Has anyone 'law minded' got any info on this.....?
Discussion
Insurance companies have two main sections:
The sales department who is targeted on getting the most money in as possible,
...and the claims department who are targeted on letting the least money out as possible.
If the policy covers 'medical and other expenses' then I see no reason why the cost of getting to outpatient treatment is not under this category.
What has basically happened is as you have said, the company is taking the p1ss.
If we consider that the complete motivation of the claims department is to minimise 'loss' ie paying out, then lets look at why they so kindly offered to pay out half - I dont think for one second they would do this is the policy did not cover it. The reason they paid out half - and the cheque was sent was in the hope it would be accepted as settlement.
The reason why they want this accepted as settlement is that it is less than what they know they should be paying out!
The 'bus' argument is codswallop. If you had taken the bus, they would have asked why you couldnt have walked!
I would keep hold of the cheque, but not cash it - as if you do this it can be seen as accepting settlement. Of course, the best thing to do is write back, and in a polite way tell them that the payout is unacceptable and that you are rejecting it, and tell them to stop messing around, or perhaps ask them
1) Why they do not class your claim under the clear heading 'medical and other expenses' and
2) Where is says in their policy that the insuree is expected to take the bus to and from medical treatment!
The sales department who is targeted on getting the most money in as possible,
...and the claims department who are targeted on letting the least money out as possible.
If the policy covers 'medical and other expenses' then I see no reason why the cost of getting to outpatient treatment is not under this category.
What has basically happened is as you have said, the company is taking the p1ss.
If we consider that the complete motivation of the claims department is to minimise 'loss' ie paying out, then lets look at why they so kindly offered to pay out half - I dont think for one second they would do this is the policy did not cover it. The reason they paid out half - and the cheque was sent was in the hope it would be accepted as settlement.
The reason why they want this accepted as settlement is that it is less than what they know they should be paying out!
The 'bus' argument is codswallop. If you had taken the bus, they would have asked why you couldnt have walked!
I would keep hold of the cheque, but not cash it - as if you do this it can be seen as accepting settlement. Of course, the best thing to do is write back, and in a polite way tell them that the payout is unacceptable and that you are rejecting it, and tell them to stop messing around, or perhaps ask them
1) Why they do not class your claim under the clear heading 'medical and other expenses' and
2) Where is says in their policy that the insuree is expected to take the bus to and from medical treatment!
gorvid said:
Thanks for the excellent help...
Is there anything to threaten them with that might have an effect???
Regulatory body...?
Anything else??
I think to be honest just rejecting it and making the two points should be enough.
What they are doing is bad, but pretty much a standard tactic.
They are making you think 'Is it really worth the hassle fighting for the last £50?'. Of course a lot of people will just not be bothered to follow it up - thus the insurance company mostly get out of paying the last bit of each claim.
You just need to turn the tables - that is make it easier for them to give you the money than keep fobbing you off. The best way of doing that is by writing back then if nothing else the company is losing more and more money writing back each time
The phrase 'I have taken legal advice' is a good one. Nondescript but then know that the game is up. If you want to 'step up' from that something like
"I have been advised that the best course of action is to request that for a final time you fulfil this claim as per your policy documentation. I must request that this claim is fulfilled in full within the next seven days. I find it reprehensable that after what we have been through already you find it necessary to make us jump through hoops in order for you to pay out as per your obligations. If this reasonable request is not completed in the next seven days I will be left with no other option than copying our correspondance to my solicitor, the BBC Watchdog programme as well as ******* (the MD of the company) for the swift completion of this matter.
They will be scared of either one of those three people enough to stop messing around.
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