|
case
studies – insurance renewals
23/11 household contents – renewal – change of policy terms –
whether sufficient to note amendment on renewal documents
In
1984, Mr K took out index-linked household buildings and contents
insurance. This included cover for his personal possessions, which
were valued at £9,150 in total. He renewed the insurance every
year. However, when he was burgled in 2001, the firm rejected
most of his claim. It said that some of the personal possessions
that had been stolen were worth more than £500 each and that such
items were not covered unless they were insured separately.
Mr
K was very surprised by this. He said he had no reason to think
these possessions were not covered, as they were items of jewellery
that his wife had owned since he first took out the insurance
in 1984. He pointed out that the firm’s promotional literature
stated ‘New for Old Replacement means exactly that’ and
that it promised ‘Reimbursement in full at today’s prices,
whatever the original cost’. The literature also said that
index-linking ‘automatically takes account of inflation when
assessing claims and renewal premiums’. Since none of the
stolen items of jewellery had been worth more than £500 in 1984,
he considered that they should all still be covered.
The
firm based its rejection of the claim on the renewal notices that,
since 1991, had stated, ‘any item worth more than £500 is not
insured at all unless specified’. The firm said that Mr K
should have noticed this and made sure that each item of expensive
jewellery was individually specified.
complaint
upheld
We considered that the firm’s decision to exclude all personal
possessions worth more than £500 constituted an unusual and onerous
policy term. And such policy terms should be clearly drawn to
the attention of policyholders. It is not sufficient for firms
merely to print them on the renewal notice without giving policyholders
any explanation or notice of the change. Most insurance policies
contain a price limit on claims for any single article but it
is not common for a firm to withdraw all cover for such items.
The
firm knew that Mr K had over £10,000 worth of personal possessions
and it should have made it clear to him that he had to specify
any item over £500. We concluded that the firm was unreasonable
to limit its settlement of Mr K’s claim on the grounds that the
claim did not meet strict policy terms that the firm had not made
clear to him. We required it to meet his claim in full, although
we said it could deduct the additional premiums it would have
charged for the past five years if Mr K had specified the valuable
items.
.............................................
23/12 household buildings – change of policy terms – need for
clear notification – swimming pool dome – dome specifically excluded
from policy – intermediary stating policy covered dome – whether
insurer entitled to reject claim for storm damage to dome
Before
Mr and Mrs A took out household insurance with the firm in 1994,
they asked their intermediary if the policy would cover the PVC
dome over their swimming pool. The intermediary wrote to them
confirming that the dome would be covered ‘at no extra cost’
so they took out the insurance and renewed it each year.
In
October 2001, a storm damaged the dome and Mr and Mrs A made a
claim. However, the firm told them the policy specifically excluded
swimming pool covers. Mr and Mrs A disputed this and said that
if the policy wording had been amended, the firm should have informed
them.
The
firm argued that swimming pool covers had probably been excluded
even in 1994, although it could not produce a copy of the original
policy to confirm this. It said Mr and Mrs A should have checked
the policy terms at the outset to see if the policy was suitable
for them. Dissatisfied with this response, the couple brought
their complaint to us.
complaint
upheld
Mr and Mrs A had specifically asked whether the policy would include
their dome and in our view they were entitled to rely on the intermediary’s
letter as confirmation that the dome was covered. It was not reasonable
of the firm to expect the couple to have then checked the policy
terms to see if the intermediary’s statement was true.
The
couple had every reason to believe that the dome was covered when
they first took out the policy. There was nothing to suggest that
the firm had subsequently altered the policy terms and notified
its customers that it had done this, so we did not agree that
it should have rejected the claim.
The
firm agreed to meet the claim, but said it would not cover the
swimming pool dome against any loss after Mr and Mrs A’s current
insurance expired.
.............................................
23/13 motor – renewal – firm choosing not to invite renewal
– whether policyholder entitled to compensation when policy not
renewed
Shortly
before Mr E renewed his car insurance in February 2002, the firm
wrote to tell him that it was transferring customers to a subsidiary.
It said Mr E would not be able to renew his policy. The subsidiary
had different underwriting criteria and was not prepared to insure
him because of the number of claims he had made.
Mr E was upset about this decision, saying it was a ‘one-sided
variation’ of his policy. He did not think the subsidiary
was reasonable to have counted windscreen damage as a ‘claim’.
He said he was entitled to £300 for distress and inconvenience
and he asked for his policy to be reinstated.
complaint
rejected
The insurance contract was an annual policy and the firm was entitled
to decide not to offer renewal. It was also entitled to decide
how many claims policyholders could make before it would decline
to insure them. We did not agree that the firm had exercised its
discretion unreasonably or that Mr E’s complaint was justified.
.............................................
23/14 motor – renewal – automatic renewal – failure to pay premiums
– whether policy should have been renewed – whether subsequent
loss covered
Mr
H had insured his car with the same firm since 1994. He renewed
his policy every year and, from 1997, the firm had renewed the
policy for him automatically.
So
after he had an accident in October 2001, he was shocked when
the firm rejected his claim, telling him he was no longer insured.
The firm said that Mr H had telephoned in April 2001 to say he
had decided not to renew. It said it had subsequently written
to him to confirm his instructions.
Mr
H denied this. He said he had no idea that his insurance had lapsed
and he had not noticed that the monthly premiums were no longer
being deducted from his bank account. The firm told him he should
have realised he did not have a valid policy.
complaint
upheld
We asked the firm to send us a recording of the telephone conversation
in which Mr H had said he would not renew his policy. But it could
neither do this nor supply any notes of the conversation. Nor
could it produce a copy of the letter it said it had sent Mr H,
acknowledging his decision to cancel the policy.
As
the monthly premium was small, we were not surprised that Mr H
had failed to notice that the deductions from his bank account
had stopped. We thought he should have noticed that he had not
received a new certificate, but we accepted his statement that
he believed the policy had been renewed automatically, as usual.
We
put it to the insurer that Mr H had intended to renew his insurance
and his failure to do so was an innocent oversight. It agreed
to reinstate the policy and to reimburse the cost of repairs plus
interest, subject to his paying the outstanding premiums.
.............................................
23/15 motor – renewal – non-disclosure
– automatic renewal – whether firm made policyholder aware of
need to disclose change of circumstances
Mr J’s motor insurance was due for renewal on 30 January 2001.
The firm sent him renewal papers, including a letter that opened
with the line ‘If you want to renew then do nothing, it’s that
easy’. Further on, the letter said, ‘If your details aren’t
the same, then please ring us’.
The
letter referred to the premium being based on ‘the details
we already have on file for you. These are listed for you on the
enclosed renewal notice’. However, the renewal notice did
not include any information about driving offences or accidents.
At the end of the letter, there was a checklist that included
a request to call the firm if any details such as ‘convictions
or prosecutions’ had changed.
Mr
J’s car was stolen in July 2001 and the firm found out that he
had been convicted of a drink-driving offence on 11 January that
year. So it told him that it would not meet the claim and that
it was cancelling his policy from the date of the renewal.
Mr
J said he had been away from home until February 2001, but that
he had called the firm then and disclosed his conviction. The
firm agreed that he had called, but it said he had not mentioned
his conviction. It said he had only asked about reducing his cover
from comprehensive to third party, fire and theft.
complaint
rejected
We did not think that the firm’s renewal invitation made it clear
that policyholders had to disclose new information to the firm.
So we did not think it was entitled to decline to meet claims
on the grounds that a policyholder had failed to disclose routine
information, including minor offences.
It
was regrettable that the firm did not record its telephone conversations
with customers, since a recording would have resolved the dispute.
In the absence of a recording, we had to decide what had occurred
on a balance of probabilities.
We thought it highly improbable that any member of the firm’s
staff would have overlooked the significance of Mr J’s being disqualified
from driving. If he had mentioned it, we thought the firm would
have said it was not prepared to offer him cover on any basis.
We
also thought that any driver would know their insurer would consider
the conviction and disqualification highly significant and would
realise they had to disclose this when renewing their insurance.
So we decided that in this particular case the firm acted reasonably
in cancelling the insurance from the date of renewal.
.............................................
|