Claims Crisis - Major Insurer pulls out saying claims culture and awards a joke

Sweet.Science

Boggles wrote: »

Unvouched payouts.

Thats the Legal systems fault. You really think insurance companies would pay out on claims if they didnt have to.

gmisk

Sweet.Science wrote: »

How did the insurance industry create this issue ?

They do very little to deter fraudulent claims (i.e. they only report very very small numbers to gardai)

NIMAN

The new attitude now is to blame the industry! That's typical of us Irish. Always someone else's fault.

Ever hear about being a law abiding citizen, personal responsibility etc?

The fault in this case, and all their previous other cases, lie directly and solely with the family. No surprise that they are travellers.

This in my opinion is tantamount to stealing and fraud, and I wish the courts would treat it as such, otherwise it will never end. Time to start hitting people with costs if they lose. It's the only thing that will stop this nonsense.

If they don't, I can only imagine what we will be claiming for in the next decade or two.

Sweet.Science

gmisk wrote: »

They do very little to deter fraudulent claims (i.e. they only report very very small numbers to gardai)

I reckon 100s of fraudalent claims a month are investigated. You think Gardai care?

Years they have being trying to bring in a special unit in the Gardai to deal with these like they have in the UK. The Gardai couldnt be bothered. Victimless crime

Wheety

Sweet.Science wrote: »

Thats the Legal systems fault. You really think insurance companies would pay out on claims if they didnt have to.

Why would they contest it when they can just increase the premium and make it back over the course of 2 or 3 years?

NIMAN

Sweet.Science wrote: »

Victimless crime

Except its not.

Everyone who holds insurance is paying for it in increased premiums.

Ask the owners of play centres, employees now out of work cos their employers can't get insurance, the ocktober fest organisers who are getting sued by drunk people twisting their ankles.......

It's far from a victimless crime.

Boggles

Sweet.Science wrote: »

Thats the Legal systems fault. You really think insurance companies would pay out on claims if they didnt have to.

It's the legal systems fault the insurance industry pay out unvouched claims?

Get up the yard will you!! :pac:

Sweet.Science

NIMAN wrote: »

Except its not.

Everyone who holds insurance is paying for it in increased premiums.

Ask the owners of play centres, employees now out of work cos their employers can't get insurance, the ocktober fest organisers who are getting sued by drunk people twisting their ankles.......

It's far from a victimless crime.

I agree - sarcasm doesnt come across well.

NIMAN

Sweet.Science wrote: »

I reckon 100s of fraudalent claims a month are investigated

I'd disagree.

Did you watch the clip of Pearse Doherty grilling the insurance CEOs in committee a few weeks back.

They investigate a miniscule amount of claims.

Sweet.Science

Boggles wrote: »

It's the legal systems fault the insurance industry pay out unvouched claims?

Get up the yard will you!! :pac:

YEah go to court and see what happens with these unvouched claims. Its happened to me. I caused €125 damage to a car. My insurance company fought it all the way to court. I gave evidence . Took the day off work etc. The other **** was awarded 45k by the judge

gmisk

Sweet.Science wrote: »

I reckon 100s of fraudalent claims a month are investigated. You think Gardai care?

Years they have being trying to bring in a special unit in the Gardai to deal with these like they have in the UK. The Gardai couldnt be bothered. Victimless crime

Then why are so few being reported to Gardai?
The insurance providers themselves are estimating fradulent claims at 20%...yet they report less than 1% to Gardai

https://www.youtube.com/watch?v=Z6GyT5cV6jw

Boggles

Sweet.Science wrote: »

YEah go to court and see what happens with these unvouched claims. Its happened to me. I caused €125 damage to a car. My insurance company fought it all the way to court. I gave evidence . Took the day off work etc. The other **** was awarded 45k by the judge

What was the decision of the PIAB?

Mr. teddywinkles

NIMAN wrote: »

The new attitude now is to blame the industry! That's typical of us Irish. Always someone else's fault.

Ever hear about being a law abiding citizen, personal responsibility etc?

The fault in this case, and all their previous other cases, lie directly and solely with the family. No surprise that they are travellers.

This in my opinion is tantamount to stealing and fraud, and I wish the courts would treat it as such, otherwise it will never end. Time to start hitting people with costs if they lose. It's the only thing that will stop this nonsense.

If they don't, I can only imagine what we will be claiming for in the next decade or two.

Yep you tell them to stop being bold.

Sweet.Science

Boggles wrote: »

What was the decision of the PIAB?

The other person rejected a PIAB award of 12k. Went to court then. You couldnt even see the damage to her car but her life would never be the same again according to her doctor

Sweet.Science

gmisk wrote: »

Then why are so few being reported to Gardai?
The insurance providers themselves are estimating fradulent claims at 20%...yet they report less than 1% to Gardai

https://www.youtube.com/watch?v=Z6GyT5cV6jw

For a criminal matter you need to prove fraud deception beyond all reasonable doubt.

Civil is the balance of probability. Like this case it would be thrown out by a judge for a civil matter but they would never get a criminal conviction . The DPP wouldnt bring it to court.

The 1% are probably home runs that Gardai would be confident in getting a charge brought

gmisk

Sweet.Science wrote: »

For a criminal matter you need to prove fraud deception beyond all reasonable doubt.

Civil is the balance of probability. Like this case it would be thrown out by a judge for a civil matter but they would never get a criminal conviction . The DPP wouldnt bring it to court.

The 1% are probably home runs that Gardai would be confident in getting a charge brought

You dont need a level of proof...it is up to the Gardai to investigate...

The guy from FBD agreed.

Boggles

Sweet.Science wrote: »

The other person rejected a PIAB award of 12k. Went to court then. You couldnt even see the damage to her car but her life would never be the same again according to her doctor

Did this happen recently?

So it went to the Civil Circuit Court and the Judge awarded 45k.

What reasons did he give, how did he outline the award?

Sweet.Science

Boggles wrote: »

Did this happen recently?

So it went to the Civil Circuit Court and the Judge awarded 45k.

What reasons did he give, how did he outline the award?

None. She had 2 medical reports saying a 24 month whiplash injury. The damage to her car wasnt visible to the naked eye. It was only that there was a small bit of paint on her car that i was found liable

45k . And around 20k on top of that in legal costs

Joke

Boggles

Sweet.Science wrote: »

None. She had 2 medical reports saying a 24 month whiplash injury. The damage to her car wasnt visible to the naked eye. It was only that there was a small bit of paint on her car that i was found liable

45k . And around 20k on top of that in legal costs

Joke

In the Circuit Court for a whip lash case that lasted what an hour or 2?

BS.

Jurgen The German

The current state of the insurance industry cannot be blamed on one root cause, it's a massively complex issue.

We have reached this point due to a couple of major issues.

1) Pricing : about 10 years ago the likes of 123 and Setanta entered the market with unsustainable pricing levels in an effort to win market share. To combat this, the established insurers like Aviva, Allianz, Axa etc began to dramatically cut their rates in an effort to retain their customers and thus a race to the bottom in terms of price point began. The issue was that on average the same level of claims were coming through however the amount of money there to cover the claims was significantly reduced due to the lower pricing.

2) The global financial crash : Up to the GFC, insurers had been able to make decent returns on their investments which resulted in them being able to absorb the claims costs that should have been covered by the premium income from policies sold. Following the GFC, interest rates were basically wiped out, property investments became worthless so that meant their claims reserves were being depleted faster than they were being recouped.

3) Legislative Change : a couple of years ago Solvency II was introduced by the ECB. In simple terms it related to legal requirements on insurers to have a minimum amount of cash available to cover the cost of claims. Iirc it's a minimum of 200% of the claim reserves which means if an insurer has €100m outstanding claims they have to have at last €200m cash in hand available to cover these. This was partly introduced to avoid another Quinn / Setanta style collapse. Massive fines can be given to insurers that fall below the minimum requirements. A couple of years ago the rules were also changed and the department of social welfare are now entitled to claim back any payments made to successful claimants that received sickness benefit while out of work, from insurers. Its another hidden cost people aren't aware of.

4) Claims : historically in recessionary times, the number of claims increase. People are out of work and making a claim is still seen by a huge amount of people as being a victimless crime. Insurers are in the business of risk and are aware claims will occur, it's the nature of the business and these are accepted as "attritional" claims however with lower income and increased claims, both genuine and fraudulent, that puts additional pressure on their finances.

5) Claims awards - Ireland is massively out of whack with the UK and Eueope in terms of awards for claims. "Soft tissue" awards here are 4 or 5 times higher on average than our European neighbor's. Our laws allow people to not only make claims for virtually anything but often times get paid out for even the most frivolous of incidents. Up til now the courts would usually side with the claimant. The book of quantum really screwed the pooch as it gave judges with zero knowledge of injuries a template to award tens of thousands of euro for the most minor of injuries.

6) the legal system : the injuries board was introduced specifically to remove solicitors from the claims process due to the length of time claims were taking to settle (more money to be paid in legal fees) and the associated but today, something in the region of 90% of injuries board cases are represented by solicitors so all it is is more red tape.


They are imo some of the major reasons for the current mire, there are others of course but as I said in my opening, it's a massively complex issue.

dudara

New thread merged into pre-existing thread.

Jurgen The German

Boggles wrote: »

In the Circuit Court for a whip lash case that lasted what an hour or 2?

BS.

There you go again, talking about things you are clearly clueless about. The claimant had medical reports for over a two year period, the claim was obviously outstanding for over two years so the legal fees detailed are not at all outlandish.

Boggles

Jurgen The German wrote: »

The current state of the insurance industry cannot be blamed on one root cause, it's a massively complex issue.

We have reached this point due to a couple of major issues.

1) Pricing : about 10 years ago the likes of 123 and Setanta entered the market with unsustainable pricing levels in an effort to win market share. To combat this, the established insurers like Aviva, Allianz, Axa etc began to dramatically cut their rates in an effort to retain their customers and thus a race to the bottom in terms of price point began. The issue was that on average the same level of claims were coming through however the amount of money there to cover the claims was significantly reduced due to the lower pricing.

2) The global financial crash : Up to the GFC, insurers had been able to make decent returns on their investments which resulted in them being able to absorb the claims costs that should have been covered by the premium income from policies sold. Following the GFC, interest rates were basically wiped out, property investments became worthless so that meant their claims reserves were being depleted faster than they were being recouped.

3) Legislative Change : a couple of years ago Solvency II was introduced by the ECB. In simple terms it related to legal requirements on insurers to have a minimum amount of cash available to cover the cost of claims. Iirc it's a minimum of 200% of the claim reserves which means if an insurer has €100m outstanding claims they have to have at last €200m cash in hand available to cover these. This was partly introduced to avoid another Quinn / Setanta style collapse. Massive fines can be given to insurers that fall below the minimum requirements. A couple of years ago the rules were also changed and the department of social welfare are now entitled to claim back any payments made to successful claimants that received sickness benefit while out of work, from insurers. Its another hidden cost people aren't aware of.

4) Claims : historically in recessionary times, the number of claims increase. People are out of work and making a claim is still seen by a huge amount of people as being a victimless crime. Insurers are in the business of risk and are aware claims will occur, it's the nature of the business and these are accepted as "attritional" claims however with lower income and increased claims, both genuine and fraudulent, that puts additional pressure on their finances.

5) Claims awards - Ireland is massively out of whack with the UK and Eueope in terms of awards for claims. "Soft tissue" awards here are 4 or 5 times higher on average than our European neighbor's. Our laws allow people to not only make claims for virtually anything but often times get paid out for even the most frivolous of incidents. Up til now the courts would usually side with the claimant. The book of quantum really screwed the pooch as it gave judges with zero knowledge of injuries a template to award tens of thousands of euro for the most minor of injuries.

6) the legal system : the injuries board was introduced specifically to remove solicitors from the claims process due to the length of time claims were taking to settle (more money to be paid in legal fees) and the associated but today, something in the region of 90% of injuries board cases are represented by solicitors so all it is is more red tape.


They are imo some of the major reasons for the current mire, there are others of course but as I said in my opening, it's a massively complex issue.

So basically the insurance industry fúcked the market through bad management and gambling.

Boggles

Jurgen The German wrote: »

There you go again, talking about things you are clearly clueless about. The claimant had medical reports for over a two year period, the claim was obviously outstanding for over two years so the legal fees detailed are not at all outlandish.

That's not clear.

Anyway solicitors don't issue medical reports.

20k for legal fees for a case of this nature is bullshít.

The entire thing has been fabricated IMO.

sydthebeat

Boggles wrote: »

So basically the insurance industry fúcked the market through bad management and gambling.

Yep in a nut shell.

Sweet.Science

Boggles wrote: »

In the Circuit Court for a whip lash case that lasted what an hour or 2?

BS.

What on Earth are you talking about

cruizer101

Boggles wrote: »

So basically the insurance industry fúcked the market through bad management and gambling.

Yes, and you can ascribe a certain amount of blame onto them, but at the end of the day they are private companies, their main purpose is to maximise profits anything else is secondary to that goal.

The main fault is that of the government in sitting by idly, they should be regulating the industry, they should be controlling the levels of payout (book of quantum needs massive review and claims should be paid out as expenses direct to hospital/physio etc), they should be legislating to ensure fraudulent claims are dealt with appropriately and assigning the appropriate resources to deal with it effectively.

markodaly

Boggles wrote: »

So basically the insurance industry fúcked the market through bad management and gambling.

Ah come on. The poster went to the effort to detail 6 reasons as to why were are where we are today. Simple, cheap oneliners from yourself notwithstanding add nothing to the debate.

markodaly

Boggles wrote: »

That's not clear.

Anyway solicitors don't issue medical reports.

20k for legal fees for a case of this nature is bullshít.

The entire thing has been fabricated IMO.

Have you ever been to court? Do you know how much it costs to bring a case to the circuit court?

Because if you did, you wouldn't be saying the above.

Boggles

cruizer101 wrote: »

Yes, and you can ascribe a certain amount of blame onto them, but at the end of the day they are private companies, their main purpose is to maximise profits anything else is secondary to that goal.
.

Yes, the best way to achieve that is by good management and not reckless gambling.