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common complaints and case studies

Jon

 

the accident wasn't my fault - so why is there "fault" claim on my records?"

Some people who contact us are confused that there’s a “fault” claim on their claims history - because they don’t think the accident was their fault. Some are surprised to find out that their insurer has settled a claim without telling them.

  • We think some complaints could be avoided by better communication. Under the terms and conditions of most motor insurance policies, insurers can settle claims without getting their customers’ permission. We’ve found insurers don’t always tell their customers what’s happened - leaving them surprised and upset when they find out.
  • We often need to explain that “fault claim” just indicates that the insurer hasn’t recovered the costs from the other driver’s policy. It doesn’t necessarily mean they think their customer is to blame for the accident. It just means they’ve looked at the evidence - decided they wouldn’t be able to defend the claim in court - and chosen to pay out rather than spend money fighting it.
  • If the insurer’s customer service has been poor - even if their decision to settle a claim isn’t unfair - we may tell them to pay compensation for any trouble and upset they’ve caused.

case study 1

When he went to renew his car insurance, Mr J found that there was a fault claim on his records. His insurer explained that they’d settled a claim for an accident in a car park he’d been involved in. But Mr J argued that the accident wasn’t his fault.

Both drivers’ versions of events were very different. But it didn’t appear the insurer had tried to find out any more about the accident. We didn’t think that the insurer had done enough to who was responsible - so we told them to change the Mr J’s records to show a no-fault claim.

Julie

 

my insurer shouldn't have settled the claim - the accident clearly wasn't my fault ...

Some people want us to get evidence about the accident - to prove it wasn’t their fault. It isn’t our role to investigate accidents and decide who’s responsible. But we’ll carefully look into the insurer’s decision - and make sure it was reasonable given all the evidence available. This evidence may include accounts from the drivers involved, witness statements, engineers’ reports and CCTV footage.

  • If we think it was unreasonable for the insurer to settle a claim, we’re likely to tell them to record to a “non-fault” claim instead. We’ll check whether their customer is unfairly paying more for their insurance - and if they are, we’ll usually tell the insurer to refund the extra money.
  • If the insurer’s customer service has been poor - even if we don’t think it’s unreasonable they’ve settled the claim - we may tell them to pay compensation for any trouble and upset they’ve caused.

 

case study 2

Mr M was involved in an accident at a roundabout. His insurer accepted an offer from the other driver’s insurer to split responsibility 50/50 - but Mr M didn’t think this was fair.

We looked at the evidence the insurer had used. The other driver had denied responsibility - and neither a loss adjuster nor an engineer hadn’t been able to decide who was responsible. In the circumstances, we thought the insurer’s decision to accept a 50/50 offer was reasonable.

case study 3

Mrs L told her insurer she’d had a minor bump with another car in a car park. The insurer agreed to contact her if they heard from the other driver’s insurer. Eight months later, when she renewed her insurance, she found her insurer had settled a claim.

The insurer had received a detailed engineers’ report about the accident - explaining the damage that had been caused. We thought it was reasonable for the insurer to rely on this independent evidence - but told them to pay £100 to make up for their poor communication.

 

Kevin

 

I've lost my no-claims bonus - but the accident wasn't my fault ...

Some people tell us they're unhappy they've lost their no-claims bonus - even though they don't think the accident was their fault.

  • We often find people have lost their no-claims bonus because their insurer has recorded a "fault" claim. And someone's premiums may also rise if their insurer has recorded a "no-fault" claim. This isn't automatically unfair. Insurers point to statistics showing that people who've had a "no-fault" accident are more likely to have a "fault" one.
  • We think some of these complaints could be avoided with better communication. That's because we often find that we need to explain what a "fault" claim means, or how a no-claims bonus (or discount) works. We've explained our approach to this common complaint.
  • If someone's unhappy that their insurer has settled a claim, we'll check the insurer's decision was reasonable. We've explained our approach to this common complaint.
  • Different insurers take different approaches to no-claims discounts - depending on the type of claim they've recorded. We'll check that what's happened to someone's no-claims bonus is in line with the terms and conditions of their policy.
  • If someone's no-claims bonus has been affected by a "no-fault" claim, we'll check whether the insurer clearly explained this could happen.

case study 5

Mr H’s car was damaged by a faulty car wash. The insurer recorded it as a “fault” claim and reduced Mr H’s no claims bonus.

We found that the insurer hadn’t asked for an engineer’s report until two weeks after the damage happened. The faulty car wash had been fixed by then. We didn’t think the insurer had done enough to investigate the claim - and told them to reinstate Mr H’s no claims bonus and record the incident as a “no-fault” claim.

Julie

 

I paid extra to protect my no claims bonus - but my premiums have still gone up ...

We hear from people who’ve paid extra to protect their no claims bonus - who are upset that their insurance premiums have risen after a claim.

  • Some complaints arise because people don’t know how no-claims discounts work. We sometimes find that someone’s no claims bonus has been protected. But the underlying cost of insurance has risen because they made a claim. They’re still getting the discount - but it’s being taken off a higher price.
  • We’ll look at the terms and conditions of the insurance policy and the no-claims bonus - and check that the insurer has applied them fairly.
  • It’s not our role to set insurers’ prices. But if they haven’t applied their price policy fairly, we’ll usually tell them to refund any extra money their customer has paid.
Kevin

 

I'm worried I've been a victim of insurance fraud - and my premiums will rise because my insurer paid out ...

Some people tell us they’ve been the victim of insurance fraud - and feel their insurer has paid out for a made-up or inflated claim. Some are worried that a large pay-out will result in a large increase in their insurance premiums.

  • In general, it’s the number of claims you’ve made - not the value of them - that affects your insurance premiums. We’ve found that knowing this can help put people’s mind at ease, even though they may still believe they’ve been scammed.
  • If someone’s unhappy that their insurer has paid out, we’ll look into whether the insurer’s actions were reasonable - given all the information they had. We’ve explained our approach to this common complaint.
  • If the evidence suggests that fraud was a possibility, we’ll check whether the insurer investigated further before deciding to pay out. If they didn’t, we may decide that it wasn’t reasonable for them to pay out.
  • There’s more information about insurance fraud - including “crash for cash” scams - on the Insurance Fraud Bureau’s website, www.insurancefraudbureau.org.

case study 6

After an accident with a motorbike, Miss F’s insurer paid the third party’s claim. But she said that the other driver was speeding. She was also suspicious about the other driver’s personal injury claim - saying she’d seen him walking around after the accident.

We could see that the insurer had looked at CCTV from the area during their investigation. The other driver’s insurer had provided expert medical evidence to support his claim. In light of this, we thought that the insurer had carried out a fair and reasonable investigation.

Julie

 

I reported a minor incident, but didn't make a claim - why have my insurance premiums gone up? ...

We hear from people who’ve reported a car incident, without making a claim - only to find their insurance premiums have risen. Some people tell us they feel like they’ve been punished for being honest.

  • Some insurers point to long-running claims data showing that people who’ve reported car incidents are more likely to claim in the future. So most insurers tell customers to report any incident they’re involved in - even if they don’t want to make a claim. If they don’t, the insurer may cancel the policy or refuse to pay a claim in the future.
  • If someone’s premiums have gone up after they’ve reported an incident, we’ll ask the insurer to explain why. We’ll also find out whether there was any other reason for the increase.
  • It’s not our role to tell insurers how much they should charge customers. But if we don’t think the insurer has applied their own price policy fairly, we’ll usually tell them to refund any extra money their customer has paid.

case study 7

Mr V reported incident with a cyclist to his insurer - saying he didn’t want to make a claim. But when his policy came up for renewal six months later, his insurer increased his premium. Mr V complained that his insurer had treated the incident as a claim.

We explained that insurers can to take incidents like this into account when deciding what premium to charge. But as six months had passed without any sign of a claim, we didn’t think that it was fair in Mr V’s case. So we told the insurer to change the record to “notification only”.

case study 8

Mrs M was accused of scratching a car. She told her insurer about the incident, but complained after finding out that they’d made a record of it on an external database.

We explained to Mrs M that it’s standard industry practice for insurers to record information about accidents and potential claims in this way. We checked that the incident had been recorded accurately - as “notification only”. After finding that it was, we decided that the insurer hadn’t acted unfairly.

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