What comes after the ombudsman?

[t1grm]

Hi all,

my car was written off by flood damage February last year.

I disputed the insurers valuation with the ombudsman after getting nowhere with the insurers own complaints procedure.

 

The ombudsman upheld my complaint and in November last year I got a cheque from the insurance company but it was well short of the settlement recommended by the ombudsman.

 

I did not cash or bank the cheque and referred the issue back to the ombudsman.

Since November they have been chasing the insurance company for clarification of how they came to the amount on the cheque but so far they have not responded.

Every time I email the ombudsman they say they are waiting to hear back from the insurer.

 

It seems to me that the insurance company regards it as a closed case because they have issued a cheque and the ombudsman regards it as a closed case because I accepted their recommendations (which as far as I am concerned the insurance company hasn't fulfilled).

 

if the ombudsman is getting nowhere

what options do I have apart from taking the insurance company to court?

 

It's a pretty sad state of affairs when the insurers start ignoring the ombudsman.

[BankFodder]

You say that the ombudsman made recommendations. Does this mean that these were recommendations made by an adjudicator or that it was a decision made by an ombudsman.

Which insurer are you dealing with? How much are we talking about here? What is the value of the cheque that they sent you?

[t1grm]

Not sure. I assume it was made by the ombudsman. I don't recall anyone mentioning an adjudicator. I'm expecting about £879 and the insurance company has sent a cheque for just under £453.

[BankFodder]

Well I have you got a copy of the letter in which the ombudsman made the recommendations? Is there a letter accompanying the cheque from the insurer?

Please put them up here in scanned PDF format

[t1grm]

Yes I have the pdf but how do I redact personal info?

 

Attached is the letter from the insurer.

 

Below is the text of the ombudsman findings.

 

By my calculation the minimum settlement should be:

Ombudsman's lower valuation threshold: £21,000

Less payment already made to leasing company: £19,770.38

Less policy excess: £350

Amount outstanding: £879.62

Amount offered by insurance company: £453.23

Shortfall: £426.39

 

Quote

"Mr XXXX complaint against AXA Insurance UK Plc
My understanding of the complaint
The consumer’s car has been deemed a total loss and he’s unhappy with the valuation amount offered. His car was valued at £20,200. Given it was a lease car; the insurer paid the finance company £19,770.38 which was the settlement due amount.
AXA didn’t give the consumer the remaining amount. Mr XXXX disagrees with this decision and believes he’s entitled to it under the policy terms and conditions.
He also says the valuation of the car is wrong. As far as he’s concerned he needs to be awarded £21,000 and £21,480 respectively which is what he says the car is worth.
He wants the remaining amount to be refunded to him.
My findings
I’ve now investigated the complaint looking at all the evidence and information available.
Where there is a dispute about a car valuation we use Caps, Glass and Carzana to check the market value of the car at the time of the incident.
The incident took place on 24 February 2019 and from the information I have, the mileage at the time was 14,000. I’ve placed these details on the sites and the market value of the car was £22,874 at its highest and £21,000 at the lowest. With this in mind, I’m satisfied that the valuation amount should be between these figures.
I’m unsure as to why AXA valued the car at 20,200. I imagine the reason why they’ve got this figure was because they added the wrong mileage on the system. In Copart’s report, it states the mileage of the car was 23,000. However, from Hopers report and by looking through the notes, it appears that the mileage was 14,000 which is what I’ve used in my valuation. The value we use is the market value of the car.
I’ve then looked at the policy terms and conditions to understand what the insurer said it will do where the valuation is higher than the finance settlement amount. In the terms and conditions under the heading ‘if your car is a total loss’ it states:
‘If our estimate of the market value is more than the amount you owe the finance or leasing company, we will pay you any remaining balance of the agreed settlement. If our estimate of the market value is less than the amount you owe the finance company, you may have to pay them the rest of the agreed balance.’
In light of this, it’s clear that the agreement was for the insurer to pay the consumer the remaining balance where the market value is more than the settlement amount. Given that’s the case in this situation, it’s fair for the insurer to pay Mr XXXX the remainder of the valuation amount.
So for this reason and the reasons explained above, I recommend AXA:
1. Value the car between £21,000 and £22,874
2. Pay the consumer the remainder of this amount after deducting £19,770.38 ( the settlement figure)from it"

 

Quote

 

 

letter.pdf

[BankFodder]

I don't understand why you have taken the lower value. I think you should take the midpoint. Please monitor this thread for a full reply tomorrow

[BankFodder]

also it's not clear whether this letter is from the ombudsman or the adjudicator. This is why we want you to put up a scanned copy

[t1grm]

I'm not accepting the lower value. I was just using it as an illustration to point out why I think their calculation is wrong. At this stage I just want an explanation of how they have come to the number they have done but I can't even get that out of them.

 

Thanks for the feedback so far. I'll wait to see what pops up tomorrow.

 

27 minutes ago, BankFodder said:

also it's not clear whether this letter is from the ombudsman or the adjudicator. This is why we want you to put up a scanned copy

 

This was a pdf from the ombudsman as an attachment on an email.

There is no heading or mention of an adjudicator. 

It's just plain text.

I'll have a look at how I can redact it and post it tomorrow. 

[BankFodder]

Send an sar to the insurer and send an sar to the ombudsman.

[t1grm]

SAR sent to both. I also chased the ombudsman and emailed the insurance company again for what good it will do. I am wondering whether it is worth returning the cheque uncashed to the insurer with a covering letter explaining the reason I am rejecting their settlement and asking for a break down of the figures. Or would that just confuse things now I've sent the SAR?

[BankFodder]

No. You must keep the cheque

[t1grm]

Noted. Thanks.

[t1grm]

So allowing for postage and Easter it's been a month since I sent the SAR's and no response from either Axa or the Ombudsman. I guess given the current situation I should give them more time to respond? I'm still not clear how this is going to help me move my case forwards.

[t1grm]

Just to update.

 

I got paid by Axa after I threatened to take them to small claims court.

I never got a response to the SAR from the ombudsman.

The SAR from Axa didn't really help.

The ombudsman never responded to any of my communications.

It seems the ombudsman only issues judgement but it's down to the individual to enforce them.