February / March 2011
'repair, replace or cash' – disputes about how insurance claims are settled
We frequently see complaints where an insurer has agreed to settle a claim – but wishes to do so in a way that the policyholder considers inappropriate.
The insurer may, for example, offer to repair a damaged item when the policyholder wants instead to receive a replacement. In other instances, the insurer agrees to a replacement but insists that it is obtained from a specific retailer.
Our selection of case studies illustrates the types of complaints brought to us and the way in which we have resolved them. Our approach to such disputes has not changed over the years – and we outline here the general principles we follow.
Most household policies now provide 'new-for-old' cover but leave it to the insurer (not the policyholder) to decide whether the claim should be settled by repair, replacement, reinstatement or cash settlement. Where a case is referred to us, we consider whether the insurer has exercised this power reasonably, in the circumstances of the individual case.
Where insurers opt for repair, we consider whether they have explained the implications of any choices made by either party. If the repairer is chosen by the insurer – or its agents (such as loss adjusters) – we are likely to conclude that the insurer will be responsible for ensuring any deficiencies in the repair are put right. If the policyholder has insisted that a particular repairer should carry out the work, then we are likely to conclude that the policyholder will be responsible for the quality of that work.
This does not mean that every repairer who has provided a policyholder with an estimate will be regarded as the policyholder's chosen contractor. We have considered complaints where the insurer told the policyholder to obtain estimates and the policyholder sought the loss adjuster's assistance in doing this. In these circumstances, we are likely to conclude that it is the insurer, rather than the policyholder, who is liable for any shortcomings in the work.
Even if the policyholder chose the repairer entirely independently, we are likely to conclude that the insurer is responsible for rectifying deficiencies in the work if it (or its agents) 'controlled' the repairer, for example by requiring the repairer to cut costs or to use certain materials or parts. In those circumstances, the repairer can no longer be regarded as the policyholder's 'agent'.
Where insurers opt for replacement, we consider whether a reasonable replacement can be obtained in the way the insurer has proposed. If, for example, the item concerned is jewellery that is antique or specially-commissioned, then we are likely to conclude that it would be unfair for the insurer to insist on the policyholder buying a modern substitute from a major high-street retailer. In such cases, we usually conclude that policyholders should be allowed to choose where they purchase a replacement and are entitled to a cash settlement (without the deduction of any discount) if they are unable to find an acceptable replacement.
Where a reasonable replacement can be obtained from a high-street retailer, insurers often specify which one – because they have a discount arrangement with that particular retailer. We are likely to conclude that this is reasonable if the consumer lives within easy travelling distance of that retailer – and the retailer can provide a reasonable replacement. Similar issues arise if the insurer offers vouchers that can only be exchanged for goods sold by a particular retailer.
Sometimes, policyholders prefer to have a cash settlement even though there is no practical reason why they could not visit the insurer's preferred retailer – and that retailer is able to provide a reasonable replacement. In such instances we will not usually consider it unreasonable for the insurer to deduct from the cash settlement any discount it would otherwise have obtained from the retailer.
Source : http://www.financial-ombudsman.org.uk/publications/ombudsman-news/92/92-insurance-claims.html
Best Regards :
Selvi Aldriani – 0817.487.0850
R&D and Technical Advisor
PT. Dian Makmur Jaya Abadi