Home Insurance Companies and the Ombudsman, Are they Honest

Home Insurance Companies and the Ombudsman, Are they Honest

Todays blog is about insurance companies providing home insurance and their relationship with the ombudsman. Are loss adjusters trying to save money for the insurance company? does the Ombudsman side with the Insurance companies? lets look at my experience recently.

This has come about after dealings iv had with them both over a recent property damage claim. my case findings will be published on the Ombudsmans website. Im not going to name anyone or the companies involved but what i will do is give you some interesting information on the process iv been involved with and tips at the end for if you ever have the misfortune to have to claim.

This article is based on a home insurance claim but it can be used as a yard stick for any claim.

In November 2016 one of my properties became available and damage was noted inside. I thought some of the damage was malicious and also water damage. I had a broker who i was using, but in the first instance upon digging out the property insurance details i ended up phoning the insurance company direct and they  made an appointment for a loss adjuster company to come.

When i did contact the broker to complain they told me that the particular loss adjusters had a lot of complaints against them and they would have brought in a different company if i had contacted them in the first place.

I met their surveyor at the property which was full of the previous peoples furniture and belonging, it also had no power on in the middle of winter. He had a look around and took some photos and less than 25 minutes later he was away.

Alarm bells rung for me when he said it looked like the radiator had leaked in the front room. I said the tenants would have called our management company if it had leaked they would not fix it themselves. It turned out the door had been kicked in and bent out of shape allowing rain water in. This was one of the points of contention as water had damaged the flooring in the front room and run down into the converted basement directly below the front damaged door and ruined the ceiling and walls below.

From this point we were in dispute and countless emails between me and the loss adjuster began and after a while he had taken a personal dislike to me which was commented by the ombudswoman as being un-professional. So in a matter of a week I went from valued customer paying our premiums on time to enemy No 1 and suspected fraudster. I know this is hard to hear but this is what happens, as soon as you make a claim these companies do not trust you. You are suspected from day one and treated like the enemy The worst thing is the loss adjuster who looks at your claim, he for some reason is able to pay you by cheque if it is under a certain amount im guessing at £5k. Do you think like me that there is a chance they will not pay you out for everything you are entitled to?

So 6 months down the line we got 3 offers and because the property was falling into more and more disrepair we had to take £4,600.00 which allowed us to do get the work done and get some more tenants in. The insurance company said we had delayed doing the work. they also said we could have done the work in 2-3 weeks. I made it clear though i would be making a complaint to the ombudsman.

A month after i made the initial claim, sods law happened and the insurance renewal came through, I contacted our broker and told them in no uncertain words we did not want to go with this company again. Our reply from the broker was “you have no choice”, no other company will take on the property while you have an on going claim”, I protested and said this just cant be right, thats like having a monopoly. We had to pay the premium in the end, but after speaking with people it turns out that this information was wrong. After arguing with them later on in the process I was asked to use another broker and take all the properties we had with them to someone else, (so we have a separate case to be taken out against the broker).

When we had renovated the property and got in new tenants i filled out the forms and opened the process with the Ombudsman. this is where we had problems.

When you start the case with the ombudsman it is not made clear that the first point of contact is someone who works for the ombudsman office. so for the first 3 months i assumed this was the ombudsman, the process was taking months and i kept complaining and emailing the guy until one day he phoned me. while speaking with the guy he said that the ombudsman always sided with the insurance company because they have professionals working for them. I was taken aback by this and said how can this by fair and independent.

I though i would be ok being a qualified damp surveyor, structural waterproofer, HNC, having professional qualifications so i set about writing a letter about how the transfer of moisture affects walls in buildings and asked for the original surveyor to produce his qualifications that were relevant to the survey he had conducted. Then a few weeks after this conversation the person I was dealing with at the ombudsman service was mysteriously taken off the case and i was appointed a new office worker who had to go through everything from the case.

I complained and told them the new person would cause further delays, so then the ombudsman service offered me £300 and i declined it. I told them about the conversation and that i was concerned the service would side with the insurance company. Fortunately all conversions are recorded and the manager who is an ombudsman listened to it back, the problem was she was just dismissive over it saying the person who said it was being re-trained. I had a massive lack of confidence and the stress was building.

I kept making it clear that i was not happy and asked for other information and evidence to be forthcoming from the insurance company but it was coming up to christmas and the office worker from the ombudsman service was now putting pressure on me so she could give her final decision. A week after christmas we got her decision even tho we wanted more evidence looked at and guess what, she sided with the insurance company on everything except a couple of months loss of rent which the insurance company did not even mention to us, even tho we were covered for it in the policy.

So i declined and sent her an email saying why i disagreed with her findings and the service in general only to receive a generated email saying she had left the service. I was speechless, you couldnt make it up. So then i had to wait for the Ombudsmans decision, which took another 8 weeks.

In the ombudswomans findings she sided with the insurance company on everything except the loss of rent. with this we were given the full months and interest of £300 which seems to be a standard payment from these. I wrote a response email going through every point but to no avail. In total we had been awarded another £4,000.00 and  £400 for the delays at the ombudsman service.

The ombudswoman in her summing up had made assumptions all along and based her conclusions on her own experiences.

One classic was that anti mould paint was no more expensive that ordinary paint and that it was not needed in water damaged properties as standard. I sent her 2 pictures of the 5ltr paint on sale, the ordinary was £10 and the anti mould paint £43.69 plus vat, this is over 70% difference.

The other was that water would not come through the door and leak through the laminate floor. I pointed out that there was a step and the skirting was there, the flooring is packed off the wall so water runs straight down but it was dismissed.

One last one of many was the wall plaster in the kitchen. she said she had seen the photos and although the wall looked wet it would dry out. I pointed out to her that the surveyor had not done his job right and not taken moisture readings so we did not know how wet the wall was or what type of plaster it was. this wall had had a chimney breast taken out in the past and when wet salts migrate to the surface.

My main issue all along was the initial survey that was not carried out correctly by the loss adjuster. The Ombudswoman just wanted to look at the clauses in the schedule, what we were and were not  covered for, she did not take into consideration the initial flawed survey. If this was a police case in court it would have been thrown out. As a damp surveyor we have certain information that have to be in a report and survey.

The insurance company never sent through what qualifications the loss adjuster had. They just said he had 15 years experience in the field. This part was dismissed by the Ombudswoman and for me it was pivotal to the case and confirms that they favour the insurance company.

I believe the loss adjusters over look things and do not give the claimant everything they are entitled to. In this case they never mentioned the loss of rent to us that we were covered for which ended up at over £3,500.00. but what they also did was to try and blame me their former customer for they delays in the procedure which was nonsense. All the delays were on their part and this was in sending over evidence asked for. There were 2 crucial parts that never materialised yet the case was heard without them. I believe that is bias on the side of the insurance company by the ombudswoman who herd the case.

Conclusion

In my experience this has happened twice and i cant help but wonder about the millions of cases where pensioners and people without my knowledge and cynicism are just accepting what these companies say and as a result take it as read that they dont have a claim or can only claim for this or that.

This may seem like a strange post to put for some but if you have ever had an insurance claim you will know what im talking about. This is the second time I have used the ombudsman service for a water damaged property and the first time the loss adjuster came out and told us we were not covered at all. The property was on 4 floors and had a burst pipe on the top floor in the freezing winter. the property had only just been decorated for new tenants.

After a few letters back and forth as well as phone conversation it was clear they were trying to get out of it. It took a year but we were eventually paid out £17,500 and £500 as a good will gesture. It seems a lot but we had to carry out the work ourselves in the first few months and did the work on a small budget as quick as we could, the real cost to the insurance company would have been around £40k so the got away with that one too because we did the work ourselves using stock materials.

If you have to claim from the insurance company you can follow the guide below to have a better chance of justice.

1 Record every conversation you have over the phone or on site, use the memo app on your phone when the representatives come to survey the damage or at meetings, it may seem covert but you need to remember exactly what has been said. answer only minimal questions, let the loss adjuster do the talking.

2 Take as many photos as you can and even videos as proof of the damage from the first time you see it.

3 Read through the terms and conditions of your schedule before the loss adjuster comes to see what you are covered for.

4 Do not take the word of the loss adjuster that you are not covered for certain things. If you think you should be covered argue your point via email. If you are not confident look on google there are people who will represent you with your claim and they will not charge you. They will get the work carried out for you and their fee comes out of the claim money.

5 Do not automatically think that the Ombudsman service is neutral, treat the claim like a job or a game. You have nothing to lose in using the service and anything you get awarded is a bonus if you feel hard done by.

6 Use qualified  professional experts if possible to comment on your claim the more the better.

7 Use your email correspondence as evidence and send them all to the ombudsman service.

8 Be very patient and remember this will be a long drawn out process, make sure you let the service know how stressed you are and how it is affecting you at every chance. Email them every couple of weeks to find our what is happening. remember only you care about your claim to them they do this as a job.

9 Take it to the wire if you are not happy but dont let your ego get the better of you and end up in court. This is a free service so you have nothing to lose, but if you are not happy you can always go to court and decline to accept the final decision. Just remember the Ombudsmans decision would be taken into account by the judge. There would be only one winner after that, the solicitors. If you agree with the ombudsmans findings you will be bound by them and the only re-course is to write a blog or contact a consumer group about your experience.

They do send you out a survey form that you can fill in.

In Summery

This is a huge problem that needs to be looked into closer. I think lots of people have been affected over the years and currently and it is worrying what the ombudsman worker said to me about the ombudsman siding with these insurance companies. This was not an off the cuff remark, the person called me to tell me. It needs some under cover reporting by watchdog or consumer programmes to get to the bottom of this.

I see they can set up cowboy builders to snare rogue traders so lets have a house with some water damage and get these loss adjuster round and see what happens, or do they think this is not in the publics interest.

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