Cancelled policy and car insurance etc

[the tinkerman]

Hi All

 

Was wondering if you could shed some light on this for a friend of mine please.

 

He had a accident and sickness policy cancelled by his insurer as they claim he did not inform them

about the date he started back to work hence they stated that they had over paid him.

 

He disputed this as originally he was told by one of their advisor's that if he went back to work on a phased return

the claim would continue so long as he did below 16 hours per week which he did for a month,

 

 

they stated he should still have informed them that he had gone back to work even if it was on a phase return,

he explained that this was not done intentionally as he had nothing to gain by not informing them

and it was just misjudgement on his behalf as did not think he needed to inform them

based on what their advisor had previously told him and

he only claimed for the month in which he was on phase return for under 16 hours and proved such.

 

They then sent him a letter stating that his policy had been cancelled but nothing about owing any money,

he decided to raise a complaint as he did not like the tone of their letter and what they were insinuating,

it was as though it was the crime of the century or something and he said If needed he would take this up with the FOS.

 

Next thing he know's he gets a letter from their complaint department stating that they have upheld their decision to cancel his policy

and would be also asking for recourse for overpayment and would be in touch in due course

( he thought Funny how they did not mention anything about recourse for overpayment in their cancellation letter,

but as soon as he raise a complaint and mentioned about going to the FOS)

 

We are talking about a couple hundred quid here at the most

which he said to the insurer just send him the bill and he will gladly pay it then he can take his case to the FOS,

 

 

5 months passed no bill arrived

 

 

he rang the same person from complaints to ask in light of his letter why had he not received a bill,

the advisor stuttered and said "oh its quite a long time ago and he would get in touch with the underwriter

and would ring him back ASAP,

 

 

couple of days went by no answer

 

 

he rang back, the advisor he spoke to was apparently on leave,

he was not happy about this as the clock was ticking for the 6 month period for him to complain to the FOS

 

 

so after a-lot of he wont get off the phone until he speak's to a manager he finally got to speak to one.

 

He explained the situation and low and behold he then gets a email from the manager the day after

stating that they are not taking the matter any further??????

 

My personal opinion is that they just wanted shut of him because he had been diagnosed as having degenerative disc disease

and they have tried their best to get off paying him in the first place

as they know from his consultants report that it is only going to get worse

 

 

to me this was a perfect opportunity to get rid so to speak,

also I reckon they were waiting until the 6 month period had elapsed before they sent him a bill

so he could not then complain to the ombudsman.

 

What he would also like to know is

does he now have to disclose this to other insurance companies

now like Car Insurance or home insurance etc.

 

Tinks

[BankFodder]

I think that this situation raises some problems.

 

Firstly, if they are refusing to insure him any further, then he is obliged to reveal this if he is asked whether he has ever been refused insurance by other insurance companies. If he failed to answer or if he failed to answer truthfully then this could prejudice any further insurances.

 

Secondly, because he has an existing medical condition, other insurance companies would probably refuse to insure him if that medical condition was part of the insured risk whereas under the insurance rules, is existing insurance company is obliged to keep on insuring him.

 

You are quite right to suggest that by taking the approach that they have, they are now in a position where they are not saddled with this risk.

 

The big mistake made by your friend is that he did not record the call. You should always record phone calls – always. You will regret it if you don't. If he had recorded the initial call then they would have been no problem. Now, although he has acted on the advice of the customer services representative, it is clear that they will deny this and he has no evidence to support what he says.

 

I think that this matter is serious enough that it is worth making a complaint to the ombudsman.

 

I'm not sure that the six-month limit operates yet because it is not yet six months from the end of the matter and also you haven't had their final response yet.

 

I would start off by getting a call recorder in place and then phone them and gently probing and raising the issue and getting to read out their screen notes to find out what they have. One of the things you need to find out is whether they do have a rule relating to phased returning to work for less than 16 hours per week. You need to find out what that rule is. I think that you should engage in a very gentle nonthreatening non-challenging discussion on the phone with them and hopefully you will be lucky enough to get one of their customer services reps to say things or to commit themselves while you are recording the conversation.

 

After that I would send them an SAR to see exactly what they've got. You will want to get things like telephone records and screen notes. Don't expect them to provide this to you immediately – you may have to chase them a bit.

 

At the end, I think that you should write them a letter and layout very carefully in chronological fashion exactly what has happened, how you have acted honestly at all times and in good faith. How you took the advice from one of their customer service representatives and that is the reason why they were not informed. How you immediately offered to refund on any overpayment and that offer is still open. How you consider that you have been treated unfairly and that if they will not reverse their decision to provide you with insurance then you want to begin a formal complaint to the ombudsman.

 

If you are lucky enough that you can get some useful information in a recorded call then come back here and we will help you take a different and slightly more aggressive approach