House break in...Insurance claims rejected
20 September 2015, 07:57 PM
#92
After over year, I think I can fully conclude this thread. I was going to post a time-line of events, but with how long this dragged out and with so much to and fro between various parties it became so long that was hard to follow.
So for those that don't want the read the start of this tread, my house was burgled, some damage to property and a fair amount of stuff was taken so this claim ended up being quite substantial, but well below the claim limit.
This situation all starts a few months after the loss adjuster's visit who asked various questions and took various details after which there was quite a lengthy arbitration period via phone and email with trying to establish values of stolen items. For example stolen jewellery was valued at scrap value, when I had independent valuations. Likewise a pair of muskets were stolen and I had no idea how to go about getting a value for them, so had to research it.
Anyway, this all seemed mostly positive; the adjuster was progressing with the claim and I already had received a cheque for the stolen electronic items (camera, laptop etc). So as far I was concerned, the claim was accepted and it was just a case of agreeing a few values and deciding on to accept vouchers or cash for finalisation of the settlement (the cash payout being less, typically).
Fast forward a few months and communications go quiet, so I chase around to find what's going on to finally be transferred to a claims handler who after going through the usual security protocols, I then find myself speaking to quite a rude man, I won't say his name yet as it may cause negative stereotypes, nor will fully describe his attitude or my opinion of him so I'll just call him Mr Rude. I am then told the claim has been rejected in its entirety, as this is a fault of my own for not properly securing my premises. I'm dumbfounded, so naturally I enquire why. I'm told by Mr Rude its because I had not set the alarm. It was set. I'm told teats what they've been told by the loss adjuster. WTF? Now conversations with this guy take a turn when it appears he is attempting to goad me into losing my temper, furthermore trying to put words into my mouth. Naturally someone less calm or controlled as me could easily take the bait here, as I'm sure it was a reversed form of entrapment. I try and make some progress though this in demanding what exact clauses in the policy that has invalidated my claim. I'm told its PY01 and the clause refers to putting all security devices into effective operation.
No where in my documentation could I find it referring to alarms, but Mr Rude is adamant it does. He even emails it to me, and what's shown in the email is not like what I have in my documentation given when I took out the policy. It makes no sense.
I appeal my case, try and talk to more senior employee in the company, but I get stonewalled and the only person I am allowed to talk to is Mr Rude, he says my appeal has been rejected on the basis that its not fair on other people who also had their claim rejected on the same ground. Oh hello, they do this often do they? Mr Rude didn't take kindly to me turning the table of accusations and using suppositions - but he's happy to do it to me! I had a moment of weakness and told of my faith in Karma, and asked him if he had the same belief - I must stress I was in no way abusive when or used any raised voices when I said this.
During these appeals I seek the advice of a barrister. For those that haven't had to use them It turns out barristers are a hell of alot more efficient that the typical solicitor who leaves everything to the last minute, they worked out cheaper too! So I collate all the details and create a time-line of events and forward my insurance documentation.
It was when scanning my insurance documentation on the flatbed scanner that in addition to my policy booklets and various correspondence was a desperate A4 sheet containing the PY01 details. In pulling the pages out the binder to scan I noted on the reverse further clauses....Oh sh*t there it is! On the front of this A4 page the clauses end half way down the page, with no indication it continues on the reverse!
Now, I was familiar with the PY01 sections before as it was included in the policy booklet which I had read over multiple times trying to work why my claim was being rejected. In the booklet PY01 is present, but the wording is different...it has no mention of alarms. Hence my confusion, so where did this poorly laid out A4 sheet come from? It turns out it was sent AFTER I renewed my policy. I was given no addendum or information to highlight that my policy terms and clauses had been changed, what had been sent was after I renewed, not before. There is also a different booklet for the same policy which has no mention of PY01 at all!
Due to finding this, my tact has changed somewhat and I inform the barrister of the situation. I had a response within the same week. The points I gave to him was that firstly I had an alarm and it was set, but somehow someone somewhere had misinterpreted that. Secondly the terms of my policy had been changed on renewal without me being adequately informed beforehand, and what had been presented was in a manner that disguised the changes made. His advise was to pursue the latter points, as the original point about the contradictions of the alarm's status would require the collection of evidence and find out where they got this information.
Unfortunately, despite the barrister's helpfulness, that's as far as he could take it. As I have to follow the set procedure that the government has already laid out; The Ombudsman. Sadly there is no way to bypass or fast-track this. A judge would likely just throw it out as soon as he hears that the ombudsman hasn't been used. The barrister was still useful as I did get advice on how best to present my case to the Ombudsman.
Just to cover all the bases I attempt to get proof of the status of my alarm. I sent a freedom of information request to the police for my witness statement. Point to note, if you ever make a statement to the police, photocopy or photograph it next time, as otherwise that's the last time you'll ever see it. Bear in mind its a legal document recording your account of events at that time. I also asked the loss adjuster's for their documentation. They refused, after stonewalling and telling me to contact my claims handler (Mr Rude). I tried asking Mr Rude, he laughed and refused. I go back to the loss adjusters, firstly trying to gain contact with the man who visited. It transpires he doesn't work there anymore, and furthermore the date of him leaving was the same time as halfway through my claim, this may explain the delay and dry up of communications. After various emails and phoning around I make contact with a more senior employee. I detail my situation and that I need to see the loss adjuster's report as there is a likeliness that information recorded within it is incorrect (the alarm's status) which has jeopardised my claim, quoting eh data protection act. He's sympathy, but again says my first point of contact is with Mr Rude, my handler.
Another dead end, so I thought. However, I get a call from a mobile number; It was the loss adjuster on his personal phone. Understanding the situation he actually went out his way to help, and had to go off the record - he couldn't print or email any documentation, but he had sight of it and he recounted the relevant details and indeed there was some incorrectly recorded information. Unfortunately because its not hard-copy information this is of limited use to me, it made me confident that there was nothing else damaging to my case within it, just the alarm bit.
So everything is compiled, detailed and referenced to copies of relevant factual documents for the Ombudsman, I sent it to the barrister for their input beforehand to ensure nothing within it could jeopardise my case. Then there was the waiting game. Its a sad fact the Ombudsman service is a overworked one, and obviously relevant to the sad state of affairs in our financial services industry. During this wait I made it imperative that the insurer was aware of this, I call once every few weeks to reconfirm this and I have not just gone away.
Finally I get contact from the Ombudsman, a pure Gentlemen with the amazing ability to sum a whole document of several hundred pages in one two page letter....all in my favour! He was clear cut in that his opinion based on what I had given him was that I did no wrong and the insurer should pay up. But he cannot make a decision yet...he has to wait for the insurer to put their case forward and they have another month to do so.
A month comes and goes...I phone for a update, still, the insurer has sent nothing. Shows how interested they are, so as such the ombudsman will proceed based solely on my information. However a week later what does the insurer do? They respond!
A week late, I make my point to the ombudsman that they had a month to do this, they messed you about and messed me about and really anything after this cut off point should be disregard. The ombudsman agreed but he has to consider late information as part of the procedure.
Its now almost 12months and once again my house is broken into again. I am still insured with the same insurer as during the claim the renewal came due and I renewed just to prevent any complication with the claim - as at that point it hadn't been rejected. Its quite common to get stonewalled when trying to get through the call centres once you aren't a policy holder as its the easiest way to get rid of a difficult caller, so I was mindful of this during the first claim.
This second claim is much more straightforward as it was just damage and no theft. Albeit expensive damage as it was all done to new window and doors frames. Repairs are agreed, but it was complicated as the authorised repairer couldn't do anything to the frames as they were still under warranty and doing so would invalidate it. So they'd have to replace them in their entirety, the problem is by the window company's own admission their frames aren't as high quality as the ones I have! (news to me), the crux of this is they don't want to do the job and will advise the insurer on a cash payout based on their value. This was easy, as seeing the frames are just a few months old I was able to get copy invoices from the builder and window company showing what they cost me and the insurer accepted this.
While this was going on though it seems dirty tricks were afoot. The insurer was using my current case as reason and justification for rejecting my first claim. The ombudsman hinted that the insurer said that this time my alarm was in effective operation and that meant that nothing was stolen. B*ll*cks was it. During the second break in the alarm was put out of action in several ways; The main one being what can be best described as a pair of gymnasts overcoming a roof overhang to get to a bellbox and rip out its wires. This would have triggered the siren on batteries for 20mins, after that it resets (as required by law) and due to the severed signal wires it will not sound again after the alarm is re-triggered. They also cut the electricity supply by pulling out the main fuse on the external meter-box.
They broke in, like the first time via brute force. But what stopped them this time was not the alarm (evident by the bellbox being damaged) but a inward opening internal door in the kitchen that was locked by a 5 lever lock and dead-bolted from the other side at the top and bottom. Quite simply after gaining entry to the kitchen containing nothing worth nicking, they reached yet another locked door and gave up. The alarm made no difference.
This was entirely different to the first break-in which was via a ladder to a upstairs window and breaking it with brute force. This gave them full access to the main part of the house.
In conversation with ombudsman, he was in agreeance that this break-in had zero relevance to the first one. And it doesn't change the fact that in his view the insurer has not properly informed me of my policy's clauses or any changes made to them BEFORE renewal. In short the alarm's status was irreverent, its the presentation and wording of their policy that's at fault. Hurrah! It doesn't end there; Ombudsman has made his decimation in my favour, to pay me the full sum, in cash plus compensation. BUT the insurer has a importunity appeal, and appal they do. It then transpires that I'm not on my own here and there have been other people in the same situation as me. The ombudsman has to then refer to these cases and talk to his colleagues that handled them. He isn't happy about this as in his opinion they are wasting time as a similar case has already been to court and settled in the favour of the policy holder. I hate to think what aggregation and cost some others have been through before me to have to go to court!
Finally, the final decision is made. I am to be paid in full plus compensation. So I wait for the cheque, and wait, and wait. I get a letter from the insurer..is it a cheque? No, a letter of refusal to renew my policy. Their excuse? I have exceeded their annual claim amounts! Erm what? The policy limit is £200K! (£2,000,000 for third party claims) So the total of my claims? Under £40K! Yeah I know its still a huge amount to claim for, silly me for having jewellery vintage watches, antique firearms, electronics, and fancy expensive aluminium windows. When all added together it obviously mounted up, but obviously nowhere near the claim limit and bear in mind I have a limit of £1500 per item on unlisted items.
I'm still confused at how I can have a £200K policy and then have it forcibly cancelled because I claimed twice for a total amount well below that. As if I was going to renew with the same insurer anyway. The problem here is because my policy has been cancelled it means that I have a negative mark against my record meaning many insurers will not even quote me. Add to that my recent claims history and my claim is still not settled (no cheque), I cannot get insured. With the expiry date looming and few options left I plead with the insurer for an extension, the answer is no. I find a few companies that will quote me, but I hit another stalling point; they can only take my policy on when they can see that my current claims have been settled, and its showing on my records that they aren't.
I make repeated phone calls to the insurer to tray and get my claims setted, I get sent in circles, hung up on, and stonewalled...remember because my policy is cancelled the average call centre worker will refuse to deal with me. Out of exasperation I call the ombudsman again, who is livid and "kicks ****" (his words). A few hours later I am reassured the computers now show my claims to be settled and the cheques are in the post. Finally!!
So here we are, up to date. I'm paying alot more for insurance, I have to have the alarm contractually maintained, I have £5000 excess on contents and another £5000 excess on home, all with a company I haven't heard of and I have to insure via a broker.
I'll end this with three things; The names of my insurance company, my policy, and my claims handler:
Legal & General
Home Insurance Extra
Majid Mahmood
This is a summary of accounts and experience based on the facts and personal experience that I have endured. These names and policies should not be confused with others bearing similar names. Insurers may change the terms of their policies despite it bearing the same name, please check your documentation before purchase or renewal.
So for those that don't want the read the start of this tread, my house was burgled, some damage to property and a fair amount of stuff was taken so this claim ended up being quite substantial, but well below the claim limit.
This situation all starts a few months after the loss adjuster's visit who asked various questions and took various details after which there was quite a lengthy arbitration period via phone and email with trying to establish values of stolen items. For example stolen jewellery was valued at scrap value, when I had independent valuations. Likewise a pair of muskets were stolen and I had no idea how to go about getting a value for them, so had to research it.
Anyway, this all seemed mostly positive; the adjuster was progressing with the claim and I already had received a cheque for the stolen electronic items (camera, laptop etc). So as far I was concerned, the claim was accepted and it was just a case of agreeing a few values and deciding on to accept vouchers or cash for finalisation of the settlement (the cash payout being less, typically).
Fast forward a few months and communications go quiet, so I chase around to find what's going on to finally be transferred to a claims handler who after going through the usual security protocols, I then find myself speaking to quite a rude man, I won't say his name yet as it may cause negative stereotypes, nor will fully describe his attitude or my opinion of him so I'll just call him Mr Rude. I am then told the claim has been rejected in its entirety, as this is a fault of my own for not properly securing my premises. I'm dumbfounded, so naturally I enquire why. I'm told by Mr Rude its because I had not set the alarm. It was set. I'm told teats what they've been told by the loss adjuster. WTF? Now conversations with this guy take a turn when it appears he is attempting to goad me into losing my temper, furthermore trying to put words into my mouth. Naturally someone less calm or controlled as me could easily take the bait here, as I'm sure it was a reversed form of entrapment. I try and make some progress though this in demanding what exact clauses in the policy that has invalidated my claim. I'm told its PY01 and the clause refers to putting all security devices into effective operation.
No where in my documentation could I find it referring to alarms, but Mr Rude is adamant it does. He even emails it to me, and what's shown in the email is not like what I have in my documentation given when I took out the policy. It makes no sense.
I appeal my case, try and talk to more senior employee in the company, but I get stonewalled and the only person I am allowed to talk to is Mr Rude, he says my appeal has been rejected on the basis that its not fair on other people who also had their claim rejected on the same ground. Oh hello, they do this often do they? Mr Rude didn't take kindly to me turning the table of accusations and using suppositions - but he's happy to do it to me! I had a moment of weakness and told of my faith in Karma, and asked him if he had the same belief - I must stress I was in no way abusive when or used any raised voices when I said this.
During these appeals I seek the advice of a barrister. For those that haven't had to use them It turns out barristers are a hell of alot more efficient that the typical solicitor who leaves everything to the last minute, they worked out cheaper too! So I collate all the details and create a time-line of events and forward my insurance documentation.
It was when scanning my insurance documentation on the flatbed scanner that in addition to my policy booklets and various correspondence was a desperate A4 sheet containing the PY01 details. In pulling the pages out the binder to scan I noted on the reverse further clauses....Oh sh*t there it is! On the front of this A4 page the clauses end half way down the page, with no indication it continues on the reverse!
Now, I was familiar with the PY01 sections before as it was included in the policy booklet which I had read over multiple times trying to work why my claim was being rejected. In the booklet PY01 is present, but the wording is different...it has no mention of alarms. Hence my confusion, so where did this poorly laid out A4 sheet come from? It turns out it was sent AFTER I renewed my policy. I was given no addendum or information to highlight that my policy terms and clauses had been changed, what had been sent was after I renewed, not before. There is also a different booklet for the same policy which has no mention of PY01 at all!
Due to finding this, my tact has changed somewhat and I inform the barrister of the situation. I had a response within the same week. The points I gave to him was that firstly I had an alarm and it was set, but somehow someone somewhere had misinterpreted that. Secondly the terms of my policy had been changed on renewal without me being adequately informed beforehand, and what had been presented was in a manner that disguised the changes made. His advise was to pursue the latter points, as the original point about the contradictions of the alarm's status would require the collection of evidence and find out where they got this information.
Unfortunately, despite the barrister's helpfulness, that's as far as he could take it. As I have to follow the set procedure that the government has already laid out; The Ombudsman. Sadly there is no way to bypass or fast-track this. A judge would likely just throw it out as soon as he hears that the ombudsman hasn't been used. The barrister was still useful as I did get advice on how best to present my case to the Ombudsman.
Just to cover all the bases I attempt to get proof of the status of my alarm. I sent a freedom of information request to the police for my witness statement. Point to note, if you ever make a statement to the police, photocopy or photograph it next time, as otherwise that's the last time you'll ever see it. Bear in mind its a legal document recording your account of events at that time. I also asked the loss adjuster's for their documentation. They refused, after stonewalling and telling me to contact my claims handler (Mr Rude). I tried asking Mr Rude, he laughed and refused. I go back to the loss adjusters, firstly trying to gain contact with the man who visited. It transpires he doesn't work there anymore, and furthermore the date of him leaving was the same time as halfway through my claim, this may explain the delay and dry up of communications. After various emails and phoning around I make contact with a more senior employee. I detail my situation and that I need to see the loss adjuster's report as there is a likeliness that information recorded within it is incorrect (the alarm's status) which has jeopardised my claim, quoting eh data protection act. He's sympathy, but again says my first point of contact is with Mr Rude, my handler.
Another dead end, so I thought. However, I get a call from a mobile number; It was the loss adjuster on his personal phone. Understanding the situation he actually went out his way to help, and had to go off the record - he couldn't print or email any documentation, but he had sight of it and he recounted the relevant details and indeed there was some incorrectly recorded information. Unfortunately because its not hard-copy information this is of limited use to me, it made me confident that there was nothing else damaging to my case within it, just the alarm bit.
So everything is compiled, detailed and referenced to copies of relevant factual documents for the Ombudsman, I sent it to the barrister for their input beforehand to ensure nothing within it could jeopardise my case. Then there was the waiting game. Its a sad fact the Ombudsman service is a overworked one, and obviously relevant to the sad state of affairs in our financial services industry. During this wait I made it imperative that the insurer was aware of this, I call once every few weeks to reconfirm this and I have not just gone away.
Finally I get contact from the Ombudsman, a pure Gentlemen with the amazing ability to sum a whole document of several hundred pages in one two page letter....all in my favour! He was clear cut in that his opinion based on what I had given him was that I did no wrong and the insurer should pay up. But he cannot make a decision yet...he has to wait for the insurer to put their case forward and they have another month to do so.
A month comes and goes...I phone for a update, still, the insurer has sent nothing. Shows how interested they are, so as such the ombudsman will proceed based solely on my information. However a week later what does the insurer do? They respond!
A week late, I make my point to the ombudsman that they had a month to do this, they messed you about and messed me about and really anything after this cut off point should be disregard. The ombudsman agreed but he has to consider late information as part of the procedure.Its now almost 12months and once again my house is broken into again. I am still insured with the same insurer as during the claim the renewal came due and I renewed just to prevent any complication with the claim - as at that point it hadn't been rejected. Its quite common to get stonewalled when trying to get through the call centres once you aren't a policy holder as its the easiest way to get rid of a difficult caller, so I was mindful of this during the first claim.
This second claim is much more straightforward as it was just damage and no theft. Albeit expensive damage as it was all done to new window and doors frames. Repairs are agreed, but it was complicated as the authorised repairer couldn't do anything to the frames as they were still under warranty and doing so would invalidate it. So they'd have to replace them in their entirety, the problem is by the window company's own admission their frames aren't as high quality as the ones I have! (news to me), the crux of this is they don't want to do the job and will advise the insurer on a cash payout based on their value. This was easy, as seeing the frames are just a few months old I was able to get copy invoices from the builder and window company showing what they cost me and the insurer accepted this.
While this was going on though it seems dirty tricks were afoot. The insurer was using my current case as reason and justification for rejecting my first claim. The ombudsman hinted that the insurer said that this time my alarm was in effective operation and that meant that nothing was stolen. B*ll*cks was it. During the second break in the alarm was put out of action in several ways; The main one being what can be best described as a pair of gymnasts overcoming a roof overhang to get to a bellbox and rip out its wires. This would have triggered the siren on batteries for 20mins, after that it resets (as required by law) and due to the severed signal wires it will not sound again after the alarm is re-triggered. They also cut the electricity supply by pulling out the main fuse on the external meter-box.
They broke in, like the first time via brute force. But what stopped them this time was not the alarm (evident by the bellbox being damaged) but a inward opening internal door in the kitchen that was locked by a 5 lever lock and dead-bolted from the other side at the top and bottom. Quite simply after gaining entry to the kitchen containing nothing worth nicking, they reached yet another locked door and gave up. The alarm made no difference.
This was entirely different to the first break-in which was via a ladder to a upstairs window and breaking it with brute force. This gave them full access to the main part of the house.
In conversation with ombudsman, he was in agreeance that this break-in had zero relevance to the first one. And it doesn't change the fact that in his view the insurer has not properly informed me of my policy's clauses or any changes made to them BEFORE renewal. In short the alarm's status was irreverent, its the presentation and wording of their policy that's at fault. Hurrah! It doesn't end there; Ombudsman has made his decimation in my favour, to pay me the full sum, in cash plus compensation. BUT the insurer has a importunity appeal, and appal they do. It then transpires that I'm not on my own here and there have been other people in the same situation as me. The ombudsman has to then refer to these cases and talk to his colleagues that handled them. He isn't happy about this as in his opinion they are wasting time as a similar case has already been to court and settled in the favour of the policy holder. I hate to think what aggregation and cost some others have been through before me to have to go to court!
Finally, the final decision is made. I am to be paid in full plus compensation. So I wait for the cheque, and wait, and wait. I get a letter from the insurer..is it a cheque? No, a letter of refusal to renew my policy. Their excuse? I have exceeded their annual claim amounts! Erm what? The policy limit is £200K! (£2,000,000 for third party claims) So the total of my claims? Under £40K! Yeah I know its still a huge amount to claim for, silly me for having jewellery vintage watches, antique firearms, electronics, and fancy expensive aluminium windows. When all added together it obviously mounted up, but obviously nowhere near the claim limit and bear in mind I have a limit of £1500 per item on unlisted items.
I'm still confused at how I can have a £200K policy and then have it forcibly cancelled because I claimed twice for a total amount well below that. As if I was going to renew with the same insurer anyway. The problem here is because my policy has been cancelled it means that I have a negative mark against my record meaning many insurers will not even quote me. Add to that my recent claims history and my claim is still not settled (no cheque), I cannot get insured. With the expiry date looming and few options left I plead with the insurer for an extension, the answer is no. I find a few companies that will quote me, but I hit another stalling point; they can only take my policy on when they can see that my current claims have been settled, and its showing on my records that they aren't.
I make repeated phone calls to the insurer to tray and get my claims setted, I get sent in circles, hung up on, and stonewalled...remember because my policy is cancelled the average call centre worker will refuse to deal with me. Out of exasperation I call the ombudsman again, who is livid and "kicks ****" (his words). A few hours later I am reassured the computers now show my claims to be settled and the cheques are in the post. Finally!!
So here we are, up to date. I'm paying alot more for insurance, I have to have the alarm contractually maintained, I have £5000 excess on contents and another £5000 excess on home, all with a company I haven't heard of and I have to insure via a broker.
I'll end this with three things; The names of my insurance company, my policy, and my claims handler:
Legal & General
Home Insurance Extra
Majid Mahmood
This is a summary of accounts and experience based on the facts and personal experience that I have endured. These names and policies should not be confused with others bearing similar names. Insurers may change the terms of their policies despite it bearing the same name, please check your documentation before purchase or renewal.
Last edited by ALi-B; 20 September 2015 at 09:17 PM.
21 September 2015, 08:11 AM
#96
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I'm glad it all sorted for you now.
Still feel insurance is one big con (and yes I understand its a business) - happy to give you an umbrella when its dry but take it away when its raining.
Richard
Still feel insurance is one big con (and yes I understand its a business) - happy to give you an umbrella when its dry but take it away when its raining.
Richard
21 September 2015, 09:41 AM
#98
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Cheers for your postings, I'm glad it went through OK in the end.
As it happens my insurance is up next month. When getting quotes I made sure to say we do not have an alarm and that our windows are non locking.
Didn't make any difference on the quote.
As it happens my insurance is up next month. When getting quotes I made sure to say we do not have an alarm and that our windows are non locking.
Didn't make any difference on the quote.
21 September 2015, 12:23 PM
#99
Well done for holding out.
I reckon your Mr Rude was set up to try and get you to lose it and tell them to stuff their policy. Then you are not a client and it goes from there.
It just goes to show what a scam insurance is in the most part.
The fact that they can cancel your policy for no fault of yours after lying about it themselves, (exceeded the threshold), is disgusting, and wants taking up with the highest authority.
I reckon your Mr Rude was set up to try and get you to lose it and tell them to stuff their policy. Then you are not a client and it goes from there.
It just goes to show what a scam insurance is in the most part.
The fact that they can cancel your policy for no fault of yours after lying about it themselves, (exceeded the threshold), is disgusting, and wants taking up with the highest authority.
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