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Ash
Ash, Solicitor
Category: Law
Satisfied Customers: 10916
Experience:  Solicitor with 5+ years experience
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Insurance company has verbally denied my claim loss

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insurance company has verbally denied my claim for the loss of wedding rings. We recently took out the policy, 3 months ago, prior to a trip to NY for my husband’s 40th. The rings were lost after i put the rings in the pocket of a bag (as we intended to go swimming with our 2 young children). My plans changed and we went to London instead to visit my mother, momentarily forgot about the rings and later found the rings were not in the bag. The loss adjuster has alleged that the version of events i initially gave when I logged the loss with The AA was different to a later version of events i provided to the loss adjuster (who is an outsourced company called I-cog services employed by The AA) who called me to take proper details of how the loss occurred over the phone the call and questions lasting 45 minutes.
My version of events were not different, the only difference that was noted was when i made the initial call to The AA I had said that I had put the rings into the outside pocket of the 'backpack', however when the loss adjuster called me to take in detail of how the rings were lost, I had said that I had put the rings in the outside pocket of my 'bag'.
When questioned why I had said a different type of bag on my initial call, I explained to the loss adjuster that at that specific time of my initial call which was less than 24 hours after I realised the rings were missing I had thought I had put them in the outside pocket of the backpack, but 4 days later during my appointment call with the loss adjuster I had more time to think and was sure I had not put them in the backpack pocket but my bag pocket.
I also gave a reason as to why I was sure also.
The second difference of events which i said when i initially called to log my loss with The AA, is that i said 'We had went swimming', and when I actually meant to say 'We had prepared to go swimming'. I started to explain to the lady when I initially called the AA to log the loss exactly what had happened, but she interrupted me and said it was not her that would take the full details of how the loss happened and that someone will call me.
On my call with the loss adjuster 4 days later on the Thursday, I explained in detail and the whole truth as per to my best knowledge of what had happened, that we had prepared to go swimming hence the reason for taking off the rings etc. I did not at any point change my story of events or say a completely different story.
My argument is that, it is irrelevant whether I had gone swimming or gone to my mother's house, or whether I put the rings in the outside pocket of the backpack or the outside pocket of my bag, the rings are lost.
If they are trying to insinuate that I am making a fraudulent claim then from what I said in my initial call does not put me at any advantage of my claim being more successful than what I said in my actual call with the loss adjuster. If I had gone swimming how would that make my claim more likely to paid out? Or if I had put the rings in the outside pocket of a backpack rather than a bag, how does put me more of an advantage of having a successful claim? It does not. So how can my claim be denied on what basis? As it is clearly evident that my motives of saying what I did were not to any advantage to me, so hence not fraudulent in anyway, just a use of the wrong words.
As far as I am concerned, I was in a very distraught and upset frame of mind when I first contacted the AA as we had just lost our wedding rings, which were very sentimental to us and actually not any amount of money could ever replace the loss we have occurred.
However I have been made to feel like a criminal by the insurance company and considering myself of my husband have no previous convictions or been committed for fraud of any type, this kind of treatment is unacceptable.
It is understandable that when a person looses something, if they knew exactly how and when it was lost and be 100% sure then it wouldn't be lost in the first place.
The loss adjuster said that they cannot understand how the rings fell out of the outside pocket of the bag and that as I had said a different bag In my initial call and said we went swimming that this is misrepresentation which is fraud and she will advise the insurance company to deny my claim.
If Intended to defraud my insurance provider surely I would have calculated my responses etc but I didn't.
What I want to know is that can they deny my claim on this basis and accuse me of fraud? and do they have solid grounds on this basis to do so? I can't see how they can, but please do let me know as I want to complain about this treatment. We have never made a insurance claim before in our lives and have no criminal convictions or been done for fraud previously either.
Submitted: 1 year ago.
Category: Law
Expert:  Ash replied 1 year ago.
Hello my name is ***** ***** I will help you.Does your policy say that you must have the rings on you, ie not leave them unattended?What is the value of the rings?Alex
Customer: replied 1 year ago.
Value of both rings combined is £2,500.Below is what my policy says about loss of valuables.Section 3 – Accidental loss or damage cover for valuables, personal belongings and money
This section is an extension to Section 1 – Contents and is automatically included if section 1 is held. Your Statement of Insurance will show the amount insured under this section.
What is NOT covered
1 The first £100 of each incident of loss or damage unless
otherwise stated in your Statement of Insurance.
2 Contact lenses.
3 Shortages of money due to clerical or accounting errors and/or omissions.
What is covered
1 Valuables and personal belongings which belong to you or
which you:
n are responsible for under a hiring or legal agreement; or n have in your custody and are legally liable for.
The most we will pay for any item, collection or set is £5,000.
2 Valuables and personal belongings that are owned by
you and are in the custody or control of any member of your family whilst they are living away from your home in Halls of Residence or any other term-time student accommodation, providing the student still has their permanent address at your Home.
The most we will pay for any item, collection or set is £1,000.
3 Your money up to £1,000.
Where they are covered
1 Whilst in your home, and anywhere in the world in your
custody or control.
But the most we will pay for any one claim caused by theft or attempted theft from an unattended motor vehicle is £2,000.
Customer: replied 1 year ago.
I have just add my policy booklet here as a file for you to see.
Expert:  Ash replied 1 year ago.
What is the cost of replacement rings?
Customer: replied 1 year ago.
Well I guess it would be the same as what I paid for them £2,500 combined. They were bespoke made to order rings and I have provided the Insurance company with the certified valuation certificate from the Jeweler who made the rings for us.
Expert:  Ash replied 1 year ago.
You have two options, to complain to the Financial Ombudsman or go to Court.You can try the Ombudsman first as this is a free option. They are available at: www.financial-ombudsman.org.ukIf that does not work then you can take it to Court.You need to write and set out your losses and request a refund within 14 days or say you will go to Court within 14 days. You should make sure you send this signed delivery and keep a copy.If they do not refund you then you can issue proceedings in the County Court. You can either do this online at: www.moneyclaim.gov.uk or by completing form N1 http://hmctsformfinder.justice.gov.uk/courtfinder/forms/n001-eng.pdf and take it to your local County Court.The Court will then issue a claim which a copy will be sent to the Defendant who will have a limited time to defend it, if not you can enter Judgment and enforce.If the claim is for £10,000 or less it will be a small claim so you will not need legal representation. Over this value you would need representation for trial.Can I clarify anything for you about this today please?Alex
Customer: replied 1 year ago.
But what about the loss adjuster said about me saying a different bag I had them in to her compared to the person who logged the call and that I went swimming but I meant we had prepared to go swimming. And how that's missrepresetation and basically implying I'm fraudulent and that she will tell the insurance company to deny my claim? What about all of that, where do I stand in regards ***** *****?
Customer: replied 1 year ago.
And sorry I didn't understand, ask for a refund of my policy premiums or the value of the rings to the Obudsman or court?
Expert:  Ash replied 1 year ago.
The difference is minimal - you know what you said. So try the Ombudsman first and then sue if necessary. You sue for the replacement cost and that would be against the Insurance Company.Does that clarify?Alex
Expert:  Ash replied 1 year ago.
Alex
Customer: replied 1 year ago.
I know the difference is minimal, but the loss adjuster was adamant that due to this my claim can be denied and that how I've broken the law and get done for that as they have the phone call recordings of what I said.
So that is not true then?
I can't get be accused of fraud or missrepresetation by the Insurnace company based on what I said?
Expert:  Ash replied 1 year ago.
I dont see how you have. Its something which is slightly different thats all. If they have a recording they should provide it to you.No you can't get accused of fraud because of what they said - there has been no finding and its not a material difference.Does that help?Alex
Customer: replied 1 year ago.
Last question please - I haven't had confirmation yet in writing that my claim is denied, however when I do get that, from what I have told you and after reviewing my policy do you agree they can't deny my claim on missrepresentation then? And if they do on that basis I have a good chance of winning if I take it further?
Also according to my policy can I state to them it doesn't matter how I lost the rings, it's that the rings are lost and I have to provide proof of ownership? Is that correct?
Expert:  Ash replied 1 year ago.
Correct, as you have not had insurance refused. I agree you have a decent chance of winning.You need to provide some evidence of ownership, ie receipt, card statement etc.Does that help?Alex
Customer: replied 1 year ago.
Yes that helps, thank you very much.Once I get written confirmation of the outcome of my claim from them I will come back to you if I need further assistance or book a phone call with you.
Expert:  Ash replied 1 year ago.
Yes you can.AlexIf this answers your question could I invite you rate my answer before you leave today.I am only paid for my work on this question if you rate my answer, using the star system at the top of the screen. Please do not forget! Thank you.Please bookmark my profile if you wish for future help: http://www.justanswer.co.uk/law/expert-alexwatts/
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