Martyn James: Has my insurance company been treating me fairly?
Don’t be put off making a complaint by red tape and impenetrable T&Cs, writes Martyn James
We all need insurance to protect the things (and people) we love. Yet insurance policies are long and complicated documents. If you come to make a claim, you can often feel a little adrift on a sea of bureaucracy and maddening T&Cs. That’s why many people give up rather than pursue a complaint.
But that could well be a costly error. The consumer association, Which? is bringing a ‘super-complaint’ to tackle ‘widespread failings in the travel and home insurance market’.
In their investigation, Which? found evidence of poor claims handling, inappropriate sales processes and firms not following the law and regulations properly. Rocio Concha, Which? Director of Policy and Advocacy, said: “In only a short space of time since submitting our super-complaint to the regulator, we've seen an outpouring of frustration and anger from consumers about their experiences with insurers and support for what Which? is doing.”


So how do you know if you’re being treated fairly? Here’s my guide.
Some readers have reported that their claims were turned down after an ‘informal’ telephone conversation. This should not be happening. If you’re making an insurance claim it’s a formal process, ultimately leading to a written response to your claim. It may be that some insurers are ‘inadvertently’ treating some calls about claims as enquiries. Insist on a full investigation.
Just because it’s in the terms and conditions doesn’t mean it’s fair. Because insurance policies cover so many bases, an insurer must give you a ‘key facts’ document, which summarises all the important bits in plain English. This should include what the policy covers, key exclusions, policy limits, risks and excess fees.
Businesses shouldn’t hide important rules deep in the main T&Cs. Policy terms must be fair, clear and unambiguous, so you know exactly what is and isn’t covered. If your claim is turned down because a term is unclear, too broad or being unfairly applied, complain.
Sometimes claims are turned down for a variety of unfair reasons. Here are a few examples I’ve seen in the last year or two:
- Damage to properties after severe weather incidents that were not considered to have met the definition of a storm.
- A woman falsely accused of being drunk when she slipped and broke her leg while wearing high heels on holiday.
- A motor claim rejected because the victim didn’t report previous minor damage to a bumper that he hadn’t noticed.
- Medical treatment for a dog that was rejected after the insurer incorrectly argued that the new condition was linked to one they previously paid out for.
- A medical claim for a stroke, rejected because a previous doctor’s appointment about pins and needles had not been disclosed when the policy was taken out.
- A travel insurance claim for theft, rejected because the insurer felt that they were not told soon enough.
Every one of these cases were overturned when the claims were appealed, either to the insurer or to the Financial Ombudsman Service (FOS), who look at financial complaints for free.
Which? also highlighted research that showed that having some medical conditions led to huge variations in quotes for travel policies – or even policies being declined. You have to tell the insurer everything they ask you to disclose, but don’t assume that one price sets a benchmark for what other insurers might charge. If you are older, have an existing medical condition, take part in adventure sports or just hate shopping around, a good insurance broker can help you find a suitable, affordable policy.
Take things further. The Financial Ombudsman Service is a free and impartial alternative to the courts. They can and do overturn unfair insurance claims under all of the circumstances I’ve mentioned in this column – and more.
There are loads of great insurance companies out there – so I don’t want to bash the whole industry. I’m pleased to say my insurers have been fantastic over the years. But if the way you are being treated doesn’t feel quite right, make a complaint. You don’t need to be an expert.
Martyn James is a leading consumer rights campaigner, TV and radio broadcaster and journalist. Visit martynjamesexpert.co.uk.
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