Insurance provider do not pay out

Hello MichaelZ ,

Thanks for getting in touch. I’m sorry to hear about the issues your Friend is having with their insurance provider.

I can see you have already opened a complaint with the Financial Ombudsman Service (FOS). FOS are there to give an unbiased answer about what’s happened. If they decide someone’s been treated unfairly they have legal powers to put things right. 

In order to look at the complaint, the FOS will need the policy number, a brief outline of the problem, and copies of any paperwork or letters. 

The FOS will look at both sides of the story and find out the facts of what’s happened. If their decision is in favour of the person complaining, they will tell the insurer to put the matter right and may ask them to pay compensation and costs. 

It’s worth knowing that there are two tiers of investigation at FOS, the first is an investigator/adjudicator; they will look at the case initially and give a recommendation based on their assessment of the facts in the case.

If your friend, or the insurer, don’t agree with the investigators opinion, they can ask for the case to be escalated to an Ombudsman. The Ombudsman will look at the case with a fresh set of eyes and will give their decision based on an impartial assessment of the facts. The Ombudsman’s decision is the final level at FOS and their ruling is final for the insurer.

At this point, if your friend still doesn’t agree, they can look to seek legal advice. This can be costly and it is always worth considering that the FOS will have already made an impartial decision on the case. If your friend still wishes to pursue legal advice at this point here are some pointers on how to seek it:

Getting Legal Advice

Finding a solicitor

To find a solicitor, talk to family and friends for a personal recommendation. Or visit the Law Society of England & Wales website:

http://solicitors.lawsociety.org.uk/

Or call the Law Society of England & Wales on 020 7320 5650

To find a solicitor based in Scotland, visit the Law Society of Scotland website:

https://www.lawscot.org.uk/find-a-solicitor

Or call the Law Society of Scotland on 0131 226 7411.

If based in Northern Ireland, contact the Law Society of Northern Ireland:

https://www.lawsoc-ni.org/solicitors

Or call the Law Society of Northern Ireland on 028 9023 1614

Other sources

It’s worth knowing that membership of a union, or staff federation may include legal services.

Packaged bank accounts may also offer a legal helpline and some insurance policies such as car or home insurance may have a legal helpline as an additional benefit. So, it’s worth checking the terms and conditions.

Disability Law Service

Provide free legal advice to people with disabilities and their carers.

For further information on the areas of law they cover visit: http://dls.org.uk/

If you’d like to contact them with a general enquiry, you can email at advice@dls.org.uk

Or telephone: 0207 791 9800 (option 7)

Law Works

Law Works is a charity working in England and Wales to connect volunteer lawyers with people in need of legal advice, who are not eligible for legal aid and cannot afford to pay.

For further information on the areas of law they cover visit: https://www.lawworks.org.uk/

Law Centres Network

Law Centres offer legal advice, casework and representation to individuals and groups. Specialising in social welfare law.

For further information on the areas of law they cover visit: http://www.lawcentres.org.uk/

Excludes Scotland

Legal Aid

Legal Aid may be available to help cover the costs of legal advice in certain situations, if the person is unable to afford the cost of legal advice themselves and their problem is serious.

For information on the circumstances covered by Legal Aid visit: https://www.gov.uk/legal-aid

Please note Legal Aid rules are different in Scotland and Northern Ireland

https://www.mygov.scot/legal-aid

https://www.justice-ni.gov.uk/topics/legal-aid

We could also have a look at the insurance claim for your friend. If your friend has a copy of the policy document and of the decline letter from the insurance company we can take a look at this and see what guidance we can offer. If you’d like our assistance with this please get in touch on 0808 808 0000 and select option 1, then 2 and then 1 again to get through to our financial guidance team, we are open between 8am and 6pm Monday to Friday. 

The Financial Guidance team also looks at matters such as mortgages, pensions and estate planning. If you feel your friend might need any support in these areas then please do not hesitate to get back in touch.

Yours Sincerely, 

Calum N 
Financial Guide 

The Financial Guidance Service will not advise you on the merits of buying, selling, cancelling or making a claim on a specific financial product from any company or otherwise provide you with any regulated services. As a guidance service, we do not provide financial advice or carry on other activities that are regulated and we are not authorised or regulated by the Financial Conduct Authority. No part of our service constitutes, nor is intended to constitute, a financial promotion within the meaning of the Financial Services and Markets Act 2000 nor an invitation or inducement to engage in investment activity. 

The aim of the Financial Guidance Service is to provide you with information to help you make informed decisions about your personal finances. For financial advice, including recommendations to buy, sell, cancel or make a claim on specific financial products or to obtain any other type of financial services, you should speak to a financial adviser or company who is permitted to provide you with those services. You can find a local financial advice firm or other type of firm who provides regulated services on the Financial Conduct Authority's website - https://register.fca.org.uk/directory/s/. 

The information that we provide you is for general guidance on your rights and responsibilities and is not legal advice. We are not liable to you for any information or services obtained by you from, or given to you by, a third party.