Insurance Claim Rejection

[Janith Seneviratne]

Hi All,

what is the best way to fight back when ur insurance claim is rejected,

i have the genuine police reports and all,

insurance company did do an investigation and claiming i wasn't the driver,

even though i am, the cars registration to everything is under my name, and the original driver was drunk

police report do state i am the driver and it was logged just a little while after the accident

Anyone have an idea what to do?

[MV-5]

http://insuranceombudsman.lk/

[GayanR]

what's the claim? Do they have eye witness with them claiming you aren't the driver?

[Crosswind]

Hi All,

what is the best way to fight back when ur insurance claim is rejected,

i have the genuine police reports and all,

insurance company did do an investigation and claiming i wasn't the driver,

even though i am, the cars registration to everything is under my name, and the original driver was drunk

police report do state i am the driver and it was logged just a little while after the accident

Anyone have an idea what to do?

Was the actual driver drunk?

[vishkid]

Happened to someone I know, the Insurance company (UA in this case) had a witness or multiple witnesses who cited the actual driver was different and was drunk.

The owner tried some semi-legal wrangling but UA did not budge.

If you're in the right though, fight by all means - you can go up the chain in the insurer, go to ombudsman, send a letter through lawyer that obligates a response with reasons.

[VVTi]

If the driver was drunk there is a good chance they will reject.

[Rumesh88]

Insurance contracts are based on utmost faith between the parties. ie the insurer believes that the information provided by the insured is always correct. For some reason if any one of the information provided by the insured found to be less than totally credible then the insurer take liberty to suspect the remaining information too. Do you have even a slight let off in any of the information provided by you? If so you are in trouble otherwise you can contest the case.

[kmeeg]

Insurance contracts are based on utmost faith between the parties. ie the insurer believes that the information provided by the insured is always correct. For some reason if any one of the information provided by the insured found to be less than totally credible then the insurer take liberty to suspect the remaining information too. Do you have even a slight let off in any of the information provided by you? If so you are in trouble otherwise you can contest the case.

Ramesh, Help me understand (since i have very low insurance knowledge), I believe the insurance is covering the vehicle right? As long as you have licensed driver and not drunk doesn't insurance should cover it?

On another point / a lesson to learn where drinking will crew your life. At-least take a cab/taxi if you are taking a drink.. Live better - Drive safe..

[Janith Seneviratne]

i am the driver, and they say they have a third part which saying im not the driver and cant even give a description of the driver, the thing they believe that over police is they say this particular person has testified twice the exact thing and even though i challenged insurance company if ur that sure im not the driver just check the finger prints, they say it can be manipulated, ROTFLMAO, all this is coz its a bit of a claim, and my insurance with this particular company is new i think they are calculation return on investment, they are believing a single persons testimony over many cz most of the others are relatives of mine and this all happened really late night

[Janith Seneviratne]

Was the actual driver drunk?

i wasnt drunk, it was my Grandmother funeral for crying out loud, just as the body was brought to my place

[Janith Seneviratne]

what's the claim? Do they have eye witness with them claiming you aren't the driver?

they say they have one

[Crosswind]

If you were the actual driver and if you were not drunk, you have a case for the insurance ombudsman. The link is posted by MV-5 above.

I somehow don't understand why the insurance company should try to pull a stunt like this. So I hope everything you claim is true. You don't need to post any further information in this thread, since we are not the judges of your case. Just take it to the ombudsman.

[VVTi]

and also don't think that the Insurance companies are NOT trolling FB groups or AL... to get an idea of what is going on... you might incriminate yourself...

A SLIC staffer once jokingly said to me that they and other insurance companies have sleepers in most of the local drags and if anyone is to crash and submit a claim, they know what to do... coz the insurance agreement clearly says no competitive racing...

[Watchman]

i am the driver, and they say they have a third part which saying im not the driver and cant even give a description of the driver, the thing they believe that over police is they say this particular person has testified twice the exact thing and even though i challenged insurance company if ur that sure im not the driver just check the finger prints, they say it can be manipulated, ROTFLMAO, all this is coz its a bit of a claim, and my insurance with this particular company is new i think they are calculation return on investment, they are believing a single persons testimony over many cz most of the others are relatives of mine and this all happened really late night

I believe you should have the right to confront/question the so-called witness. And the witness should go to the police if he wants to legitimize his evidence as part of the incident.

Anyway, the ombudsman is more likely to give you a solution rather than us. But please do update us on what the final outcome was.

Edited January 13, 2015 by Watchman

[Rumesh88]

Ramesh, Help me understand (since i have very low insurance knowledge), I believe the insurance is covering the vehicle right? As long as you have licensed driver and not drunk doesn't insurance should cover it?

On another point / a lesson to learn where drinking will crew your life. At-least take a cab/taxi if you are taking a drink.. Live better - Drive safe..

It is not that simple when something happens. There are conditions, sometimes explicitly expressed and sometimes implied, in an insurance contract. For example, your own car is usually insured for personal use only. But as it happens very often if you use your car to travel for official purposes then the insurer can argue that your car is not covered by the insurance unless it is explicitly mentioned in the policy. Usually insurers do not investigate accidents to such fine details but if the claim value is high ( suppose you run into a Lamborghini) then they might. Most of the time when the insurer raises an objection, it is solely for the purpose of delaying the payment as long as they can but eventually they pay. For me, insurance as a business is not really a viable operation in SL cos it is common knowledge that with the right approach you can always manipulate evidence. I have seen warehouses/factories going up in flames just to claim insurance on the stock value. So it is not very surprising to see insurers taking every possible countermeasure prevent such bogus claims.

[Jor-el]

So what happened to this? Did insurance accept the claim?

[Janith Seneviratne]

We'll Finally After Months, Ombudsman stepped in, found out they were just bluffing without any provable evidence, and they have broke ut most good faith by hiding evidence in favor of my, so now time to hit hard on them

[The Don]

We'll Finally After Months, Ombudsman stepped in, found out they were just bluffing without any provable evidence, and they have broke ut most good faith by hiding evidence in favor of my, so now time to hit hard on them

Do you have the ombudsman report in writing? If so would you mind posting a copy. This is a VERY serious matter and will affect the purchase decisions of many other members.

I'm of the view that if the matter has been properly investigated, there is no barrier to publicly shaming the company who is responsible for this. Utmost good faith is one of the 6 principles of insurance. I hope the Ombudsman will refer the matter to the regulator.

[Crosswind]

Janith, you have not mentioned the insurance company. You should do that (UA was mentioned by vishkid not janith).

Post any evidence you have (you can strike out personal data).

[Janith Seneviratne]

waiting for the letters, as there is a another inquiry for the investigation officer involved and the technical officer, after that i'll get the letters, they say even after that its a board decision to accept the claim

Edited June 14, 2015 by Janith Seneviratne

[Crosswind]

What nonsense... their intenal inquiries are not your business. Maybe you should pay another visit to the ombudsman.

[Watchman]

Yep. I'm with crosswind. If the Ombudsman said you should be paid, that's final. Their internal board, agent, receptionist nonsense is not your concern.

[Rumesh88]

I am with Crosswind too. Now that thye know the payment is mandatory they are just using their delaying tactics. Once I had been a victim of the same situation when my BIL was handing a claim under power of attorney while I was away. The payment was on hold for more than 6 months giving one excuse after the other whenever my BIL made inquiries. When I returned all I did was walking into the manger's office with the file in my hand and confronting him with the question "when are you going to pay me?" throwing the file on to his table. Without even blinking his eyes once he said the payment was ready and could be collected the next day from their head office. Nothing personal, but that's how dirty the people in the insurance business are. Yes, as others say above it is time you pay another visit to the ombudsman.

Edited June 15, 2015 by Rumesh88

[YALA]

janith for everyone's sake post the name of the insurer minus any other details this way others can avoid going to them plus we can share your story with others outside of the forum. Fb is the best way to share your story will spread like wildfire used in blackwater bay in game of thrones.

[Mike Page]

I agree with YALA.

I am so sorry to hear about your story. I can only imagine the headaches you must have gone through with this. If you don't mind, could you please share the name of the insurance company as I feel it would be beneficial for all of us.