Insurance claim - rejected for non disclosure for a rejected claim 5 years ago

[josh]

I am writing to ask is it possible to obtain advice

we have insurance cover and have made a claim, the claim has been rejected (but was originally accepted and repairs started) as the Insurer has come back and said we never disclosed a claim made 5 years ago and therefore the claim is rejected, we have loss assessors appointed and they appointed contractors, the insurance will pay them for the work they authorised but have rejected the claim

Is there legal redress for us, we are based in north England.

Thanks

[Crazy council]

Re: Insurance claim - rejected for non disclosure for a rejected claim 5 years ago

Hi

did they regect it for any other reason, have you complained through there procedures yet. Are the insurance using a claims managment co

[des8]

Re: Insurance claim - rejected for non disclosure for a rejected claim 5 years ago

Need more information.
Is this a motor claim (assuming not at the moment)
What are the circumstances of this claim?
Fault or non fault?
Is this a new policy, or a renewal?
Start date of policy, and if poss exact date you completed proposal.

Details of non disclosed claim:
Date
circumstances & cost
fault or non fault

Why did you not declare it? Forgot about it?
Do you have a copy of the proposal form you could post up?

[josh]

Re: Insurance claim - rejected for non disclosure for a rejected claim 5 years ago

Hi there

the claim is for water leak due to burst pipe

the details of the non disclosed claim was from 2009, it was damage to a TV but rejected as they said it was not accidental, (we just left it and did not argue) we have been with 4 different insurers since and never claimed, they asked us for 5 years insurer details, and then accpeted the claim appointed loss adjusters and we appointed loss assesors, they ripped out our floors and carpets put in dehumidifiers and then yesterday rejected the claim based on non disclosure - this was a completely innocent mistake and not at all misleading as we had thought that as there was no payment it means there is no claim, but they are not taking our point of view and all they have done since the Bgining of October is denied any communication or progress and now this, our Loss assessor (has advised us) he will see what they come back with on Monday as it is with their underwriters, he has said though that they will pay his contractors even if they deny our claim?? dont know what to make of what is going on, we are non the wiser now.

Have complained but not heard anything other than they can take up to 4 weeks to decide, so its the complaint about the progress that has led to the rejection in my opinion, I dont know where we stand!!

[josh]

Re: Insurance claim - rejected for non disclosure for a rejected claim 5 years ago

sorry building and contents claim, it was accepted 4 weeks ago and we were advised there would be excess of 250 each on buildings and contents, we put a complaint in, now this...................what on earth are these companies like, they state that the 2009 year has a claim so therefore may be invalid.

[josh]

Re: Insurance claim - rejected for non disclosure for a rejected claim 5 years ago

New Policy from 01/08/14

Claim in 2009 was in or around October 2009 but I had completely forgot, they wanted to know the names of all the insurance companies which we could not remember and then have been giving details as we have found them!

[josh]

Re: Insurance claim - rejected for non disclosure for a rejected claim 5 years ago

not sure if they can do this so any advice would be greatly appreciated

[des8]

Re: Insurance claim - rejected for non disclosure for a rejected claim 5 years ago

OK
IMO you have a good case to take this forward.
You did not realise that a claim which had been rejected still remains a claim.
In fact if you make a claim which is not covered by a policy you could argue that a non valid claim is no claim at all as it is an error.
If they continue to reject the claim on grounds of non disclosure, after you have exhausted their complaints procedure, refer to Financial ombudsman service.
Here's how they regard innocent errors: http://www.financial-ombudsman.org.u...disclosure.htm

The Consumer Insurance (disclosure & Representations)Act 2012 will apply here as if a misrepresentation is honest and reasonable the insurer must pay the claim. It is for the insurer to
show that a qualifying misrepresentation was deliberate or reckless.

[josh]

Re: Insurance claim - rejected for non disclosure for a rejected claim 5 years ago

OK
IMO you have a good case to take this forward.
You did not realise that a claim which had been rejected still remains a claim.
In fact if you make a claim which is not covered by a policy you could argue that a non valid claim is no claim at all as it is an error.
If they continue to reject the claim on grounds of non disclosure, after you have exhausted their complaints procedure, refer to Financial ombudsman service.
Here's how they regard innocent errors: http://www.financial-ombudsman.org.u...disclosure.htm

The Consumer Insurance (disclosure & Representations)Act 2012 will apply here as if a misrepresentation is honest and reasonable the insurer must pay the claim. It is for the insurer to
show that a qualifying misrepresentation was deliberate or reckless.

Hi Des8

within 14 days of taking the policy out I posted this letter with a note on the proposal form by post, they have ignored or not bothered to read this letter from me!

Dear sir

Please note as the proposal form was filled online at the Confused.com web site and for completeness, we attach our proposal form and ask that you check all the details and the claims history with your own records as I have filled out the details as best I can from memory.
I trust this is in order and should this present any problems please come back to me, and I will try and provide further details if and when requested by you, I accept the policy on this basis within the 14 days and have made full payment, and ask that this is noted.

Any comments appreciated

[des8]

Re: Insurance claim - rejected for non disclosure for a rejected claim 5 years ago

"Please note as the proposal form was filled online at the Confused.com web site and for completeness, we attach our proposal form and ask that you check all the details and the claims history with your own records as I have filled out the details as best I can from memory."
More indications that you were acting in good faith

See what the loss assessor comes back with on Monday.

Is the claim being handled by the insurer or a claims company?
Being nosey now, which insurer are you with?

[josh]

Re: Insurance claim - rejected for non disclosure for a rejected claim 5 years ago

Its being handled by a loss adjuster now then have gone into background and a claims manager is dealing with it, we appointed a loss assessor, to keep down the hassle and stress as I am in fulltime employment and look after a disabled person; but don't know if we did the right thing as all we seem to be doing is calling him and now he comes back with this....Its now gone to the underwriters - god knows what they will say.

ITS Sterling Insurance - via confused direct, never again!!

[josh]

Re: Insurance claim - rejected for non disclosure for a rejected claim 5 years ago

Can the insurance company start the work through contractors, like removing carpets and stuff making the house unsafe and then use the excuse that their underwriters are assessing if we are covered, due to a non paid claim which was not remembered (not paid) and then stopping all work, i HAVE put a complaint in last week and this is what has delayed the work and this comes up, as the matter was not being dealt with since 4 weeks since the incident.

How are we to live in the mess they have made and now stopped work do we have any remedy for this legally?

[des8]

Re: Insurance claim - rejected for non disclosure for a rejected claim 5 years ago

IMO, on the basis of what you have told us, the insurers are out of order.
1) you did not neglect to disclose a claim. If a claim is submitted which is not covered by the policy, there is no claim.
2)The incident was almost five years prior to the proposal to the current insurers. You asked them to check the record.You do not believe there was a claim, and obviously it was not at the front of your mind.
3) As per the 2012 Act, the onus is on the insurer to show any misrepresentation is deliberate or reckless.
4) To authorise remedial works BEFORE ascertaining if the claim is accepted, BEFORE checking the underwriting position, is reckless on the part of the insurer. I have never come across this situation previously, and I just wonder how the insurers can possibly justify making the house unsafe.
Was it made unsafe by the water damage caused by the burst pipe. or solely by the actions of the builders?
Is it actually unsafe, i.e. dangerous to live in, or just very inconvenient?
If it was rendered unsafe by the builders did the insurers arrange alternative accommodation for you?

At the moment nothing can be done. Wait until Monday and see what your loss assessor comes back with. It may well be that the insurers will reverse the rejection.
If they don't, you can take it from there.
Complaints to their CEO may be successful, but if not your eventual choice will be either the Financial Ombudsman Service (which is free, but takes forever) or county court claim (where there may be cost implications dependent on the size of the claim)

[josh]

Re: Insurance claim - rejected for non disclosure for a rejected claim 5 years ago

IMO, on the basis of what you have told us, the insurers are out of order.
1) you did not neglect to disclose a claim. If a claim is submitted which is not covered by the policy, there is no claim.
2)The incident was almost five years prior to the proposal to the current insurers. You asked them to check the record.You do not believe there was a claim, and obviously it was not at the front of your mind.
3) As per the 2012 Act, the onus is on the insurer to show any misrepresentation is deliberate or reckless.
4) To authorise remedial works BEFORE ascertaining if the claim is accepted, BEFORE checking the underwriting position, is reckless on the part of the insurer. I have never come across this situation previously, and I just wonder how the insurers can possibly justify making the house unsafe.
Was it made unsafe by the water damage caused by the burst pipe. or solely by the actions of the builders?
Is it actually unsafe, i.e. dangerous to live in, or just very inconvenient?
If it was rendered unsafe by the builders did the insurers arrange alternative accommodation for you?

At the moment nothing can be done. Wait until Monday and see what your loss assessor comes back with. It may well be that the insurers will reverse the rejection.
If they don't, you can take it from there.
Complaints to their CEO may be successful, but if not your eventual choice will be either the Financial Ombudsman Service (which is free, but takes forever) or county court claim (where there may be cost implications dependent on the size of the claim)

Thank you Des8

The fact is that the house was safe, they informed us that they would have to remove the ceramic floor tiles, to dry the concrete, they also removed the carpets as they were soaking wet, but in addition moved the stairs carpets as they said they were to be replaced, so they insurer instructed the assessor (whom we appointed) through their Loss Adjuster from Davies group to authorise removal.

It was only this Friday that they said there was going to be a repudiation of the cover due to non disclosure and it went to the Insurers.

I have a letter from the insurer confirming the following on Tuesday - then they stopped all work and the repudiation term came along, we have not been offered alternative accommodation at all, we have a disabled person at home whom we are having to follow all the time as there is no grip on the stairs for her to move up and down and its a hazard, the dust is all over the house from the tile floor cement, which is unstable.

This has been ongoing for nearly 5 weeks now, the floors dried and were ready for work 2 weeks ago!!!!

This is their letter - where they were still completing checks and confirmed the only issue was 2012 to 2013



Dear

I thank you for your email below forwarding the attachments. I have spoken to D insurance and they confirm that was with them from 14/08/11 to 14/08/12.


I just need confirmation of the insurers for the 2012-2013 year and the insurance history will be complete.

As explained it is a requirement of acceptance of the policy that the customer have un-interrupted cover prior to the Hastings policy. At the moment we do not have details of the insurers for the 2012-2013 year which indicates a gap in cover.

As you will appreciate, it is important that we receive confirmation of continuous cover and so look forward to receiving confirmation of the insurers for the period from 14/08/12 to 14/08/13.

I look forward to hearing from you.

Kind regards



BSc (Open), Cert CII | Claim Manager


so we trawled through paperwork and send them this information, they already have all this information on the Insurance Claims computers where they found the non paid claim from October 2009, so we don't know why they were asking us for these details in writing?

We have just had enough, sorry for my rant!

[des8]

Re: Insurance claim - rejected for non disclosure for a rejected claim 5 years ago

Can you either post up a copy of your proposal form and policy (suitably redacted) or put up a link to it on line.?