HI!

I was google searching for mishandled claims by the NU and came across your posts.

I was hit from behind in an RTA in Dec 04 by a driver who was insured by the NU. They acted very promptly in the first instance, writing to me and arranging medical care for my injuries.

However I dislocated my shoulder during the accident and this went undiagnosed at A&E. I finally got surgery to repair my shoulder in April 2008, three and a half years after the accident, which I had done on the NHS because the NU failed to get my injury diagnosed. (After one year of physio which did not resolve the issues, they paid for me to see a Consultant who confirmed I had disruption to the AC joint, but the NU would not pay for me to have an ultrasound - which was the tool that finally found the problem but not until January 08).

The way they have handled my case has been appalling. My files moved location at least three times in the first year. On the many occassions that I spoke with them in that first year, they were unable to locate my files or tell me who my case handler was.

I also escalated my case to the CEOs office, where I ranted and cried at them until some action was taken, but even this action did not deliver any benefit to me.

I am seeing them in court next month to settle the claim, but much of my claim hinges around loss of earnings, which occured throughout the period that I was injured. However they are stating that they are only responsible for my time off work directly after the accident and directly after my surgery.

I have tried and tried to get them to take responsibility for the delays in getting my diagnosis and to cap it all I now have to read insulting statements levied against me - whilst they accept no liability whatsover for the disruptions to my life in the four years it has taken to get to this point.

Does anyone know anything about the Onbudsman or any body that I can contact to formally register my complaint against them, given that they are not interested in hearing it?

Any information that anyone has would be most welcome.

WalkingATM:

Here's a further update

My claim has now been settled by NUD and in addition, a rather over worked but extremely curtious and helpful lady from the Complaints Department rang me and we have finalised the complaint too.

Overall, it took 13 weeks to get to this point so I would advise anyone contemplating using NU, to think long and hard about that "Quote me happy" quote and consider the hidden costs and inconvenience you may encounter if, in the unfortunate event, you have to make a claim.

Hiya WalkingATM,

Excellent news in the end then! With any company, they would always like to avoid a complaint made to the ombudsman because it costs them money! Threatening them with this can sometimes be effective but not always practical if there are surrounding factors as to why there is seemingly more time being taken with your case. The Financial Services Authority also have strict guidelines as to how a claims department should operate and how claims are settled. For this reason alone you will probably see the fall of smaller companies with many being fined for inefficiency. I agree that those reading this should reconsider 'Quote me Happy' and I have tried, in vain, to inform readers of this on here previously. Sometimes this just falls on deaf ears and people are completed blinded by an attractive price/benefits when, in fact, it really is like the Nationwide advert with the fishing rod and hook!

RE:
>And one final note from me to Coyote and S_Whitie, if two people, who appear to be extremely knowledgeable about the claims
>management side of the industry, can have such different interpretations, what chance the man in the street? A case for the "plain
>english" cause perhaps?

Hallelujah! A very good point and I appreciate you pointing it out. You'll be pleased to know that insurers have come a long way with their plain English jargon and documents; and will continue to do so as part of a long operation to make insurance as transparent as possible.
The problem is, insurance isn't easy. It's not easy for the insurance professionals to understand sometimes and it certainly isn't easy for Joe Public. It's taken me literally thousands of hours of studying to fully understand insurance and appreciate the need for it - not only as a protection and peace of mind, but also for the economy. Without insurance in the UK, no-body would have any money, there would be no such thing as banks and catastrophes' would go be left un-cleared.

The Chartered Insurance Institute (CII) have regular surveys regarding professionalism in insurance. My personal view is that every telephone agent in a call centre should have attained at least CertCII level before continuing to discuss insurance, and that a broker should have DipCII or ACII with or without Chartered Status. Then, of course, the next level FCII - maybe with MSc in Risk Management. Unfortunately if you telephone places like Elephant, Direct Line, or any of the other shoddy companies out there for example, then you will not find any of them with this sort of qualification!

I'd personally like to speak to somebody who has a clue rather than a teenager fresh from secondary school operating a switch!

Thanks for coming back to let us know ATM, good luck with it all!!

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Coyote

> Can you provide a link to the documentation which states NU's definition of fraud please? >> No, because as far as I know this is not > published on any external website, sorry.

Well, can you provide the document ID number from Norwich Union so that I may take a look?


>I think this has gone on long enough now. Take a moment to read the thread from start to finish with a view that my comments are
>speaking about insurance claims in general terms. I would not and never have declined a claim due to a minor innocent
>misrepresentation.

Forgive me, but this is nothing more than 'stating the bleedin' obvious'. If YOU read the post thoroughly, we have already discussed that the reason you would not and never have declined a claim due to misrepresentation is because you are unable to do so and any party victim to this type of disregard from the insurer should seek assistance with the Financial Services Authority. You are correct in saying that this has gone on long enough, but clearly not long enough. You, as a claims manager of 6 years, are still struggling with the difference between misrepresentation and insurance fraud. How do you expect to be taken seriously or to expect other members to understand the methods and mechanics to insurance when you are providing incorrect advice?!

>It is clear to me that you have spent a lot of time researching and studying the information available on the internet. You might be
>interested to know that insurance companies will spend the time and money (even in low value claims) to prove if a claim is
>fraudulent.

LOL. Again, stating the bleedin' obvious. This has nothing to do with misrepresentation so you are veering into same depths of abyss as you have in your previous posts. The claims advisor must be satisfied with many different aspects of the claim such as ensuring the party had financial interest in the vehicle at the time of loss; that the claim is valid through an insured peril, that the claim amount seems reasonable in-line with the value insured (could amount to fraud if investigated);- amongst eight other things.

I'd just like to point out that I've spent very little time researching and studying the information available on the internet. I actually know what I'm talking about but I spent less than three or four minutes and found links available to point the readers in the right direction rather than being led up the garden path!

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Coyote

Here's a further update

My claim has now been settled by NUD and in addition, a rather over worked but extremely curtious and helpful lady from the Complaints Department rang me and we have finalised the complaint too.

Overall, it took 13 weeks to get to this point so I would advise anyone contemplating using NU, to think long and hard about that "Quote me happy" quote and consider the hidden costs and inconvenience you may encounter if, in the unfortunate event, you have to make a claim.

And one final note from me to Coyote and S_Whitie, if two people, who appear to be extremely knowledgeable about the claims management side of the industry, can have such different interpretations, what chance the man in the street? A case for the "plain english" cause perhaps?

Thanks anyway, I have enjoyed reading everyone's comments.

Can you provide a link to the documentation which states NU's definition of fraud please?

No, because as far as I know this is not published on any external website, sorry.

I think this has gone on long enough now. Take a moment to read the thread from start to finish with a view that my comments are speaking about insurance claims in general terms. I would not and never have declined a claim due to a minor innocent misrepresentation.

It is clear to me that you have spent a lot of time researching and studying the information available on the internet. You might be interested to know that insurance companies will spend the time and money (even in low value claims) to prove if a claim is fraudulent.

s_whitie:

It is very different to work in the insurnace industry and deal with these claims on a day by day basis and to sit there and copy and paste text or provide links to websites.

I take it that from being "qualified" that you are a policyholder that took on an insurance company after having a claim turned down and for your own benefit I take it you won.

NU's definition of fraud is "the intention to deprive the insurance company of money or services that it is not entitled to"

Take from that what you will

No, your assumptions are incorrect. I'm not a policyholder that took on an insurance company after having a claim turned down. As stated, I pay a 'proper premium' to a decent insurer and have no problems whatsoever. When I say 'qualified' I mean extensive studying, courses and examinations - several of which in the topic being discussed.

Can you provide a link to the documentation which states NU's definition of fraud please? Either way, it makes no difference because there is no fraud involved by not declaring modifications on a vehicle. This is a breach of utmost good faith and dealt with entirely differently and the claim cannot be repudiated.

I'm not sitting here copying and pasting from websites. I'm giving my response and backing it up with fact as per the Financial Ombudsman and the Financial Services Authority. So far we've just seen your opinion which, as I said, is a little alarming when a fraud claims manager says that misrepresentation and non-disclosure is fraud. It's at the other end of the spectrum.

Sorry to take a proverbial 'pee' on your parade but I think the issue is quite important. Believe me, I completely understand that some people just try it on and are blatantly avoiding the premium and this should be dealt with in a harsher manner but the fact of the matter is, it isn't. Currently. You'll find that the FSA's clampdown on Treating Customers Fairly (TCF) will only aid the guilty parties! Watch this space. By this time next year there will be increase costs in claims. Mark my words...

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Coyote

It is very different to work in the insurnace industry and deal with these claims on a day by day basis and to sit there and copy and paste text or provide links to websites.

I take it that from being "qualified" that you are a policyholder that took on an insurance company after having a claim turned down and for your own benefit I take it you won.

NU's definition of fraud is "the intention to deprive the insurance company of money or services that it is not entitled to"

Take from that what you will

--So, you are telling me that if a policyholder insures a vehicle as being a standard model but then when a claim arises that vehicle
turns out to be heavily modified and they claim the higher value, that they are not trying to obtain a monetary advantage?

I'm telling you it's not fraud to insure a vehicle that is heavily modified and not declaring it. The policyholder is not looking to make a claim and insures the vehicle with slight good faith, just not adhering to 'utmost good faith'. You go on to use a different variable ie. 'and they claim the higher value'. This COULD amount to fraud if it is intentional and proven as such.
The onus of proof is on the insurer to prove that the insured is trying to claim for more than entitled. If the policyholder has purchased and insured Vehicle A stating a value of £3000 but a standard model costs just £1000, but he/she tries to claim for £3000, then this is not fraud. If the policyholder purchased and insured Vehicle A for £1000 but tried to claim for £3000 then this could amount to fraud, but the insurer would need to prove intent and will request documentation. ie. The vehicle could have been in a poor condition, but it may have been fully restored (still to the manufacturers standard) thus increasing the value after purchase. For more about this, please see the link as previously posted: http://www.financial-ombudsman.org.uk/publications/ombudsman-news/21/insurance-fraud.htm

-- Very True, but this taken as a last resort when fraud cannot be proven.

Well, yes, that's what I said 'again where fraud is suspected but not proven'.

-- I understand both sides of the argument fully, the one thing I am unsure on is as to whether you are an insurance professional or a disgruntled policyholder - no offence intended but they are clearly two different standings.

Hmm, well I'm quoting ICOBS and have stated that I'm qualified to speak about the issue. No offence taken, but I'm very much far from a disgruntled policyholder. I choose my insurer's VERY carefully and never have a problem with them! As per WalkingATM, you do get what you pay for!

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Coyote

Coyote, for a start I am in no way or never had implied that this case is one of fraud (I’m sure you will tell if I am wrong).

Fraud is "intent to deceive and desire to induce the firm to pay more than it otherwise would". Misrepresentation and non-disclosure falls into the utmost good faith category. They may be obtaining a service by deception (at best) but certainly not fraud as there is no monetary value involved for a payout!

So, you are telling me that if a policyholder insures a vehicle as being a standard model but then when a claim arises that vehicle turns out to be heavily modified and they claim the higher value, that they are not trying to obtain a monetary advantage?

Sometimes insurers will pay a claim but will not offer to renew a policy, again where fraud is suspected but not proven. This is a valid contractual right that insurers have but an option that needs to be weighed against the knowledge that it will be very difficult, if not impossible, for the customer to obtain insurance cover again.

Very True, but this taken as a last resort when fraud cannot be proven.

(1) non-disclosure of a fact material to the risk which the policyholder could not reasonably be expected to have disclosed; or

(2) non-negligent misrepresentation of a fact material to the risk; or

Again, true but in these cases the ND/MR is minimal and would not normally take my option 2. We would look to settle on 3 or 4.

I've had time to re-read plenty of the comments from start to finish. I'm not unclear at all... are you?

I understand both sides of the argument fully, the one thing I am unsure on is as to whether you are an insurance professional or a disgruntled policyholder - no offence intended but they are clearly two different standings.

s_whitie:

Coyote, I'm intrigued. What exactly is your professional background?

The four options I listed are the options available to an insurer on the grounds of misrepresentation. Yes innocent misrepresentation is not a case of insurance fraud but deliberate misrepresentation or nondisclosure is. In a case of proven insurance fraud I wouldn't even need to refer to any of these options, I would just chuck the claim out on the basis of it being a false claim.

I have in none of my comments said that innocent misrepresentation leads to a repudiated claim other than option number 2. Please, if you have time, read all the comments from start to finish and if you are still unclear then feel free to ask me any direct question to a point I have raised.

My professional background is irrelevant but I'll just say I'm 'qualified' to speak about the issue being discussed. You state that you are a claims fraud manager. You should know that deliberate misrepresentation and non-disclosure is NOT insurance fraud. The two are COMPLETELY different. Fraud is "intent to deceive and desire to induce the firm to pay more than it otherwise would". Misrepresentation and non-disclosure falls into the utmost good faith category. They may be obtaining a service by deception (at best) but certainly not fraud as there is no monetary value involved for a payout!

To quote from Financial Ombudsman website, "The fact that members of a firm’s staff are personally satisfied of the claimant’s bad faith is not sufficient proof of dishonesty.". Please may I take this opportunity to refer you to http://www.financial-ombudsman.org.uk/publications/ombudsman-news/21/insurance-fraud.htm

Sometimes insurers will pay a claim but will not offer to renew a policy, again where fraud is suspected but not proven. This is a valid contractual right that insurers have but an option that needs to be weighed against the knowledge that it will be very difficult, if not impossible, for the customer to obtain insurance cover again.

In addition, please refer to the following Insurance Code of Business

ICOBS 8.1.1 R
1An insurer must: 3) not unreasonably reject a claim (including by terminating or avoiding a policy)
ICOBS 8.1.2 R

A rejection of a consumer policyholder's claim is unreasonable, except where there is evidence of fraud, if it is for:
(1) non-disclosure of a fact material to the risk which the policyholder could not reasonably be expected to have disclosed; or

(2) non-negligent misrepresentation of a fact material to the risk; or

(3) breach of warranty or condition unless the circumstances of the claim are connected to the breach and unless (for a pure protection contract)

In the case of the OP, the insurer would NOT repudiate the claim. When it comes to modifications, it is very hard to prove that the insured had any knowledge of a modification. It is almost nye on impossible unless thorough investigation into the insured's history were to be carried out and it could be proven that he/she has more than the 'average' knowledge in motor vehicles. A bodyshop/garage/mechanic would have more knowledge about motor vehicles than an administration assistant etc.

I'm not disputing that you could just 'chuck the claim out on the basis of it being a false claim' in a 'case of proven insurance fraud', but this is not the issue. The loss in this case is not fraudulent and the claimant does not stand to gain financially.

In the case of WalkingATM, we are talking about non-disclosure not insurance fraud, so I have no idea why we are veering into the depths of insurance fraud...? Without wishing to sound rude, I find it quite shocking that a 'Claims Fraud Manager of 6 years' doesn't know the regulatory definitions and differences between Misrepresentation/Non-Disclosure and Fraud. It's a little worrying to say the least!

I've had time to re-read plenty of the comments from start to finish. I'm not unclear at all... are you?

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Coyote

Coyote, I'm intrigued. What exactly is your professional background?

The four options I listed are the options available to an insurer on the grounds of misrepresentation. Yes innocent misrepresentation is not a case of insurance fraud but deliberate misrepresentation or nondisclosure is. In a case of proven insurance fraud I wouldn't even need to refer to any of these options, I would just chuck the claim out on the basis of it being a false claim.

I have in none of my comments said that innocent misrepresentation leads to a repudiated claim other than option number 2. Please, if you have time, read all the comments from start to finish and if you are still unclear then feel free to ask me any direct question to a point I have raised.

.

.

I think we are going round in circles here.

Options 1 and 2 (as stated) would not happen. The claim wouldn't be declined on anything other than fraud. As a claims fraud manager of 6 years, I'm sure you will be familiar with the FSA regulations and also that misrepresentation is NOT insurance fraud and the intent would have to be proven clearly in a court of law. This particular case would not go that far.

RE Comment:
"You will be surprised with the number of times we have asked the previous keeper and they tell us they told the policyholder but they have then failed to disclose this to the insurer.".

Again, you will not be able to refuse the claim on a third party's say so, unless it is clearly documented that the vehicle is modified. Even then, it would be hard to prove that the insured has deliberately not told the insurer about this as they may not have read the previous history on the vehicle. The document would need to be signed to have any glimmer of proof that the insured was in full knowledge of it's modification.

RE Comment:
"One point is that the majority of these cases are blatent modifications ie spoilers, engine size increases, body kits being added etc. Now don't tell me that you look at a car like this and think "ahh thats nice, that must be just how they roll of the production line!"

Are you saying collectively or as one? I know a lot of people that used to own Ford Escorts. From the production line they didn't have a rear spoiler or alloy wheels. Any person working on the project of making these vehicles could tell you this. However, none of them knew that the rear spoiler was a modification and three out of four didn't even know what an alloy wheel was. In actual fact, they said almost exactly what you have cynically pointed out ie. 'ahh thats nice'! Onus of proof; and very hard to do!

WalkingATM (OP), I appreciate this thread was originally formed to discuss the merits of Norwich Union and their claims handling, but this has been discussed in it's entirety, with advice given regarding this. Both S Whitie and I picked up on your comment about one agent claiming the car has been modified and your failure to declare it. I'm sure you appreciate the great importance of such an issue. I am in FULL agreement that you get what you pay for and to watch out for the 'low quotes', and I commend your efforts at letting the others on the board know about it. Norwich Union are not the best insurer out there; especially with household insurance !!

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Coyote

Fair point WalkingATM, you not these forums are like, it starts as helpful advise and before you know it there is a side debate going on (no offence intended, I enjoy a good debate as much as the next person).

Hope you get somewhere soon. To be honest these things can normaly be sorted out pretty quickly by speaking to the right people. If a claim is being investigated then a claims handler has taken that decesion, speak to them or there manager to get an update, it's the least the can do. If not a call to the Chief Exec office should sort things out.

I had a similar problem with NU a few weeks ago and got it sorted in 2 days.

Good luck

All

I am all for a robust discussion regarding the merits of claims handling and validation, but this thread was aimed at discussiing the length of time taken by Norwich Union to process the claim and not the validity of the claim itself. "What would a reasonable person expect" is probably the answer I was seeking and probably that vast majority who may also be looking for clarification.

However, your comments make interesting reading for anyone who buys a car with a new set of tyres, mags, seat covers, tinted windows, a new air filter, etc, in fact anything added that is not factory fitted, not just body kits, free flowing exhausts, etc. It would appear to me that the insurance companies could use any of the above to repudiate a claim on that basis.

Hopefully, if you start a thread about car modifications, with all your comments attached, it may bring clarity to others who might be in the same boat.

Coyote:

s_whitie:

"it wouldn't be fair to assume that every person paying a higher price for a vehicle should be aware that their vehicle could be modified. Such a suggestion is a little absurd. "

re your comments, why would the vehicle be at a higher price. Surely you would question this when you buy the vehicle otherwise you would go for the cheaper of the two vehicles? At the end of the day you are paying for the vehicle and having to insure it, make sure you know what you are buying (buyer beware)

I agree it is not common for insurers to pursue a policyholder to refund a TP claim but that is each and every insurers option to pursue if they wish.

To be honest I have dealt with quite a lot of cases like this and have always said, if the vehicle is modified and the policyholder is innocent of misrepresentation then we deal with the claim on the basis the premium is adjusted to reflect the insured vehicle's Correct specification.

I understand people will say that it is not the policyholders fault that he did not know what the vehicle was but why should the insurer pay for their mistake. They are only pricing the policy on the information given to them so if that information is wrong then as far as I am concerned why shouldn't the insurer adjust the premium before dealing with the claim?

"re your comments, why would the vehicle be at a higher price. Surely you would question this when you buy the vehicle otherwise you would go for the cheaper of the two vehicles?" Are you being serious? Some people will only go to look at one car and buy it at the asking price, some will haggle, some will look at 30 cars before making a decision. It may not be on price that the vehicle is chosen, it could be a number of factors. My point was that the insurer cannot repudiate a claim stating "you could have got 'X Car' for £100 cheaper 3.5 miles down the road. You MUST have been aware this was modified. We're not paying out". I'm sure you appreciate the point that's being made. Yes, if the information is wrong then the insurer shouldn't pay for a mistake. The problem is who's mistake? It's not the insurer's because they were not informed by the insured, the insured may not have known about it, etc. The chain is far too long and there is no 'negligence' as such as it's not a requirement to let the buyer beware and, again, it would be unreasonable for a person without knowledge of cars to know such information. They should pay the premium for that modification/modifications as if it were before policy inception; or taken out of the claim payout. The problem comes when that insurer would not cover the modification in the first place; they may need to make an unusual exception in this circumstance and compromise with the insured.

My point was that the insurer cannot repudiate a claim stating "you could have got 'X Car' for £100 cheaper 3.5 miles down the road. You MUST have been aware this was modified. We're not paying out".- No I never said that

I said - To be honest I have dealt with quite a lot of cases like this and have always said, if the vehicle is modified and the policyholder is innocent of misrepresentation then we deal with the claim on the basis the premium is adjusted to reflect the insured vehicle's Correct specification.

They should pay the premium for that modification/modifications as if it were before policy inception; or taken out of the claim payout. The problem comes when that insurer would not cover the modification in the first place; they may need to take an unusual exception in this circumstance and compromise with the insured.

I previously said -

They then have 4 options:

1. the misrepresentation was deliberate to obtain a cheaper premium. This could lead to them cancelling your insurance and declining the claim.

2. the misrepresentaion was not deliberate but had they know the facts they would not of insured the car. Again the claim will be declined.

3. As 2 but the would of insured the vehicle at a higher premium. In this case they will deduct the increase in premium from the value of the vehicle.

4. no further action is required.

If you read all of the above then I think you will see that we are both saying the same thing. My point is that as a fraud manager I know that I can write to the previous keeper and asked them for a history of the vehicle. If they tell me that the vehicle was modified then why can't the policyholder ask the same question when buying the vehicle. You will be surprised with the number of times we have asked the previous keeper and they tell us they told the policyholder but they have then failed to disclose this to the insurer.

One point is that the majority of these cases are blatent modifications ie spoilers, engine size increases, body kits being added etc. Now don't tell me that you look at a car like this and think "ahh thats nice, that must be just how they roll of the production line!"