Does This Constitute Fraud under the Fraud Act 2006?

[GreyDad]

Hello, first and hopefully last post here!

I have submitted a claim on my house insurance with H____ P_____. A loss adjustor from G____ S______ was appointed at my behest after I found the performance of the insurer's claims handler below the standard I expected.

The loss adjustor had stated in an email that the claim would be sent to the underwriters, A___, to determine liability and expected to get an answer within 7-10 days.

After several weeks had elapsed, I asked the loss adjustor the status of the claim and he said that there was a delay as there were variances from my statement of fact which had been flagged to the Underwriters. He stated that it took 5 and 10 working days for a response from the Underwriters (HP) to be passed on to the Insurers before being communicated to the loss adjustors (GS). I asked if there was an internal dispute resolution process that I could initiate with the Underwriter, (A); he confirmed that there was but stated "The first stage in this instance if you have a dispute would be to raise it with me and I will happily register it for you."

I contacted the CEO of A (Underwriter), imploring them to deal with my claim fairly and in a timely manner; my request was referred to the complaints department and after I submitted my policy information, I was told that A had no involvement in my claim.

The loss adjustor responded to an email and provided an update highlighting that the Underwriters were still scrutinising the claim and had not accepted liability. When asked to confirm who was scrutinising the claim, the loss adjustor confirmed that it was A. I immediately contacted A and renewed my queries regarding my claim and their involvement and they refuted all involvement except for handling my initial contact with the CEO.

I engaged with the Insurer, HP, and relayed some of my concerns regarding the alleged involvement that A was having with my claim; it was confirmed in writing that A had not been involved in the claim and that the Insurer's underwriters had been dealing with the claim.

Would this code of conduct meet the criteria for a fraud charge under the Fraud Act 2006?

It is the gain or loss which I am struggling to determine. By false representation/failing to disclose information could it be argued that he undermined my knowledge of the claim with a view to influencing my decision making regarding the claim?

Many thanks

[PallasAthena]

In my opinion there is no possibility that this is a criminal offence under the Fraud Act. Other opinions are available.

[GreyDad]

In my opinion there is no possibility that this is a criminal offence under the Fraud Act. Other opinions are available.

Thank you for the response.

The loss adjustor has repeatedly stated in writing that the claim is being dealt with by the underwriter; it transpires that at no point has the underwriter been involved in the claim. Fraud includes false representation, failing to disclose information or an abuse of power - his conduct meets the definitions under the Fraud Act 2006.

As I stated in the initial question, can having information withheld or misrepresented constitute a risk of loss? ie I have not been made privy to all of the information which I am entitled to under the FCA principles and as a result could make an ill informed decision.

[PallasAthena]

You are clutching at straws. s2, s3 and s4 would all require that the loss adjuster had been "dishonest" (not merely that he was wrong or incompetent) and that his "intention" was to cause you loss. Both those things. Nothing you have posted goes anywhere near meeting either of those tests. In my opinion.

[GreyDad]

You are clutching at straws. s2, s3 and s4 would all require that the loss adjuster had been "dishonest" (not merely that he was wrong or incompetent) and that his "intention" was to cause you loss. Both those things. Nothing you have posted goes anywhere near meeting either of those tests. In my opinion.

I am not clutching at straws, I am asking for legal advice from legally qualified people.

If the insurance company can say that fabricating events involving 2 insurance companies is not dishonest conduct (if ordinary and honest people, knowing or believing the circumstances to be as the defendant knew or believed, would consider it dishonest) then I am happy to consider their determination and explanation. I expect that investigating the complaint will shed further light.

[wales01man]

For qualified legal advice you need to got to a Solicitor very few on here and those that are only offer their opinions

[GreyDad]

For qualified legal advice you need to got to a Solicitor very few on here and those that are only offer their opinions

I think you're right, takes a Welshman to speak some sense. Da iawn

[PallasAthena]

I am not clutching at straws, I am asking for legal advice from legally qualified people.

If the insurance company can say that fabricating events involving 2 insurance companies is not dishonest conduct (if ordinary and honest people, knowing or believing the circumstances to be as the defendant knew or believed, would consider it dishonest) then I am happy to consider their determination and explanation. I expect that investigating the complaint will shed further light.

GreyDad, I have over 30 years experience handling insurance claims and the relevant qualifications and on the evidence you posted it's my opinion that arguing this is fraud is hopeless and a waste of your time. You are clutching at straws.

What you have is evidence of poor customer service. Follow through the internal complaints procedure and if that is unsatisfactory refer it to the Financial Ombudsman Service.

If you believe it is crime under the Fraud Act 2006 then you should report it to the police as soon as possible. Good luck with that.

[des8]

well in that case you should read the Fraud Act in its entirety and not just the first phrase.
As pointed out in post 4 by PallasAthena "intention" is required if the actions are to be deemed "fraudulent"

Pob lwc

[GreyDad]

GreyDad, I have over 30 years experience handling insurance claims and the relevant qualifications and on the evidence you posted it's my opinion that arguing this is fraud is hopeless and a waste of your time. You are clutching at straws.

What you have is evidence of poor customer service. Follow through the internal complaints procedure and if that is unsatisfactory refer it to the Financial Ombudsman Service.

If you believe it is crime under the Fraud Act 2006 then you should report it to the police as soon as possible. Good luck with that.

Oooooooh thanks for that.

I am not referring it to the Police, and have not said that was my intention. I have asked if it constitutes a risk of loss.

My intent is for the insurer to use their internal dispute resolution process to look at whether the code of conduct constitutes fraud or incompetence. I expect they will go for incompetence rather than trying to wriggle out of everything.