Other Insurance co want money back

[LDFerguson]

First, I'd read through the policy conditions to establish whether or not the policy you have should have paid you or not. If not, then you have a decision to make as to whether you feel it's right to (a) keep the money that was paid to you by mistake or (b) pay it back.

Assuming your choice is (a) you need to write a letter to the insurance company, sending it by registered post and clearly stating the following: -

(1) Their agent advised you that the policy would pay out even if you were in receipt of sick-pay. (If you have this in writing, all the better. If not, just be as specific as you can about what was said, dates etc.)

(2) You disclosed fully the fact that you were in receipt of sick-pay on the claim form and yet they paid out the claim.

Based on the above, you do not feel you have any obligation to repay the claim payments.

Tell them that this is your final position on this matter and that you want a Final Response Letter from them, because if you are not happy with their reply, you will be bringing your complaint to the Financial Services Ombudsman. You cannot go to the Financial Services Ombudsman until you have received a Final Response Letter from the insurance company.

 

[martindfs]

First, I'd read through the policy conditions to establish whether or not the policy you have should have paid you or not. If not, then you have a decision to make as to whether you feel it's right to (a) keep the money that was paid to you by mistake or (b) pay it back.

Assuming your choice is (a) you need to write a letter to the insurance company, sending it by registered post and clearly stating the following: -

(1) Their agent advised you that the policy would pay out even if you were in receipt of sick-pay. (If you have this in writing, all the better. If not, just be as specific as you can about what was said, dates etc.)

(2) You disclosed fully the fact that you were in receipt of sick-pay on the claim form and yet they paid out the claim.

Based on the above, you do not feel you have any obligation to repay the claim payments.

Tell them that this is your final position on this matter and that you want a Final Response Letter from them, because if you are not happy with their reply, you will be bringing your complaint to the Financial Services Ombudsman. You cannot go to the Financial Services Ombudsman until you have received a Final Response Letter from the insurance company.

LD thx for your reply. under the policy T&C's i should not have recieved full premium but only part as this is totally their error and over the past 8 months they never once asked me was i or not recieveing sick pay other than on the claim form. i have evidence that i declared sickpay as i copied that initial claim form which states the fact clearly.

their agent who no longer works for them clearly stated this but i do not have it in writing. i do however have the original forms from that day and he didnt even fill out the details. i have 2 forms which he signed and gave to me, he took the monthly premium of E85 and off he went.

thank god i copied everything for my own records from day 1 and honestly i think this insurace co are trying to kid people. in order for me to recieve my monthly premium i had to get my GP to fill out a continuation form and then this would be assesed by the insurance assesor, if they were happy with the claim details then payment was made but this form would also have to be signed by my employers stating that i was off due to injury etc but that was it.

any other advice would be appreciated LD and if i am totally at fault then i will pay back every penny without hesitation but i clearly am being bullied by this co. i have the forms filled out and ready to be posted to financial ombudsman but after reading your post ill hold off and wait for their final response.

****just recieved a call from the insurance co who are trying to assist me. they are getting onto the underwriters and i clearly stated my intentions and the bullying tactics in which i am going through. i hope this can be settled in the right manner as i have a strong case

 

[LDFerguson]

their agent who no longer works for them clearly stated this but i do not have it in writing.

It's irrelevant that their agent no longer works for them. Assuming he was an employee of theirs at the time (as distinct from a self-employed broker) then he was speaking on behalf of the company. So it was "the company" who gave you this verbal assurance at the point of sale. And the company is still around. If writing to the Ombudsman, make a clear reference to this conversation including as much of what was said as you can remember and pointing out the date and approximate time of the meeting at which it was said.

 

[martindfs]

It's irrelevant that their agent no longer works for them. Assuming he was an employee of theirs at the time (as distinct from a self-employed broker) then he was speaking on behalf of the company. So it was "the company" who gave you this verbal assurance at the point of sale. And the company is still around. If writing to the Ombudsman, make a clear reference to this conversation including as much of what was said as you can remember and pointing out the date and approximate time of the meeting at which it was said.

LD thx you for the advice. illl wait to see what this company come back with today because ive the evidence to really take this on and to show that i personally have done nothing wrong

 

[Seagull]

At worst, you'd have a case against them of misselling, in that their agent told you something which they are saying is untrue.

 

[Guns N Roses]

under the policy T&C's i should not have recieved full premium but only part

It would appear that according to the Term & Conditions your Insurance Company overpayed you and you owe them the balance.

Whether or not it's worth their while to pursue for the money is another matter.

 

[martindfs]

It would appear that according to the Term & Conditions your Insurance Company overpayed you and you owe them the balance.

Whether or not it's worth their while to pursue for the money is another matter.

GNR i agree totally but i was misinformed by their agent who totally give me untrue information regarding the policy. they trained this agent and its their responibility to investigate him as he was great at talking and wheeling n dealing sort of an agent.

also it took them 8months to ask how much sickpay was i getting. their assesors must get a slap also as i have declared everything from day 1 and hid nothing

 

[Guns N Roses]

mathpac, its the money and stress involved in using a solicitor. i would rather try and do it myself as i have all copied documents to use in my favour.

It sounds like you're more stressed handling this situation by yourself.

Hiring a solicitor is the only realistic option for you now!

 

[martindfs]

It sounds like you're more stressed handling this situation by yourself.

Hiring a solicitor is the only realistic option for you now!

im not stressed im just furious and will defend myself to the best possible manner as this company is totally unprofessional and have clearly messed up

 

[dereko1969]

I didn't think you could go to the Financial Ombudsman until all dispute resolution procedures in the company were finished with first?

I would clearly state as others have said that
- you specifically raised the issue of whether this policy would provide you with an additional amount to the sick pay you would receive from your employer and their employee stated that you would;
- you would not have taken the policy out if you had known that this was not the case (mis-selling on their part);
- at all times you have been honest and filled in all the forms that they provided you with, so obviously their procedures for monitoring claims are poor as this "issue" should have been spotted at the time the first claim was submitted

Then see what they say.

To be honest with you, I really don't see why you're not getting your union's legal team involved in this. Was this insurance bought through a group scheme in work? If so, then obviously there will be a significant number of your colleagues in the same position who may also have been mis-sold policies.

 

[Time]

I didn't think you could go to the Financial Ombudsman until all dispute resolution procedures in the company were finished with first?

Once you have a final response you can.

 

[martindfs]

I didn't think you could go to the Financial Ombudsman until all dispute resolution procedures in the company were finished with first?

I would clearly state as others have said that
- you specifically raised the issue of whether this policy would provide you with an additional amount to the sick pay you would receive from your employer and their employee stated that you would;
- you would not have taken the policy out if you had known that this was not the case (mis-selling on their part);
- at all times you have been honest and filled in all the forms that they provided you with, so obviously their procedures for monitoring claims are poor as this "issue" should have been spotted at the time the first claim was submitted

Then see what they say.

To be honest with you, I really don't see why you're not getting your union's legal team involved in this. Was this insurance bought through a group scheme in work? If so, then obviously there will be a significant number of your colleagues in the same position who may also have been mis-sold policies.

a few of us joined together but outside work and we all met with the agents one on one. their proceedures are very very bad. the job i had getting money from them in the first place was rediculous as i had to get alot of info for them and as well as being seriously injured i co-operated in full and produced all releant info in which they requested.

 

[elcato]

I presume you have stopped the policy and premium payments. It appears that they are no use to you as you gain nothing even if you are sick.

 

[martindfs]

I presume you have stopped the policy and premium payments. It appears that they are no use to you as you gain nothing even if you are sick.

Elcato, i am paid up fully till 19th of this month. they have not paid me since january 2012 and i was told to keep premiums up till im back at work which will be next week. during an interogation by their assesor on tuesday she told me that they will not be paying me any longer and they will be running this past their legal team.

they are recording all telephone conversations but i am still stressing the obvious that i have outlined from post #1. they are really trying to use bullying and scare tactics but im standing firm on this as i have evidense of zero wrong doing on my behalf and thank god i have copies of eveything!

 

[dereko1969]

Once you have a final response you can.

How is that different to what I said originally?

 

[elcato]

they are really trying to use bullying and scare tactics but im standing firm on this as i have evidense of zero wrong doing on my behalf

How are they bullying you ? Asking for a refund is hardly bullying. They appear to have missold you a policy at worst. Given that the assurance that sick pay was not an issue was purely verbal means that they could be just as well within their rights to say it wasn't said - Just playing devils advocate here, not saying it didn't happen. You have stated that the form has the evidence that you have informed them of the sick pay is good enough for you to state that you are not willing to refund the money on the grounds that the policy was missold. Inform them of this in writing and ask them for a final reponse and leave it at that.

 

[martindfs]

How are they bullying you ? Asking for a refund is hardly bullying. They appear to have missold you a policy at worst. Given that the assurance that sick pay was not an issue was purely verbal means that they could be just as well within their rights to say it wasn't said - Just playing devils advocate here, not saying it didn't happen. You have stated that the form has the evidence that you have informed them of the sick pay is good enough for you to state that you are not willing to refund the money on the grounds that the policy was missold. Inform them of this in writing and ask them for a final reponse and leave it at that.

this week a senior assesor phoned me. i quickly realised that there was not only her questioning me and the tone of the questioning changed rapidly as i could give exact detail etc in regards to my claim. at 1 stage i stated that i felt threatened by her questions and tone and also i stated that i felt as if i was getting interogated by not only her but other people sitting with her.
i stated everything in which i did and i backed up all information with clear evidence on my behalf.i will wait for their response before i do anything else. she said that the case would be run past their legal team and that does not phase me at all.

if however i have done anything fraudulantly i will pay back all monies in full but i really havent done a thing wrong. i have given exact info to them from day 1 and i think this company and their staff need to change the way they sell and assess claims.

 

[martindfs]

guys got phone call friday from the insurance co's complaints department. they are still investigating but certainly not closed. at this stage what should i do? sit back and wait for a their decision?

 

[LDFerguson]

Tell them that when they do eventually decide what they're doing, to put it to you in writing and that you want their letter to state that it's their final response. If you're not happy with what they do, you can't take it to the Financial Services Ombudsman without a final response letter.

 

[Time]

The OP is really pandering to the insurance company by his soft approach by phone. Everything should be in writing. He really needs a written final response. They will avoid issuing one for as long as they can if the OP does not press them.