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Hello community,
I wanted to share my recent experience with the Financial Ombudsman Service regarding an insurance claim dispute, which has left me questioning the fairness and logic of their procedures. This journey has been eye-opening, revealing how a seemingly simple term can derail a claim.
The Heart of the Matter:
My dispute revolved around a claim that was initially denied by my insurer, a decision upheld by the FOS. Central to this was the interpretation of the term "agreement" within my policy.
This is the term used in the policy contract: A dispute regarding an agreement for the sale, purchase or hire of goods or services that are not for your business use.
The Vague Definition Dilemma:
Both the insurer and the FOS relied on a dictionary definition of "agreement" to justify their decision. The definition they used stated an agreement as a "decision or arrangement often formal and written between two or more groups or people." This struck me as peculiar for two reasons:
Lack of Legal Precision: The definition used was from a general dictionary, not a legal one. This is concerning as insurance contracts, by nature, should align more closely with legal definitions due to their complexity and potential impact on policyholders.
Inconsistency with Online Definitions: A simple Google search shows varying definitions of "agreement," many of which do not insist on the formality or written nature as the one used by the FOS. This raises questions about the fairness and clarity in the interpretation of policy terms.
For example, the definition of an agreement to me is what the English Law defines what an agreement is, not the Cambridge dictionary.
The Logical Leap:
My argument, based on English law and industry practices, was that an implied agreement had been formed through extensive interactions with a service provider. However, this was dismissed due to the lack of a formal, written contract and payment transaction, despite the commonality of informal agreements in professional settings. Even a barrister has confirmed that I had an agreement with the company despite no written formal contract or payment, and the company were under the duty of care. However, this is what FOS has said:
You make several references to how legal services work, what is recognised in English Law and Solicitors Regulation Authority "SRA" principles. But I think its important to confirm that we are only looking at your case from an insurance perspective and not a legal one.
In terms of what constitutes an "actual agreement", again this would not be in the context of legal services and where the policy doesn't define something, a general rule is by referring to the Dictionary definition which in this case is:
a decision or arrangement, often formal and written, between two or more groups or people:
Therefore, I'm still of the opinion that your claim doesn't meet the requirements of the policy as there was no formal or written agreement with xxxx
A System Set in Its Ways:
Throughout this process, I've felt that the system favors rigid interpretations over practical realities. The insistence on a narrow, perhaps outdated, understanding of terms like "agreement" can lead to seemingly unfair outcomes for consumers.
Seeking Collective Insights:
This experience has been more than just a personal struggle; it has highlighted potential flaws in our systems that need addressing. I'm keen to hear your thoughts and experiences.
I really think the FOS is there to protect the big companies, as most people just agree with whatever FOS says or just give up.
I wanted to share my recent experience with the Financial Ombudsman Service regarding an insurance claim dispute, which has left me questioning the fairness and logic of their procedures. This journey has been eye-opening, revealing how a seemingly simple term can derail a claim.
The Heart of the Matter:
My dispute revolved around a claim that was initially denied by my insurer, a decision upheld by the FOS. Central to this was the interpretation of the term "agreement" within my policy.
This is the term used in the policy contract: A dispute regarding an agreement for the sale, purchase or hire of goods or services that are not for your business use.
The Vague Definition Dilemma:
Both the insurer and the FOS relied on a dictionary definition of "agreement" to justify their decision. The definition they used stated an agreement as a "decision or arrangement often formal and written between two or more groups or people." This struck me as peculiar for two reasons:
Lack of Legal Precision: The definition used was from a general dictionary, not a legal one. This is concerning as insurance contracts, by nature, should align more closely with legal definitions due to their complexity and potential impact on policyholders.
Inconsistency with Online Definitions: A simple Google search shows varying definitions of "agreement," many of which do not insist on the formality or written nature as the one used by the FOS. This raises questions about the fairness and clarity in the interpretation of policy terms.
For example, the definition of an agreement to me is what the English Law defines what an agreement is, not the Cambridge dictionary.
The Logical Leap:
My argument, based on English law and industry practices, was that an implied agreement had been formed through extensive interactions with a service provider. However, this was dismissed due to the lack of a formal, written contract and payment transaction, despite the commonality of informal agreements in professional settings. Even a barrister has confirmed that I had an agreement with the company despite no written formal contract or payment, and the company were under the duty of care. However, this is what FOS has said:
You make several references to how legal services work, what is recognised in English Law and Solicitors Regulation Authority "SRA" principles. But I think its important to confirm that we are only looking at your case from an insurance perspective and not a legal one.
In terms of what constitutes an "actual agreement", again this would not be in the context of legal services and where the policy doesn't define something, a general rule is by referring to the Dictionary definition which in this case is:
a decision or arrangement, often formal and written, between two or more groups or people:
Therefore, I'm still of the opinion that your claim doesn't meet the requirements of the policy as there was no formal or written agreement with xxxx
A System Set in Its Ways:
Throughout this process, I've felt that the system favors rigid interpretations over practical realities. The insistence on a narrow, perhaps outdated, understanding of terms like "agreement" can lead to seemingly unfair outcomes for consumers.
Seeking Collective Insights:
- Has anyone else faced similar challenges with insurance claims and the FOS?
- What are your thoughts on the reliance on non-legal definitions in policy interpretations?
- Any advice on how to navigate these situations or bring attention to these systemic issues?
This experience has been more than just a personal struggle; it has highlighted potential flaws in our systems that need addressing. I'm keen to hear your thoughts and experiences.
I really think the FOS is there to protect the big companies, as most people just agree with whatever FOS says or just give up.
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