I wonder if anyone can offer me some advise on dealing with insurance company. I have been with AMI for over 15 years but I am seriously considering changing insurance company now after what happened to my mum house. My mum's bath was accidentally damaged last year and we put in an insurance claim to AMI. AMI organise a plumber to replace the bath but after about a month we found out water was slowly leaking onto the bedroom next to our bathroom that caused mould onto the carpet and wall. We complained to AMI and they insist my mum need to pay yet another access while they are investing the case. They dragged on the case for another 9 months by telling my mum to wait and until now they try to settle the case by only compensate $1000 cash to us for a repairing job which could easily cost us over $3000. I rang their complain line and their manager said they are not responsible for the quality of the plumber work and hence AMI is not responsible for this. I wondering what fault a customer like my mum has? Anyone can offer me an advise?
They are CATEGORICALLY responsible for the quality of the plumber THEY hired to remedy the issue with your mothers house. They are responsible for any and all subsequent damage he causes, or fails to prevent.
Goodayeall: They dragged on the case for another 9 months by telling my mum to wait and until now they try to settle the case by only compensate $1000 cash to us for a repairing job which could easily cost us over $3000.
I agree with the two comments above, the Insurance Ombudsman service however can only be used once other avenues have been exhausted, the insurer has to formally notify the insured party that "deadlock" has been reached.
You need to establish the cost of the claim. That's actually not their job to determine, despite this being the way it "normally" works with car claims, broken windows etc where they just fix stuff and the insured party might not even be told what the costs were. "Could easily cost us over $3,000" is not doing that - you need to know by getting quote(s) for the required work, then lodging the claim. It's one claim - so their levying of the excess twice is wrong.
If they reject that, then take the next steps.
Their call centre staff aren't usually very knowledgeable. It's best to communicate in writing - email is fine, and make sure you keep records.
Incidentally, I just submitted a claim to AMI. An internal leaking pipe caused water damage.
Leak is fixed , I thought the cost would be covered. But, AMI now tell me they have a 'special' clause limiting damage from internal leaks to a very measly 1500.
While I don't think our repair costs will be much more that that (just a bit of repainting and plastering), I am surprised. I get insurance to protect against this very kind of thing. A leaking pipe could potentially wipe out ones life savings, so , is this not what insurance is for?
I get the whole actuarial maths etc, but, I don't mind paying a little more to cover this stuff.
Anyway, I have been with AMI for 10 years or so, they've been good on payouts (one car, one house, one iphone claim) but might be time to do a review.
I think that could be right - to take them direct to small claims rather than the Insurance Ombudsman - as it's not so much an insurance dispute, but that the contractor caused a loss.
I'd be surprised if it can't be sorted out quite simply though and without need for that - once the OP gets a quote for the repair and presents it to the insurer.
I had to do this (prove my claim) many times to put together my $250k earthquake repair claim. Insurer made their offer, bit by bit I had to examine each aspect, argue for more where they'd been a bit light on their offer or missed aspects of repair completely. They accepted every extra I proposed without question. That totalled about $100k worth of repairs that they'd initially missed or under-costed.
Can I ask what is "small claim" and what do I need to do? Yes AMI gave us a total cost of $3300 but only agreed to pay the $1500 (less $400 excess) under their rule
I don't know who is the subcontractor but AMI told me that the subcontractor insurance company decline liability (message via AMI). I thought AMI can take further action like suspend the contractor and sub-contractor until they resolve the issue but they choose to take the easy way to incentive us to end the case. Very unprofessional and disappointed.
AMI internal complaint department told me "I always has a choice" to choose the plumbler so is "All my fault". I don't really get it as my mum never been offer that choice.
I have been very loyal to AMI so far but I really doubt they are professional enough when deal with dispute like this.
Can I ask what is "small claim" and what do I need to do? Yes AMI gave us a total cost of $3300 but only agreed to pay the $1500 (less $400 excess) under their rule
I don't know who is the subcontractor but AMI told me that the subcontractor insurance company decline liability (message via AMI). I thought AMI can take further action like suspend the contractor and sub-contractor until they resolve the issue but they choose to take the easy way to incentive us to end the case. Very unprofessional and disappointed.
AMI internal complaint department told me "I always has a choice" to choose the plumbler so is "All my fault". I don't really get it as my mum never been offer that choice.
I have been very loyal to AMI so far but I really doubt they are professional enough when deal with dispute like this.
I get what AMI are saying - you could have chosen your own plumber or taken one from their list. ie, the plumber was effectively your choice.
Either way, you sue AMI, or sue the plumber in small claims.
Why on earth do tradespeople have indemnity insurance if not for this very thing???
The whole thing stinks in my view. AMI's treatment and the plumbers treatment of you is appalling.
Do you know if the plumber is a member of the Master Plumbers organisation or some other professional body? Could possibly address your claim via that avenue.
kiwiharry: Do you know if the plumber is a member of the Master Plumbers organisation or some other professional body? Could possibly address your claim via that avenue.
The OP has no relationship with the plumber therefore no claim could easily be brought against them from the OP. This is ENTIRELY the Insurance companies issue and small claims will resolve it, or the Insurance omsbudsman.
If it were me, I'd be asking to speak to the head of claims, and politely and firmly explaining what the costs related to the issue were and giving them 7 days to remedy or have made a plan to remedy before taking this further. I'd follow up any conversation with an email or written communciation to the same effect.
I've won a number of big battles with insurance companies including something very similar when my grandparents died and a pipe bursting. They offered $1200 settlement and eventually paid out about $22K.
Originally someone else was dealing with it and had agreed to the $1200 settlement, but 3 phone calls later it was sorted.
Did take threatening to publicise the matter for them to take me seriously.
The OP has no relationship with the plumber therefore no claim could easily be brought against them from the OP. This is ENTIRELY the Insurance companies issue and small claims will resolve it, or the Insurance omsbudsman.
Are you sure from a legal standpoint? The OP effectively chose the plumber , AMI just paid the bill .
I would think the insurance ombudsman would be the first place to go -- -they are free for a start.
Then, if there is no luck, lodge a disputes tribunal claim naming both AMI and the plumber.
IANAL and the OP possibly should get professional advice from their CAB. That is an interesting point about them choosing the plumber, over the insurance companies choice, but I can't see where the OP said that.. However I would have though that it would still be the insurance company that has entered into the contract with the plumber. So it has to be done though them.
It sounds like the insurance comapny are treating it as another event, rather than a defect with the insurance repair job.
The OP should have CGA coverage for this anyway, which also covers services. You would have to prove that the damage is the result of the insurance repair work done. Potentially it may not be directly related to the repair, but due to that black plastic piping etc, that may have been aggravated by the repair job,.
I recently had an insurance job done, and the tradespeople cause substantial damage to something else. We went back to the insurance company about it, and they said we should communicate with their contractors (who they choose) but they had subcontracted out the work to another party. So our contract was with the insurance company, so they in the end were responsible for putting right the other damage to, as it was caused by work on the insurance claim. They infact said that under the CGA, we have to give the original company the opportunity to put the work right. In the end they did (6 month process overall) , although it wasn't perfect, so in the end it worked out.
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