Insurance claim query
Discussion
Hi Guys,
If anyone with insight to the insurance industry could comment on this, I'd be most grateful.
We have a somewhat complex situation following a house fire at my parents home. My father passed away as an indirect result of this, this happened in May.
Prior to the fire, my mother cared for my father who had numerous health issues, she is 84, and was coping well, although needed help with shopping and tasks she as 'paperwork' as is perhaps understandable.
The house was uninhabitable, and post fire she stayed initially with my sister. Outside of her familiar environment it became clear she struggled and at times she was unsafe (not being able to work my sisters cooker, and leaving it on for example) - typically behaviour of the elderly when removed from a familiar environment.. For this reason we moved her to a care/ respite home in the first week of July where she seems happy. We believe if she was back in her own home things would improve.
The problem I have is with the alternative accommodation payment from the insurance.
The insurance policy states that they will provide like-for-like accommodation. The house is a 4 bed/ 2 bathroom house which would rent for about £3000 /month (unofficially (for now) confirmed by an estate agent).
They have offered £1800, which in the area would get you a 2 bed flat of maybe a small house. RIghtmove shows one property for rent that is 'similar' although not detached which is £2995/ month.
I spoke to them and they explained by like-for-like they mean accommodation that would meets the needs of the residents. They actually gave the example of meeting additional costs for pets or carers.
My argument is that this is not like-for-like, and further, the financial ombudsman states that like-for-like would for example be the costs for a property with the same number of bedrooms/ bathrooms.
The care home costs are way above 3K/ month, and we are not trying to claim this, just what the house would rent for, which would help us out.
My other argument that my mothers needs have changed as a direct result of the fire, which is therefore an insurable loss. They (as above) stated that they would provide accommodation that meets the needs of the residents, yet appear to be refusing to do so, although as I mentioned, we are not trying to claim this, just the like-for-like rental value of the house.
Have I got any chance here of arguing this, if I'm barking up the wrong tree fair enough, but I really don't have the energy at the moment to take on something that has no chance.
The house is nearing completion in terms of renovation, just the flooring and blinds/ curtains to go, and then get all the contents back - so I'd image 2 months.
Thanks in advance.
If anyone with insight to the insurance industry could comment on this, I'd be most grateful.
We have a somewhat complex situation following a house fire at my parents home. My father passed away as an indirect result of this, this happened in May.
Prior to the fire, my mother cared for my father who had numerous health issues, she is 84, and was coping well, although needed help with shopping and tasks she as 'paperwork' as is perhaps understandable.
The house was uninhabitable, and post fire she stayed initially with my sister. Outside of her familiar environment it became clear she struggled and at times she was unsafe (not being able to work my sisters cooker, and leaving it on for example) - typically behaviour of the elderly when removed from a familiar environment.. For this reason we moved her to a care/ respite home in the first week of July where she seems happy. We believe if she was back in her own home things would improve.
The problem I have is with the alternative accommodation payment from the insurance.
The insurance policy states that they will provide like-for-like accommodation. The house is a 4 bed/ 2 bathroom house which would rent for about £3000 /month (unofficially (for now) confirmed by an estate agent).
They have offered £1800, which in the area would get you a 2 bed flat of maybe a small house. RIghtmove shows one property for rent that is 'similar' although not detached which is £2995/ month.
I spoke to them and they explained by like-for-like they mean accommodation that would meets the needs of the residents. They actually gave the example of meeting additional costs for pets or carers.
My argument is that this is not like-for-like, and further, the financial ombudsman states that like-for-like would for example be the costs for a property with the same number of bedrooms/ bathrooms.
The care home costs are way above 3K/ month, and we are not trying to claim this, just what the house would rent for, which would help us out.
My other argument that my mothers needs have changed as a direct result of the fire, which is therefore an insurable loss. They (as above) stated that they would provide accommodation that meets the needs of the residents, yet appear to be refusing to do so, although as I mentioned, we are not trying to claim this, just the like-for-like rental value of the house.
Have I got any chance here of arguing this, if I'm barking up the wrong tree fair enough, but I really don't have the energy at the moment to take on something that has no chance.
The house is nearing completion in terms of renovation, just the flooring and blinds/ curtains to go, and then get all the contents back - so I'd image 2 months.
Thanks in advance.
Sorry to hear about the loss of your father and this difficult situation.
I guess they are arguing an elderly, single lady does not need a 4 bedroom house but there has to be a compromise made as putting her in a much smaller place after all this could be quite a shock and one she/you do not need.
They were taking the premiums on the basis of a 4 bedroom house so not sure why they feel that is not the basis for negotiation.
Hopefully someone in the business can advise you more but I'd say keep plugging away. Having said that, it could also be the dispute over costs is at least getting them to get the work done quickly. I'd certainly be pushing for speed and quality here.
How does your Mum feel about a smaller place for 2 months or so?
I guess they are arguing an elderly, single lady does not need a 4 bedroom house but there has to be a compromise made as putting her in a much smaller place after all this could be quite a shock and one she/you do not need.
They were taking the premiums on the basis of a 4 bedroom house so not sure why they feel that is not the basis for negotiation.
Hopefully someone in the business can advise you more but I'd say keep plugging away. Having said that, it could also be the dispute over costs is at least getting them to get the work done quickly. I'd certainly be pushing for speed and quality here.
How does your Mum feel about a smaller place for 2 months or so?
Policy wordings vary greatly, you would need to share the wording and details of any exclusions to be able to form a judgement on the accommodation.
The wording is likely designed to mean it meets the needs of the residents in so much as matching the number of bedrooms to the residents that need them, in the area in which they current live. I appreciate where you’re coming from as ‘like-for-like’ is ambiguous, but it doesn’t mean that you can get a house with a blue door and 2 sheds because the existing house had those things.
I would foresee that the insurer may argue that a care home is not like for like to any rented accommodation. A home insurance policy is designed to cover physical losses but not physical/mental injury.
Also you would need to check the policy allows for a cash alternative for the accommodation…sounds like they’ve made an offer to you, but this may be discretionary. Your mother may not be entitled to any costs if she does not rent like for like accommodation.
Most of the above is just general musings (from someone that works in the insurance industry), but without the wording no one can say for sure.
I would suggest to take the £1800pm now, but register a complaint that it’s below market value and request £3kpm. Document evidence of the values of rentals in the area, then take to FOS if the insurer rejects your complaint.
At least then you have nearly 2/3rds the money in the bank now with potentially more to come.
The wording is likely designed to mean it meets the needs of the residents in so much as matching the number of bedrooms to the residents that need them, in the area in which they current live. I appreciate where you’re coming from as ‘like-for-like’ is ambiguous, but it doesn’t mean that you can get a house with a blue door and 2 sheds because the existing house had those things.
I would foresee that the insurer may argue that a care home is not like for like to any rented accommodation. A home insurance policy is designed to cover physical losses but not physical/mental injury.
Also you would need to check the policy allows for a cash alternative for the accommodation…sounds like they’ve made an offer to you, but this may be discretionary. Your mother may not be entitled to any costs if she does not rent like for like accommodation.
Most of the above is just general musings (from someone that works in the insurance industry), but without the wording no one can say for sure.
I would suggest to take the £1800pm now, but register a complaint that it’s below market value and request £3kpm. Document evidence of the values of rentals in the area, then take to FOS if the insurer rejects your complaint.
At least then you have nearly 2/3rds the money in the bank now with potentially more to come.
mph999 said:
My other argument that my mothers needs have changed as a direct result of the fire, which is therefore an insurable loss. They (as above) stated that they would provide accommodation that meets the needs of the residents, yet appear to be refusing to do so, although as I mentioned, we are not trying to claim this, just the like-for-like rental value of the house.
I think you should be entitled to £3K/month, as this is in line with the policy wording. I know you're not looking for anything above that but re the above wording, I think that applies to their pre claim needs, not their post claim needs. So I don't think her altered needs are an insurable loss. Her initial needs are. My thinking on that is that say I was living in a one bed flat. Paying a lowish premium. Part of that cover is them paying to rent another one bed flat if mine is uninhabitable, for a while. If I suffered serious injury in a fire, and needed to be in a specialist burns rehabilitation unit, at £5K/week, I don't think they are responsible for that. The premium they've charged hasn't catered for those possible costs.
Just my hunch.
Thanks for the replies ....
The wording of the policy handbook for the description of alternative accommodation (up to £50K)
"The extra coat of similar alternative accommodation for you, your family and your domestic pets"
(I need to get hold of the policy documentation, not just the 'handbook', as I guess that will be more in-depth).
... and from "https://www.gocompare.com/home-insurance/guide/alternative-accommodation-cover/"
"According to the Financial Ombudsman, alternative accommodation should be comparable to the insured property, and should allow you and your family to continue your normal lives as easily as possible."
I agree a care home is not like-for-like, and we never asked to claim the full cost, just the rental value of the house.
They are happy for a cash alternative.
Interesting point that the enhanced needs after the event may not be covered, makes sense, but as above, we weren't asking for this.
The wording of the policy handbook for the description of alternative accommodation (up to £50K)
"The extra coat of similar alternative accommodation for you, your family and your domestic pets"
(I need to get hold of the policy documentation, not just the 'handbook', as I guess that will be more in-depth).
... and from "https://www.gocompare.com/home-insurance/guide/alternative-accommodation-cover/"
"According to the Financial Ombudsman, alternative accommodation should be comparable to the insured property, and should allow you and your family to continue your normal lives as easily as possible."
I agree a care home is not like-for-like, and we never asked to claim the full cost, just the rental value of the house.
They are happy for a cash alternative.
Interesting point that the enhanced needs after the event may not be covered, makes sense, but as above, we weren't asking for this.
Yes mate, get the policy wording and read the full detail including the exclusions and relevant definitions of words/terms (anything capitalised or in bold should have a definition).
The ‘like-for-like’ is now ‘similar’, which lessens the strength of your case a bit.
I’m not saying this to be argumentative with you, just statement of fact to assist you in preparing to engage with the insurer.
The ‘like-for-like’ is now ‘similar’, which lessens the strength of your case a bit.
I’m not saying this to be argumentative with you, just statement of fact to assist you in preparing to engage with the insurer.
The policy is about them providing accommodation, not cash to spend as you please.
I suspect that matters.
I don't think you'll get far claiming that an 84 year old suffering from what is basically old age was substantially caused by the fire.
It's a house insurance policy not the NHS.
The insurance Co may be being quite generous in paying out anything which isn't backed by a receipt for the things they are obliged to pay for.
The difference of £1200 a month is small in the scheme of things, your Mother's needs have changed, you need to concentrate on that and look after her going forwards.
I suspect that matters.
I don't think you'll get far claiming that an 84 year old suffering from what is basically old age was substantially caused by the fire.
It's a house insurance policy not the NHS.
The insurance Co may be being quite generous in paying out anything which isn't backed by a receipt for the things they are obliged to pay for.
The difference of £1200 a month is small in the scheme of things, your Mother's needs have changed, you need to concentrate on that and look after her going forwards.
OutInTheShed said:
The policy is about them providing accommodation, not cash to spend as you please.
I suspect that matters.
I don't think you'll get far claiming that an 84 year old suffering from what is basically old age was substantially caused by the fire.
It's a house insurance policy not the NHS.
The insurance Co may be being quite generous in paying out anything which isn't backed by a receipt for the things they are obliged to pay for.
The difference of £1200 a month is small in the scheme of things, your Mother's needs have changed, you need to concentrate on that and look after her going forwards.
Pistonheads at its very best. Looking after the finances and making sure that the insurance company does what it's contacted to do is very much part of the looking after.I suspect that matters.
I don't think you'll get far claiming that an 84 year old suffering from what is basically old age was substantially caused by the fire.
It's a house insurance policy not the NHS.
The insurance Co may be being quite generous in paying out anything which isn't backed by a receipt for the things they are obliged to pay for.
The difference of £1200 a month is small in the scheme of things, your Mother's needs have changed, you need to concentrate on that and look after her going forwards.
OutInTheShed said:
The policy is about them providing accommodation, not cash to spend as you please.
I suspect that matters.
I don't think you'll get far claiming that an 84 year old suffering from what is basically old age was substantially caused by the fire.
It's a house insurance policy not the NHS.
We are told the policy provides like for like accommodation. This would cost £3K/month. Op has his mother staying somewhere that costs more than £3K a month, but is only asking for £3K month. This isn't "cash to spend as you please", nor is it asking the insurers to act as the NHS. It's a perfectly reasonable claim under the terms of the cover we've been told applies. I suspect that matters.
I don't think you'll get far claiming that an 84 year old suffering from what is basically old age was substantially caused by the fire.
It's a house insurance policy not the NHS.
The only justification for them only paying £1800 would be if they had a deal with a Nationwide property rental company whereby they could rent a £3K house for mum for only £1800.
It's like my policy covering me for a hire car. It only pays that if I need a hire car and get one.
It doesn't pay me to buy a motorbike instead.
Sadly the OP's Mum doesn't appear to need 'like for like' house as she doesn't seem to be in a fit state to make use of one.
If the stay is not permanent, then the Council might pay anyway.
The Age UK website can be helpful.
Also 'like for like' housing for one person might mean something different from having the same number of spare bedrooms.
If they could provide an adequate house in the same area, with similar useful facilities etc, that might meet a reasonable definition of 'like for like', as in being in a bedsit or B&B in S
horpe would not be 'like for like'.
You can rent a house big enough for 2 people to rattle around in, in a reasonable place, for a lot less than £1800 pcm.
It doesn't pay me to buy a motorbike instead.
Sadly the OP's Mum doesn't appear to need 'like for like' house as she doesn't seem to be in a fit state to make use of one.
If the stay is not permanent, then the Council might pay anyway.
The Age UK website can be helpful.
Also 'like for like' housing for one person might mean something different from having the same number of spare bedrooms.
If they could provide an adequate house in the same area, with similar useful facilities etc, that might meet a reasonable definition of 'like for like', as in being in a bedsit or B&B in S
horpe would not be 'like for like'.You can rent a house big enough for 2 people to rattle around in, in a reasonable place, for a lot less than £1800 pcm.
OutInTheShed said:
It's like my policy covering me for a hire car. It only pays that if I need a hire car and get one.
It doesn't pay me to buy a motorbike instead.
Sadly the OP's Mum doesn't appear to need 'like for like' house as she doesn't seem to be in a fit state to make use of one.
If the stay is not permanent, then the Council might pay anyway.
The Age UK website can be helpful.
Also 'like for like' housing for one person might mean something different from having the same number of spare bedrooms.
If they could provide an adequate house in the same area, with similar useful facilities etc, that might meet a reasonable definition of 'like for like', as in being in a bedsit or B&B in Shorpe would not be 'like for like'.
You can rent a house big enough for 2 people to rattle around in, in a reasonable place, for a lot less than £1800 pcm.
Do you know much about the law and insurance?It doesn't pay me to buy a motorbike instead.
Sadly the OP's Mum doesn't appear to need 'like for like' house as she doesn't seem to be in a fit state to make use of one.
If the stay is not permanent, then the Council might pay anyway.
The Age UK website can be helpful.
Also 'like for like' housing for one person might mean something different from having the same number of spare bedrooms.
If they could provide an adequate house in the same area, with similar useful facilities etc, that might meet a reasonable definition of 'like for like', as in being in a bedsit or B&B in S
horpe would not be 'like for like'.You can rent a house big enough for 2 people to rattle around in, in a reasonable place, for a lot less than £1800 pcm.
OutInTheShed said:
It's like my policy covering me for a hire car. It only pays that if I need a hire car and get one.
It doesn't pay me to buy a motorbike instead.
Sadly the OP's Mum doesn't appear to need 'like for like' house as she doesn't seem to be in a fit state to make use of one.
If the stay is not permanent, then the Council might pay anyway.
The Age UK website can be helpful.
Also 'like for like' housing for one person might mean something different from having the same number of spare bedrooms.
If they could provide an adequate house in the same area, with similar useful facilities etc, that might meet a reasonable definition of 'like for like', as in being in a bedsit or B&B in Shorpe would not be 'like for like'.
You can rent a house big enough for 2 people to rattle around in, in a reasonable place, for a lot less than £1800 pcm.
it states "similar accomodation suitable for the resident". It doesn't pay me to buy a motorbike instead.
Sadly the OP's Mum doesn't appear to need 'like for like' house as she doesn't seem to be in a fit state to make use of one.
If the stay is not permanent, then the Council might pay anyway.
The Age UK website can be helpful.
Also 'like for like' housing for one person might mean something different from having the same number of spare bedrooms.
If they could provide an adequate house in the same area, with similar useful facilities etc, that might meet a reasonable definition of 'like for like', as in being in a bedsit or B&B in S
horpe would not be 'like for like'.You can rent a house big enough for 2 people to rattle around in, in a reasonable place, for a lot less than £1800 pcm.
if they're claiming that (due to only being one of her) the house only needs to be 1-person big, I think it's fair to counter-claim that "suitable" accomodation is now a nursing home at £10k/month (or whatever they cost), as thats what she needs now..
OutInTheShed said:
It's like my policy covering me for a hire car. It only pays that if I need a hire car and get one.
How do you know this? Have you seen the policy? It might cover like for like accommodation, regardless of if it's needed or not. That's what the OP is saying, and he has seen the policy. It seems to me that "like for like" is a more specific description than "similar". So it'll be interesting to see if there is a third description in the full policy and what it is.
All you'll be able to do is to make a complaint. The ins co are unlikely to budge then you'll go to the ombudsman for their determination.
Good luck
All you'll be able to do is to make a complaint. The ins co are unlikely to budge then you'll go to the ombudsman for their determination.
Good luck
OP just say who the insurer is, or at least drop a heavy hint, and chances are it'll be easy enough to find their T&Cs online. FWIW (probably not a lot), I've had a look at a couple of home insurance policy docs and the wording re alternative accommodation in both is clear enough that they're not (necessarily) covering the full rental value of the house that's been damaged, rather it's more like a reasonable amount to see you through until you're back where you were. Tbh that's exactly what I'd expect to see in a set of T&Cs for standard home insurance - entitlement to a payment that gets you genuine like-for-like accommodation would be an add-on feature or something you'd only find in a premium product. That's of no real relevance though as it's obviously only your policy that matters, so name names and we can take a look.
It’s LV - I got hold of the policy terms and conditions today.
The wording in that is
“The cost of comparable alternative accommodation if you are the occupier, including for any domestic pets living with you.”
The wording in the policy handbook is : like-for-like
We got a couple of estate agents in yesterday, average rental cost was £3200/ month.
Really appreciate the inputs.
The wording in that is
“The cost of comparable alternative accommodation if you are the occupier, including for any domestic pets living with you.”
The wording in the policy handbook is : like-for-like
We got a couple of estate agents in yesterday, average rental cost was £3200/ month.
Really appreciate the inputs.
mph999 said:
It’s LV - I got hold of the policy terms and conditions today.
The wording in that is
“The cost of comparable alternative accommodation if you are the occupier, including for any domestic pets living with you.”
The wording in the policy handbook is : like-for-like
We got a couple of estate agents in yesterday, average rental cost was £3200/ month.
Really appreciate the inputs.
Cost.The wording in that is
“The cost of comparable alternative accommodation if you are the occupier, including for any domestic pets living with you.”
The wording in the policy handbook is : like-for-like
We got a couple of estate agents in yesterday, average rental cost was £3200/ month.
Really appreciate the inputs.
You have no cost for comparable accommodation if you're not paying for any 'comparable accommodation'.
Cost not 'value'.
Reality check. Your £3200 pcm figure is over £100 a night.
I've had some fairly tidy airbnbs for more like £70 a night.
An open market rental figure with 12 months security of tenure may be less than relevant?
I get the feeling this is quite a big claim, IMHO the ins co are not being unreasonable. If you upset them arguing over this aspect of the claim, they may play hardball over every part of the claim.
OutInTheShed said:
Cost.
You have no cost for comparable accommodation if you're not paying for any 'comparable accommodation'.
Cost not 'value'.
Reality check. Your £3200 pcm figure is over £100 a night.
I've had some fairly tidy airbnbs for more like £70 a night.
An open market rental figure with 12 months security of tenure may be less than relevant?
I get the feeling this is quite a big claim, IMHO the ins co are not being unreasonable. If you upset them arguing over this aspect of the claim, they may play hardball over every part of the claim.
It doesn't state that you have to incur the cost of the comparable accommodationYou have no cost for comparable accommodation if you're not paying for any 'comparable accommodation'.
Cost not 'value'.
Reality check. Your £3200 pcm figure is over £100 a night.
I've had some fairly tidy airbnbs for more like £70 a night.
An open market rental figure with 12 months security of tenure may be less than relevant?
I get the feeling this is quite a big claim, IMHO the ins co are not being unreasonable. If you upset them arguing over this aspect of the claim, they may play hardball over every part of the claim.
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