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Kasare
Kasare, Solicitor
Category: Law
Satisfied Customers: 1301
Experience:  Solicitor, 10 yrs plus experience in civil litigation, employment and family law
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HelloRE: Financial Ombudsman Complaint - UKI recently made

Resolved Question:

Hello
RE: Financial Ombudsman Complaint - UK
I recently made a complaint to an Insurance Company in the UK Allianz Insurance PLC, regarding their refusal to pay out on a claim I had made. They provided me with a final response on 7th August 2014 however contained in their final response letter they stated that if I could collate further evidence to support my claim they would reconsider their final response.
In their final response letter they quoted that "As per our discussion today, we will put on hold our decision to decline the claim and will consider this further if you are able to present any further evidence to show the property was occupied within 30 days prior to the loss although, should no additional evidence be available we will be unable to consider our position any further"
I then spent some time collating further evidence but they still refused to pay out on my claim. Therefore on the 9th February 2015 I sent my complaint to the Financial Ombudsman 3 days over the 6 month time limit originally stated in their final response letter, as it was clear we were not going to be able to resolve this matter directly with Allianz. Unfortunately the Financial Ombudsman have confirmed that the complaint should have still been received within the 6 month time limit from the the final response letter from Allianz even though they had continued to correspond with me in regards ***** ***** evidence provided. Therefore my understanding when I received Allianz's final response was that I could accept their decision or put a complaint in to the Financial Ombudsman within 6 months or alternatively supply further evidence in support of my claim and that Allianz's final decision was on hold until they had further considered any addition evidence I supplied to see if they would reconsider there decision.
Does the 6 month rule still apply in these circumstances?
Submitted: 2 years ago.
Category: Law
Expert:  Kasare replied 2 years ago.
Hi, thanks for your question, I will assist you with this.
I can see your problem but you should not let their initial responses deter you.
The Ombudsman's complaints-handling rules are set out in the Financial Conduct Authority (FCA)'s handbook of rules and guidance. Their website states "If the consumer fails to refer the complaint to us within six months, it is unlikely that we will be able to consider the merits of their complaint." - note the "unlikely".
So whilst the rules state that they cannot consider a complaint referred more than six months after the date on which the financial business sent the consumer its final response your position is that this was not the final response.
Nevertheless, there are also exceptions to this 6 month rule. They can consider the complaint if they consider that your failure to comply with the six-month time limit was "as a result of exceptional circumstances", or if the financial business does not object.
I would suggest that you revert to the Ombudsman and inform them that in light of the Insurance Company's letter of 7 August you do not consider the 6 month period commenced until the letter declining the claim after you submitted further evidence, or that alternatively, the fact that you are 2 days outside the period, given the additional provision of information to the Insurance company and waiting for their further "final" response to fall within their exceptional circumstances provision to allow them to investigate.
I hope this assists. Any further questions, please ask.
Customer: replied 2 years ago.

Thank you that is vary helpful.

Kind regards

David

Expert:  Kasare replied 2 years ago.
Not a problem David - if you need anything else, please ask.
please do not forget to rate my answer before you go!
Many thanks
Kas
Kasare and other Law Specialists are ready to help you
Customer: replied 2 years ago.

Dear Kasare



I would like you to answer another question that I will be happy to pay another fee for.



Another issue has arisen about the date and how I was informed about the Final offer, and the final offer its self.


On the 7.8.14 the insurance co phoned me and informed me of their decision that they would not be paying out on my claim and they would be sending to a final offer letter to me stating this.


The date I gave you before 7.8.14 was the date they phoned me and the date the letter was dated, but I did not receive the letter until after the 12.8.14 as I had emailed my insurance broker telling him I had nor received anything yet.



I sent by recorded delivery post, my complaint to the ombudsman on 9.2.15 it was delivered on 10.2.15,



so if you take the time from when I received the letter to when the ombudsman received my complaint it is within the 6 months.



so what is the official stand point in this case


Does the phone call constitute me receiving their final response?


Or must I receive it in writing?



Is it the date the letter was written on or the date i received it?



Kind regards



David




Expert:  Kasare replied 2 years ago.
Good morning David
I would argue that the letter was the final offer/decision. In legal disputes this is usually considered to be received 2 days after the date of the letter, but if you can show that this was not received, by way of your email chaser until after 12.08.14 then I would advise the Ombudsman that your letter was in fact received within their 6 month limit.
But I would also recommend that you use the "In the alternative that you consider the date of the telephone call to be the date of the final decision..." - and then go on with the information I provided above.
Does that help? If you have any other concerns or queries, please ask.
Thanks
Kasare
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