Insurance Disputes

When an insurance claim is refused, your insurers will provide you with a reason for the refusal.

There are many reasons why a claim is rejected and some common reasons include:

• Incorrect information being provided to the insurers at any stage.
• Lack of due care or negligence on your part, which resulted in the incident you are trying to claim for.
• You didn’t take truthfully or accurately answer the questions on the insurance application.

Your insurers will provide a reason for the refusal, and if you don’t agree with it, you have to provide your argument against their decision. This can be done through:

• Review your policy documents and learn if all the information you provided was accurate.
• Identify the relevant clauses in the policy documents, which states that you are covered.
• If the policy is ambiguous or poorly constructed, you need to make a note of it.

If you had any further correspondence with your insurers, which highlighted a change in your circumstances, you would want to discuss it with your insurers.

The aim of your argument would be to gather evidence that refutes the claim being made by the insurers.

Insurance disputes can vary in time based on the value and complexity of the claim.

Not all insurance disputes are the same, which is why we need to assess a case before informing your on how long the matter can take.

We have a large number of experience in dealing with insurance disputes. The matters were complex and required specialist knowledge, which is why we would be ideal to work on your claim.

You can contact us to discuss our historic claims, and enquire about our knowledge in this niche area of law.

Person A vs. Building Insurer

Person A, the claimant, is a young enterprising Londoner. He bought a derelict Victorian building in a town on the Essex coast with a view to converting it into several self-contained flats. He went to his usual insurance broker and purchased a building cover whilst he renovated the building. The building was not occupied during the renovation stage, and he travelled to supervise the builders from his London home. The renovation was going well, and 2 flats on the upper floors were completed. One day he received a call from one of his contacts that a local TV channel was covering a fire at his property. The local fire brigade attended quenched the fire, but the building was completely destroyed.

He reported the incident to his building insurers who appointed their own investigators known in the industry as loss assessors. He in turn appointed his own advisors which in the industry are known as loss adjusters. The investigation and negotiations between the two appointed agents continued leading to the insurers to refuse his claim under the contract of insurance on the grounds that he was in breach of the terms of the contract and had failed to report material fact when the policy was purchased.

As in many cases Person A did not consult lawyers in the hope that loss adjusters would be able to settle his claim. Once the claim was rejected Person A instructed Abdul Hafezi to take over the claim from loss adjusters and deal with the insurers and their lawyers.

We agreed to deal with his claim under the no win no fee regime. Insurers continued to deny liability and alleged that apart from material non-disclosure the fire had been caused by defective electrical installation. We attended the premises, took photographs and appointed an electrical contractor to attend the damaged building and prepare a report on the state of the electric installation before the fire. We took detailed statement from Person A, insurance broker Person A’s brother who was managing the project and number of other tradesmen who had worked on the building before the fire. We arranged for purchase of an insurance cover known in the industry as legal expense cover. There is a premium for this policy but only to be paid by Person A if the claim was successful.

The precaution negotiation did not go well. We instructed a senior/junior barrister also on no win no fee basis and instigated proceeding in the Central London County Court. Two years into the litigation and under an obligation imposed by the civil procedure rules the clam was mediated by an independent mediator appointed by the parties. As often happens after whole day at mediation the claim was settled by the insurers together with MA’s legal costs.

It should be noted that since 2013 one cannot recover the extra fee we charge known as success fee and the insurance premium from the insurers and these were deducted from the damages recovered by MA.

Note;
insurance policies are often bought via a broker and more than not on the net by completing a proposal form. At the end of the form is a declaration which one would sign. It stats that you have an obligation to disclose all facts leaving it to the insurers to decide if it/they are material to the policy sought. There is a principal known as Good faith in insurance contracts. The onus is on you the proposer to act in good faith and disclose all facts to unable the under writer to assess the risk and determine the premium. Insurers always looks at this point whenever a claim is made and it is thus important to set out comprehensive history on the proposal form to avoid the heartache of rejection.

Generally, we provide an initial assessment for free. If you would like for us to review your policy documents, we will provide you with a fixed fee quotation.

The quotation will cover a review of your policy and a consultation with you where we try to identify the merits of your claim. If we feel you have a case worth fighting for, we can offer you a number of appropriate arrangements.