500 offered £40,000+ settlement, £2,000 offered over £100,000.

 

It is such a shame that the protection set up with the FSMA has been exploited by the companies set up to protect us for their own benefit, proven by the exponential growth of the FOS.

 

I am sad that anyone could be so naive to believe that 'your supposed results mean there has been no institutional fraud most likely I think'.

Never worked in the insurance industry.

My advice get a grip on reality!

Please do not waste everyones time posting.

 

I have & quote fact. You are a very sad individual enjoying the pain and sorrow of another.

 

Do not reply again on this thread

Please don't be rude ( your posts will probably get deleted by admin).

The FOS won't deal with business insurance complaints, as far as I know.

The body that would deal with a business insurance complaint regarding unfair trading practice would be the FCA.

Please don't be rude ( your posts will probably get deleted by admin).

 

The FOS won't deal with business insurance complaints, as far as I know.

 

The body that would deal with a business insurance complaint regarding unfair trading practice would be the FCA.

I have tried contacting the FCA.

They do not accept complaints from the general public. They advised that the only recourse is personal legal action.

As I say there is no-one to fight or defend he position of the individual.

Industry has this well sewn up

I have tried contacting the FCA.

 

They do not accept complaints from the general public. They advised that the only recourse is personal legal action.

 

As I say there is no-one to fight or defend he position of the individual.

 

Industry has this well sewn up

That is a bit odd re FCA not dealing with complaints, as from April the FCA have taken over some of the work from the OFT. I have seen numerous people reporting that the FCA had taken their complaint, but I don't think they have process of seeing an individual complaint to conclusion. I think what happens is that the FCA will make enquiries, pass on the complaint to the Insurers and place a note on their files to see if they receive a number of similar complaints. i.e it is not anything like the FOS process, with the FCA only taking action if they get loads of similar complaints.

Please do not waste everyones time posting.

 

I have & quote fact. You are a very sad individual enjoying the pain and sorrow of another.

 

Do not reply again on this thread

Calling someone who has nearly 30,000 posts (most of which I presume is to help others) a sad individual enjoying the pain and sorrow of another is... well, it's just sad, Sad sam.

Your first post saying that there is fraud from insurance companies - I can not see the fraud. The insurance companies make you an offer and it is up to you to negotiate on that offer and offer any evidence that would back up your negotiations. At the end of your post you state that the only option available to UK consumers is to take legal action at their own cost. The same option available to insurance companies should there be a fraudulent claim.

Calling someone who has nearly 30,000 posts (most of which I presume is to help others) a sad individual enjoying the pain and sorrow of another is... well, it's just sad, Sad sam.

 

Your first post saying that there is fraud from insurance companies - I can not see the fraud. The insurance companies make you an offer and it is up to you to negotiate on that offer and offer any evidence that would back up your negotiations. At the end of your post you state that the only option available to UK consumers is to take legal action at their own cost. The same option available to insurance companies should there be a fraudulent claim.

I feel sorry for the others that may have received what I would classify as abuse.

Onto your topic, Insurers can go to the the FOS, the FOS will investigate fraud if the Business makes the allegation. They will not if the individual makes the allegation.

If an insurer alleges fraud they refuse to pay the claim. Hence again it is in the individuals hands to take legal action against the company with bottomless pockets & Legal firms on retainer.

It is amazing that if someone claims £1,000 for £200 of goods the insurance industry cries fraud.

But when the allegation is returned, several cannot see how costing an individual £100's £1,000's or £100,000's you find acceptable.

That is despicable.

With regards offers, http://www.cila.co.uk/files/Anti-Fraud/Fraud_Guide.pdf

President of the Chartered Institute of Loss Adjusters (CILA) was asked at a conference what was the difference between a claim for negotiation and a fraudulent claim.

He provided this view: “A claim that was two times overstated was probably a claim for negotiation. A claim that was 10 times overstated was probably bogus and fraudulent.”

My point what is a claim that is 1000 x a difference.

But then again 'you can not see fraud'.

Sad sam, if an insurance company deceives you in order for the insurance company to make a gain, then yes it is fraud.

But from your original post, I can not see how fraud has occurred in the examples you have given.