Insurance Claim Rejection

[The Don]

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

As far as I know the insurance ombudsmans decision is binding on the insurer. You should remind your insurer that not implementing his decision risks heavy penalties and fines by the regulator and they should not test your patience or resolve.

The internal inquiry is a matter for them to undertake and resolve. You have nothing to do with it.

[Janith Seneviratne]

This inquiry is conducted by the ombudsman, not the insurance company, insurer is SLIC, i contacted the ombudsman's office they said inquiry is at end of the month, ombudsman is waiting to give things officially till he wants to know what the So called Private investigator and the technical officer has to say regarding there reports, btw i talked to an guy the SLIC, he said even-though the ombudsman give a letter saying to accept the claim, it still has to be approved by the SLIC board of engineer, its a good lesson for my for trusting a government institution for the first time, should have gone with V*P or something, to date its been 7 months, and Got to know SLIC even dont entertain appeals

[Crosswind]

This inquiry is conducted by the ombudsman, not the insurance company, insurer is SLIC, i contacted the ombudsman's office they said inquiry is at end of the month, ombudsman is waiting to give things officially till he wants to know what the So called Private investigator and the technical officer has to say regarding there reports, btw i talked to an guy the SLIC, he said even-though the ombudsman give a letter saying to accept the claim, it still has to be approved by the SLIC board of engineer, its a good lesson for my for trusting a government institution for the first time, should have gone with V*P or something, to date its been 7 months, and Got to know SLIC even dont entertain appeals

According to insurance ombudsman's website:

Any award/decision given by the Insurance Ombudsman upto a sum of Rs. 1,000,000 /= after inquiry into a complaint made by a policy holder (insured) against the insurance company(insurer), is binding on the insurer and the insurer is expected to honour such Award/decision.

The story of SLIC needing to approve ombudsman's decision is nonsense.

[Janith Seneviratne]

Hope they honor that

[Crosswind]

Hope they honor that

Could you please grow a pair...

[The Don]

Hope they honor that

There is no issue of hope here. It is the law.

You have been persistent up to now. Keep up the pressure on both the ombudsman and the insurance company. Get a lawyer to draft papers threatening to sue them for the cost of repairs, cost of not having use of the vehicle for so long, cost of damage to your reputation through false allegations. Also tell them you will be writing to every single national newspaper with your story and the ombudsman decision.

The journalists will have a field day

What you might not realise is Insurance is all about reputation. Nobody buys insurance from a company who does not pay up when needed. If they do not capitulate after the above then they are a bunch of idiots and you should pressure the ombudsman to simultaneously take legal action for showing contempt to his judgement.

You need to really stand up here rather than using words like "hope"

[Janith Seneviratne]

yea, i do understand what you mean Don, im not giving up, i have the cards, i use a lawyer for the letters cz there's a gravity those letters than the way we write, they have started dragging things again saying private investigation officer not available, i cant intervene on that, gonna wait a another week or so and ask ombudsman what we suppose to do

[Watchman]

Due, there's nothing to do with a private investigator... the ombudsman told the insurance COMPANY (the company as one entity) to pay you. What everyone here is telling you is that it's not your concern what happens within the company.

[Crosswind]

I think what the guy is trying to say is the ombudsman's inquiry is not over yet and the ombudsman has asked the insurance company to produce the investigator.

Anyway Janith I hope the lawyer told you this but if they based their whole case on a so-called eye witness account, then if it is proven to be false, you are in a position to sue the insurance company and seek further damages.

[Janith Seneviratne]

Yes @Crosswind, that eye witness claim is already proven not reliable by the ombudsman

[Crosswind]

Yes @Crosswind, that eye witness claim is already proven not reliable by the ombudsman

I think this is the part which is not clear to everyone... if the eyewitness' claim is proven to be false, the case has collapsed as far as your opposition is concerned... so what else is there to investigate?????

[Jor-el]

SLIC...

Cliché!

[Janith Seneviratne]

I think this is the part which is not clear to everyone... if the eyewitness' claim is proven to be false, the case has collapsed as far as your opposition is concerned... so what else is there to investigate?????

i didnt get that either, but he wanted to what happened to the missing evidence of a first party involved in the accident, its not that easy to argue with the ombudsman, he's more like an arrogant old guy who wants to have the total control, its better to let him do his thing the way he want

[The Don]

i didnt get that either, but he wanted to what happened to the missing evidence of a first party involved in the accident, its not that easy to argue with the ombudsman, he's more like an arrogant old guy who wants to have the total control, its better to let him do his thing the way he want

I see, so the ombudsman enquiry is not complete. In that case you need to let that complete before you can expect the insurance company to draw matters to a close.

I think the issue here is, by ruling against the insurance company, the ombudsman is effectively accusing the insurer of insurance fraud which is a VERY serious offence. This might be the reason such care is being taken, so as the investigation is comprehensive.

The above is so serious it can lead to charges being bought against the insurer by law enforcement and its operating license put under threat. Being a semi government entity the second is unlikely to happen, but some people will have a case to answer.

I think we have all jumped up prematurely.

To be honest you cannot argue with a ombudsman. If you are not happy with the ombudsman's decision you have other avenues to pursue but you need to wait till the investigation is complete and decision formally anounced in writing. It will usually have a time line under which the insurer is expected to comply.

Edited June 22, 2015 by The Don

[Janith Seneviratne]

yea, spot on Don, cant rush, have to give time, i know atleast this will take atleast a another month or so

[Sierra Charlie]

i didnt get that either, but he wanted to what happened to the missing evidence of a first party involved in the accident, its not that easy to argue with the ombudsman, he's more like an arrogant old guy who wants to have the total control, its better to let him do his thing the way he want

This gentleman happens to be the lecturer of business law in my MBA class and i raised a question similar to yours just to get an idea on how to proceed with a case like this. He didn't divulge much information on actual technicalities but what I realised is that he's a fair guy and apparently, lawyers are not allowed to appear before the ombudsman since it's a matter of arbitration. If there was a lawyer appearing for the insurance company, you can raise concerns with valid reasons and he will most probably uphold your concerns.

Best is to form a logical argument before you meet him. It's been quite a long period for the insurance company to settle the claim and I feel that you should raise concern over the lost utility of the vehicle for the duration with the ombudsman. Also, try to get the insurance company to agree on action items before you leave the ombudsman and figure out a way to get minutes of the meeting and verify the minutes with the ombudsman. That way, you can get the insurance company to adhere to some sort of a checklist.

For all intents and purposes you're the victim in this case and as I feel it, the best way to win your case is to make a logical, strong case with the ombudsman.

[Batteries]

According to insurance ombudsman's website:

Any award/decision given by the Insurance Ombudsman upto a sum of Rs. 1,000,000 /= after inquiry into a complaint made by a policy holder (insured) against the insurance company(insurer), is binding on the insurer and the insurer is expected to honour such Award/decision.

The story of SLIC needing to approve ombudsman's decision is nonsense.

Insurance company do not have to honor the Ombudsman verdict.As per my friend.Only thing he can do is to go to courts.I know guy who has the same problem.When the Insurance company did not honor the agreement given by the Ombudsman he was asked to go to courts.

[Crosswind]

Insurance company do not have to honor the Ombudsman verdict.As per my friend.Only thing he can do is to go to courts.I know guy who has the same problem.When the Insurance company did not honor the agreement given by the Ombudsman he was asked to go to courts.

I would prefer to believe what insurance ombudsman's website says, over what your friend says.

Anyway, if an insurance company decides to go against the ombudsman's verdict, it will be an extremely risky call.

[Batteries]

I would prefer to believe what insurance ombudsman's website says, over what your friend says.

Anyway, if an insurance company decides to go against the ombudsman's verdict, it will be an extremely risky call.

My friend is the guy who went through this process.Insurance company either can accept or reject Ombudsman decision. If they reject you have to go to Courts.

[Vave]

Try to get consultation from lawyer

[Sallyyy]

Don't think that you will get your money back. Accident is really horrible shit. Try to get life insurance at quality company. You don't know if it was the last accident in your life. However, I don't want to afraid you. I just want to recommend you service which give you opportunity to compare offers of life insurance exactly on their website. On usave you can research a lot of guides and get a lot of information about it. Police wrote that you was driver and is the biggest reason for insurance company don't give you money.

Edited March 29, 2020 by Sallyyy