How The Ombudsman Works

How The Ombudsman Works

The Financial Ombudsman is a body that works as a high court for insurance companies who suspect claimants of fraud, and for claimants who believe that they should receive a pay out from their policy but are being rejected by their insurer. It is a difficult issue because the insurance companies have to prove intent of deceit on the part of the claimant, whilst the claimant has to demonstrate a complete innocence when it comes to the overlooking of certain information on the original policy.

When the Ombudsman is approached with a case most of the details have already come to light, giving both sides the opportunities to prepare or support their position, and confusing facts even further. It therefore has to work along certain, well documented and clear lines in order to reach a final decision.

Firstly, exaggeration does not necessarily mean fraud. Insurance firms sometimes wish to ignore claims because the customer has mistaken the cost of replacing an item that they have claimed for. In order to discount the claim the firm has to show that the customer was trying to obtain more than they were entitled to claim under the terms of the policy.

General dishonesty is not allowed to count as evidence either. Just because the customer may have lied in another context is not enough to prove that the current claim is a fraud. Firms have to operate on a case by case policy and cannot rely on evidence offered by another individual regarding previous dealings with the individual.

The Ombudsman also considers that a customer who presents a forged document to support a claim is not necessarily committing a fraud. It is not enough for the document to be a forgery, but proof has to be obtained that demonstrates that the claimant knew the true source of document. Even if a customer knowingly presents a false document, that is not enough for a firm to reject a claim.

The Financial Ombudsman operates along lines that support the claimant wherever possible. As is only right the claimant is considered to be innocent until the insurance company can prove guilt, though this makes it easier for individuals to carry out an insurance fraud.

For the average customer, however, the Ombudsman’s operational lines offer a safety net. Many people who have insurance claims rejected have not perpetrated direct fraud but instead made mistakes that may be difficult to explain but are nonetheless innocent. In order to avoid such situations make sure that you are as comprehensive as possible when submitting an application for a policy, it is impossible to give too much information. If you do your research properly, you will get a good value policy, whatever information you submit to the insurance firm.

Article Source: http://www.new.citynewslive.com

Thomas Kerrin is author of article written on home insurance & house insurance . For more information, please visit :www.co-operativeinsurance.co.uk/servlet/Satellite/1203668836269,CFSweb/Page/Insurance-Home

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