Seeking legal advice

[Shaun]

So I'm currently in a battle with my mechanical insurance company over a claim on my vehicle.

They've turned down my claim:

Some back story. I purchased mechanical insurance three months ago (my vehicle met the age, servicing, and mileage requirements). Some time afterward my transmission stopped working. It was a sudden failure. The gearbox suddenly couldn't shift out of first gear. Not because the automatic-clutch or the gears, but because because the mechatronic unit stopped working properly and my DSG gearbox couldn't find where second gear was (mechanic's words). I thought I would be fine because my policy covered my gearbox

So as above they excluded my claim based on clause "M" in my policy, but supposedly also due to clause "K":

Now, I've spoken to Volkswagen. They have said, "Worn bearings are a failure. There is no service interval (meaning the transmission isn't supposed to need servicing) and therefore any failure of the parts is a failure".


They also felt that any reputable insurance company would cover this. Which is also what my mechanic said. Now I'm currently in the process of going through a financial disputes organisation which is free and therefore I'm not taking to a lawyer as of yet (or going through the insurance ombudsman yet). I'm needing to send away a written submission about my complaint/why I feel my claim should not be declined. I'm wanting advice on how I should word my complaint. Do I tip toe around the semantics of "failure" and "worn" and simply claim that my mechanic used the wrong terminology when sending the reasons for the claim to them, or do I ignore that and talk about the subjectivity of "failure" and worn and simply make an argument that anything could be considered "natural deterioration" and therefore the basis of turning down my claim is a complete joke. Or am I simply in the wrong and I should have read my policy better before purchasing my insurance?

Thanks in advance for any advice given.

 

[Dylan]

fuck em

 

[Ronaldo]

I read your post patiently and tried to come up with something to help you but this is something very specific and technical. This is a rare case and I doubt that a group of internationals (FIF) could help you with it. Have you talked to friends and family?

Can't you ask a lawyer how to word the letter? If yes, it might cost a few bucks but it sure would be worth it if the insurance company end up repairing your car.

 

[K.I.]

Did Volkswagen tell you their that in an email or a phone call?

It looks like they are saying its a failure and ur insurance is saying its not. If you were to write the letter a lawyer may help the wording but i would keep it fact based and present ur arguments accordingly, won't help if you say them turning it down is a complete joke.

Also issues with the gearbox usually gives u trouble over time, for it to all of a sudden stop working points to a failure, not natural deterioration.It may be different with different cars and newer cars though but i would focus on what VW said, thats the most important thing.

 

[firmino]

well, sure there must be an independent arbitration for such a matter. that's where i would try my luck.

 

[RichDAS]

As much as this forum does help a lot, you could also post this on Reddit, there are subreddits made specifically for these sort of matters and come with a bunch of professional advisers.

 

[Tovny]

Let me preface what I'm about to say with the fact that while I do have a law degree, I don't have any practical experience with it yet, so while what I'm about to say makes sense to me in theory, it may not apply in practice.

These clauses would in my opinion apply only to parts that are actually subject to wearing out. Going by what Volkswagen told you, the ball bearings in the gearbox are not liable to wearing out, so the fact that it happened means, it must have happened because of a fault in the part. Similiar thing goes for clause K, ball bearings should not deteriorate over time, thus the part must have been faulty.

I would also remind the insurance company that Volskwagen is the expert when it comes to mechanical questions, so they are the ones that have the authority to say whether the failure is a result of worn out parts (or natural deterioration in clause K), or of a faulty part, in which case you have a right to compensation.

Hopefully this will be helpful, but I would again remind you, things may not work the same in the real world.

 

[Black Knight]

Damn. Created an account over 8 years ago. Managed to not post in the post-treble euphoria. Remained silent throughout our descent through the 7 circles of hell. First post to help a fellow member in need.

You're weird.

I like you.

 

[Tovny]

I had nothing of value to post.

 

[Glass box]

Insurance companies will always do their best not to pay.

How much time do you have to file an appeal?

 

[Wallace]

Have you tried escalating up the management of the insurance company before going all the way to external parties?

My experience with the low level customer service representatives in NZ for these kinds of things (insurance companies included) has been a nightmare also, to say the least. It is very often useful to talk to someone more educated up the food chain.

 

[Candreva Crosses]

Let me preface what I'm about to say with the fact that while I do have a law degree, I don't have any practical experience with it yet, so while what I'm about to say makes sense to me in theory, it may not apply in practice.

These clauses would in my opinion apply only to parts that are actually subject to wearing out. Going by what Volkswagen told you, the ball bearings in the gearbox are not liable to wearing out, so the fact that it happened means, it must have happened because of a fault in the part. Similiar thing goes for clause K, ball bearings should not deteriorate over time, thus the part must have been faulty.

I would also remind the insurance company that Volskwagen is the expert when it comes to mechanical questions, so they are the ones that have the authority to say whether the failure is a result of worn out parts (or natural deterioration in clause K), or of a faulty part, in which case you have a right to compensation.

Hopefully this will be helpful, but I would again remind you, things may not work the same in the real world.

Damn, promote this guy. Not all heroes wear capes.

 

[Howl]

I doubt this is going to help and you probably already know this, but...

It looks like you're probably going to go through a dispute process to hopefully fix it. I work for a credit card company and the only knowledge I can give on this field is that it will be useful if you can get an independant report from your mechanic and even some official letterheaded documents from Volkswagen to support your case further then you may get it sorted because otherwise the disputes teams dont give a fuck.

Here in UK, the complaints teams (in banks) do what they can before letting it get to the ombudsman if you have a strong case because they get charged a few hundred pounds in fees the moment it gets to the ombudsman and then usually a lot more time and hassle. I dont know if its the same with motor insurance, but it may still be resolved if you compile a good enough claim that is supported.

Also, your insurance company sound like a bunch of cocksuckers.

 

[Fitzy]

Damn, promote this guy. Not all heroes wear capes.

Maybe he does

 

[Glass box]

So I'm currently in a battle with my mechanical insurance company over a claim on my vehicle.

They've turned down my claim:

Some back story. I purchased mechanical insurance three months ago (my vehicle met the age, servicing, and mileage requirements). Some time afterward my transmission stopped working. It was a sudden failure. The gearbox suddenly couldn't shift out of first gear. Not because the automatic-clutch or the gears, but because because the mechatronic unit stopped working properly and my DSG gearbox couldn't find where second gear was (mechanic's words). I thought I would be fine because my policy covered my gearbox

So as above they excluded my claim based on clause "M" in my policy, but supposedly also due to clause "K":

Now, I've spoken to Volkswagen. They have said, "Worn bearings are a failure. There is no service interval (meaning the transmission isn't supposed to need servicing) and therefore any failure of the parts is a failure".


They also felt that any reputable insurance company would cover this. Which is also what my mechanic said. Now I'm currently in the process of going through a financial disputes organisation which is free and therefore I'm not taking to a lawyer as of yet (or going through the insurance ombudsman yet). I'm needing to send away a written submission about my complaint/why I feel my claim should not be declined. I'm wanting advice on how I should word my complaint. Do I tip toe around the semantics of "failure" and "worn" and simply claim that my mechanic used the wrong terminology when sending the reasons for the claim to them, or do I ignore that and talk about the subjectivity of "failure" and worn and simply make an argument that anything could be considered "natural deterioration" and therefore the basis of turning down my claim is a complete joke. Or am I simply in the wrong and I should have read my policy better before purchasing my insurance?

Thanks in advance for any advice given.

Since I don't know how much time do you have to file an appeal or if you have that right to do so in the insurance company (law is different everywhere), I would advise you to get a lawyer, sue them, pay for an expertise which supports your claim (if the experts alrerady told you that you have right to be paid for the damage).

Then if you win they will pay you for the sum you ask (if it's reasonable, get this straight with the lawyer) and plus all the expenses you made throughout the process.

 

[Shaun]

Insurance companies will always do their best not to pay.

How much time do you have to file an appeal?

I have as much time as I want supposedly. Just trying to get my arguments straight in order to fight this in the best possible way. The financial disputes organisation which is completely independent is free so I'm going through that first. If I have no luck with that I will advance it and get a lawyer.

 

[Tovny]

Maybe he does

These kind of references are why I lurk on this forum. (Also because my self-destructive mind thought liking Inter was the best way to slowly kill itself. It wasn't wrong.)

Back to the shadows now.

 

[Pimpin]

hey mate, my girl is a lawyer albeit a commercial one, ill get her to take a look on it once im home

- - - Updated - - -

tbh, just bragging that im banging a lawyer

 

[Glass box]

I have as much time as I want supposedly. Just trying to get my arguments straight in order to fight this in the best possible way. The financial disputes organisation which is completely independent is free so I'm going through that first. If I have no luck with that I will advance it and get a lawyer.

Then I would suggest you still get an expertise, try to appoint a meeting with someone of the Insurance company, and persuade them that it is in mutual interest to pay (expenses and time for a case in a court of law is not a wanted scenario for nobody). They surely have experience when they were wrong and got sued and then paid anyway. Because they will try to make you give up, but if you show you would rather fight they might change their mind.

If you can't appoint a meeting, then send them a warning letter that you would sue them if they don't pay, along with a sum for the damage and point out the facts on why they are wrong for denying your request. Give them a deadline of 8-10 days to contact you. If you want to settle with them out of court of law, that is so much you can do, IMO. But if you have another idea then go for it.

 

[K.I.]

I had nothing of value to post.

None of us do mate