Financial Obundsman process- advice please?

[Michen]

Has anyone done this ref an insurance company disputing the claim? I won’t bother explaining the circumstances but my vet wrote a cracking letter and is strongly disagreeing with their decision. They have reviewed and their vet disagrees with mine.

I am very happy to invest a few hundred quid if needed to get another vet opinion On my side- would this be helpful? Would it help if I got more than one?

The amount is circa 2/3k and I don’t want to throw good money after bad but I am convinced they should be paying this claim, as is my vet, so I think it’s worthwhile. Their latest letter condradicts itself throughout and misses out various points my vet has raised.

Any tips on the process gratefully received, I wasn’t going to push it further as frankly for the money I wasn’t sure it would be worth the hassle, but actually- I do not feel this should simply be “accepted” in hindsight.

 

[Sandstone1]

Not insurance but have had a complaint go through the ombudsman. It was fairly straightforward. You firstly put in a complaint with the company concerned and give them a chance to put it right. If not happy with the answer you get you take it to the ombudsman. You can do it online. They will ask you for all info. They then give the company a chance to answer the complaint. If the ombudsman does not agree they then tell the company what they need to do to put things right. It does take a while but its worth it. Of course the ombudsman will not always find in your favour. Its free though so certainly worth doing.

 

[Bernster]

No direct experience in the insurance context but have some experience of similar processes/contexts.

1 Check your insurance companys internal complaints process as you may be expected to exhaust that first or at least can explain why you haven’t done that, or why it’s not appropriate to do that.
2 Im sure you’ve don’t this but obv there is quite a lot of into online about the process. It’s intended to be something anyone can access and therefore not overly complex, although if you’re not familiar it may seem a bit daunting getting your case together.
3 I wouldn’t normally expect you’d need a 2nd opinion for your complaint. If you want to, yes it would add to your case but generally they seem to evaluate your info v the insurance co and take a view based on that, rather than looking for any expert third party type opinion. That would be more relevant for a court case.
4 Get your case together, this will be largely a paper exercise so make sure you’ve got really good notes etc to evidence your case.

 

[paddy555]

1 Check your insurance companys internal complaints process as you may be expected to exhaust that first or at least can explain why you haven’t done that, or why it’s not appropriate to do that.

this.
Call up their web site and you should find it. You may have to complain to the person dealing with the claim, then to their manager and finally to the ombusdman. Different firms have different complaint procedures.
If you can't find it e mail them and ask them to give details of their complaint's procedures.

 

[sherry90]

Currently going through the process with Petplan. Ombudsman is painfully slow due to Covid but worth doing, nothing to lose.

 

[Fluffypiglet]

I work in insurance and am well aware of complaint resolution requirements. You need to ask your insurers to give their Final Response to your complaint (they have 8 weeks to do this where you have lodged a complaint against their decision) and advise that you will go to the FOS at the point of 8 wks whether they have concluded their investigation or not as is your right. If you only ask them to review their decision it might not be considered a complaint and doesn't start the clock ticking for them to issue their final opinion. FOS only become involved after a Final Response has been issued by the insurer and FOS is free for you, the insurers will get charged a case fee. As mentioned above, you have nothing to lose by taking this route.

I have to caveat this with the fact that I have no details of your claim nor equine insurance. But this is the general info about getting a complaint to the FOS. The FOS are not qualified vets so will review it to ensure policy terms have been fairly applied.

If the FOS did not find in your favour you don't have to accept their ruling and you could then try to send in more info to them to see if that would alter their opinion.

Good luck.

 

[Fluffypiglet]

PS, the FOS website is quite useful ...

 

[Melody Grey]

Not equine insurance, but experience of pursuing a bank for mis-selling a loan on solar panels. Painfully slow (even Pre-Covid) but I did get there in the end in my favour. My complaint was literally open for 18 months on the grounds that there were other similar complaints they wanted to look into before responding to them all with the same approach/ ruling.
It’s the end of the line in dispute resolution, so I’d still go with it if your insurer doesn’t respond adequately. You have nothing to lose, just expect it may take time.