Disputing Insurance liability with Ombudsman

enixus on 02/09/2014 - 10:39

Hi

In May this year I was involved in a car accident at an intersection. It was pretty clear I wasn’t at fault but since and since I only had third party property damage I contacted the other party’s insurance to pay my damages. I was shocked when they told me I was at fault !!!! They started quoting nonsense road rules to me and when I point them out to the correct road rules on the Queensland transport website, they said that they were not going to change the liability regardless (both myself and the other party agreed on the version of the events).

I went to the police to file a report , they interviewed all parties involved and decided that I had the right of way and the other car was at fault.

There was a witness but their version of the events was different than the other party and myself and wasn’t reliable, although even in their version I still had the right of way.

I also had a letter from Queensland Transport explaining the road rule applying to my situation saying I had the right of way.

They disregarded all of the above and now my insurance is closing my claim. They said that because they can’t pay my damages (I am not covered for it) and the other insurance doesn’t accept liability, they can’t do much else.

I thought of lodging a dispute against the other insurance with the financial ombudsman, it is a good idea ? Are they good at dealing impartially with situations like mine ?

I am so stressed about this that I am physically sick from it. I don't remember a headache free day since then ….

Any advice on what to do ???

Automotive

Comments

  • iampoor on 02/09/2014 - 10:54
    +1

    As you are in Queensland this will be relevant:

    http://www.legalaid.qld.gov.au/legalinformation/carsanddrivi…

    http://www.legalaid.qld.gov.au/legalinformation/Pages/Organi…

    As they have replied QCAT is probably not the way to go, you are on the right track with the Financial Ombudsman, suggest that you contact them as soon as possible to get the ball rolling.

    I have also found Legal Aid (in Victoria) to be fairly responsive and it is free so you might want to pop in for some advice.

    Good luck.

    • enixus on 02/09/2014 - 10:57

      Thanks

      I will take a look at Legalaid as well and hopefully somebody will help :)

  • suchislife12 on 02/09/2014 - 11:07

    Do you mind explaining what exactly happened? Knowing an insurance assessor I may be able to attempt to understand why they aren't paying up and how you can make them. If both parties have the same version of events it's hard to see it as clear cut as you are describing it.

  • ilostnemo on 02/09/2014 - 11:40

    In WA, there is always a traffic offence recorded against the persons name who caused the accident. This clearly tells who is responsible, ie Drunk Driving, Failing to Give Away, Wreckless driving, etc. I would ask the police if the other party has been charged.

    I assume you have no actual car insurance, and just have coverage via your car registration.

    Good Luck with it.

    After this is all cleared get proper insurance. I hate paying it each month and haven't had to use it for 20 plus years but I sleep well at night, knowing I have it.

    • enixus on 02/09/2014 - 11:54

      thanks,

      the police decided not to charge the other driver since they didn't attend the scene. Reason being that if they disputed the ticket it would have taken more resources than what it was worth.

      I have only third party damages , It's an old car, so my insurance would pay the other car but not mine.

      • Noblejoker on 02/09/2014 - 12:48
        +1

        Who is your insurance with?
        Have you enquired with your insurer?
        Some Third Party Property Damage offer an additional cover often called Uninsured Motorist benefit or similar. This basically offers to pay for YOUR damage as if your had full comprehensive cover usually up to a limit like $5K. It usually carries the proviso of having all the other parties details and for your to be clearly not at fault - which it seems your would satisfy.

        If your don't have this option then make sure you get the Insurers denial in writing and then submit a request to their Internal Dispute Resolution IDR process. All Australian insurers must run an IDR and going through that will mean someone else in the company, usually with higher authority, will review the claim. They take an attitude of what would the ombudsman do and regularly pay claims that have been denied. The ombudsman will want you to go through this process first before you pursue through IOS

        If you are knocked back under IDR then I strongly suggest you use the legal aid to help your pursue the insurer, as well as lodge a complaint through the IOS (ombudsman).

        Insurers like this give the industry a bad name (which I dislike as I am in it)

        • enixus on 02/09/2014 - 13:33

          Yes I have the uninsured motorist benefit but only applies if the other party doesn't have insurance. In this case the other driver is insured and has lodged a claim.
          I just called the Ombudsmen and they gave me the number for the other insurance company's Dispute resolution area.

          Thank you for this information, you gave a little hope :)

        • Noblejoker on 02/09/2014 - 21:40
          +1

          @enixus: ah yes of course - they are insured but with aholes
          Good luck

  • enixus on 02/09/2014 - 11:43

    We were both stationary at an intersection. This particular road is one lane road in each direction,

    and lanes are divided by a wide nature strip. At this particular intersection there is a break in

    the divider, with a short lane in each direction to allow people to turn in and out. She was in the dividing strip facing a give way sign and I was in the opposite direction , waiting to enter the dividing strip, and I was facing a stop sign.
    When all traffic on the main road was gone I went straight ahead and she turned into me.

    Her insurance first said that I was at fault as I had a stop sign and she had the giveway sign, so I quoted road rule 69A .
    The Insurance then said to me that she was making a u-turn and the giveway sign was only for the cars on the main road. I then told them about the U-Turn road rule :"When you are doing a U-turn, you must give way to all other vehicles and pedestrians even if other vehicles are facing a GIVE WAY or STOP sign."

    They are now saying that I failed to come to a complete stop at the STOP sign and therefore I am at fault.

    Both parties have the same version of events but the other insurance is saying I didn't come to a complete stop, which of course isn't true and they can't prove it either.

    Below is where I got all the info in regards to stop and giveway signs :

    http://www.tmr.qld.gov.au/Safety/Queensland-road-rules/Road-…

    I hope I am making some sense :)

  • cypher67 on 02/09/2014 - 12:48
    +1

    Pretty simple rule of thumb is whenever you have an accident, call the police. Get them to determine who is at fault on the spot and makes things so much easier when you file a claim. Insurance agencies are always going to try shift the blames, sames them cash, and your are not their customer so they dont care how much this annoy you and out you out of pocket.

    • Noblejoker on 02/09/2014 - 12:52
      +1

      Cypher that is kind of true but all insurers have standards they agree to and I doubt the ombudsman would agree they are meeting those standards in this case.
      If the OP had no insurance at all I would have little sympathy but not everyone has a car worth full insurance and he has TPPD (bomb) cover

    • AG_ACT on 02/09/2014 - 14:00
      +1

      I don't know what it's like in other states, but in the ACT, they refuse to attend if no one is hurt. They say all that is required is for a report to be lodged within 24 hours.

      • NosDan on 03/09/2014 - 12:02

        AG_ACT 21 hours 32 min ago
        I don't know what it's like in other states, but in the ACT, they refuse to attend if no one is hurt. They say all that is required is for a report to be lodged within 24 hours.

        yep thats the same in SA and has been for 20 odd years that i personally know of. unless theres traffic blocked that cant be removed or an injury cops dont give a rats arse….

    • enixus on 02/09/2014 - 14:43

      In all honesty I was in shock when the accident happened and didn't know what to do. The police has to attend if you call them, at least that's what they told me after, but at the time I wasn't thinking very well, my kids were crying and I was a bit hysterical myself. I went later to report the accident but from now on I will call them regardless of how small the accident is. I also installed a crash cam in my car now, too late for this accident but it might prove useful in the future …

      • BenK-Oz on 03/09/2014 - 07:12
        +1

        There are traffic accident lawyers who will claim through the other persons insurance plus claim their fees as well.
        Last time someone rear ended me i used a lawyer instead of my insurance company and it worked out well

        • bluesky on 03/09/2014 - 15:37

          Did a quick google on traffic accident lawyers - quite a few seem to mention claiming for injury in car accidents. Where there is no physical injury, but you are not at fault, will it be easy to engage such a lawyer (on a no fee no win basis). Any additional info appreciated.

          OP, perhaps it is not too late to engage such a lawyer. Good luck!

        • BenK-Oz on 03/09/2014 - 16:30
          +1

          @bluesky: I got the name of the lawyer i used from an accident repair place
          usually the repair place engages the lawyer on your behalf, do the repairs etc.., and keep the fees, but i didnt want to use that repair place, so just took the name of the lawyer and called them up myself.
          the lawyer will be able to advise you on whether they are likely to be successful or not, i'm not gonna give advice on that in case i get sued ;)

        • enixus on 03/09/2014 - 17:25

          @berserkk:

          Thanks for all the info. I will look one up and chat to them. I've got some pretty good advice on this forum so far, thanks again :)

  • gummibear on 06/09/2014 - 23:27

    Care to name the other insurer? It's always handy to know who to watch out for.
    If you aren't comfortable to do so, that's ok

  • enixus on 07/09/2014 - 17:23

    I will name the insurance once I have everything sorted. I will talk to them directly on Monday to find out what they have to say. Next will be their IDR Department and then Ombudsman if necessary. I have spoken to couple of lawyers and was told to either pay them $1500 to take the insurance to court or just suck it up and pay my own damages :(

    • bluesky on 07/09/2014 - 19:03

      Since you were not at fault, I was hoping you will be able to get a lawyer to act on a no-fee, no-win basis. All the best on Monday.

  • enixus on 08/09/2014 - 12:38

    I just spoke to the Insurance company. They still consider me mostly at fault but they couldn't give me a very satisfying explanation.
    She said that they usually blame the person with a STOP sign regardless if the other had a Giveway sign but this is Against Road Rules. I said that and she replied that I was still at fault.
    She said her client was completing a u-turn when I went straight and collided.
    I am trying to look at it from the Insurance perspective, to see if I broke any road rules but I can't see how.
    I have asked for the claim to be reviewed by their internal IDR but I don't hold my hopes up. If they refuse to acknowledge road rules I don't think their IDR is going to be any better and agree with me.
    She wasn't giving me any good reason as to why I was at fault, just kept repeating about her client completing a u turn and that I should have giving her way as I had the stop sign !!!!
    Has anyone have any experience with the insurance IDR?

  • fox81 on 09/09/2014 - 21:43

    u turn must give way to all traffic.

    anyway, you need a lawyer if you want to fight this. the insurer has no obligation to do any more on this until then.

  • enixus on 15/09/2014 - 16:53

    This nightmare has finally come to an end. The IDR of Suncorp took one day to decide that I was not liable for the accident and will be paying for my damages !!!! What a relief .
    Thanks everyone for your kind advice :)

    • Noblejoker on 16/09/2014 - 12:22
      +1

      Yep as stated - IDR is the way to go - any shades of grey and it usually goes in your favour
      Well done
      Now go and buy yourself some comprehensive insurance with a reputable insurer so you can trust this won't happen ever again :)

    • bluesky on 17/09/2014 - 13:41
      +1

      I am honestly glad your stresses and headaches are over :-)

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