1 reviews | Active since Mar 2019
Rejection of claim based on service provider's opinion not facts, how fair is that?
OUTsurance has rejected my claim based on “OPINION STATEMENT” made by their services provider. Their inspection report state according to the opinion not the "fact". By just an opinion my claim did not make business sense to OUTsurance. I referred my matter to ombudsman, who promised to review it but later they also came back with the same attachment and requesting that I make an appeal should I not be happy with the outcome. How do professionals turn such blind eye, its so unfortunate that we are gambling with our money to OUTsurance for just opinions and the so-called Insurance Ombudsman claiming to sort the client difference with the insurance company in a cost-effective, efficient and impartial way but allow an insurance to reject a claim based on an opinion. Consumers are just as good as naked in this administration.
This opinion was submitted by the OUTsurance service provider Prescor 160 CC, they have said that “We in our opinion, do not think that any insured peril has occurred but rather inferior materials and incorrect building practices. This should be, in our opinion, a dispute between the builder and the client. We, in our opinion think that all the damaged walls will have to be sc****d down, Plaster removed where necessary, apply correct waterproofing, repair plastering where necessary and only then painted. On doing measurement we have estimated how many walls will have to be replastered and how much repair is necessary on each. We will only have a better idea once repairs commence and once paint is removed to get a more accurate idea of the extent of re plastering and waterproofing that will have to be done.” OUTsurance made a judgement to reject my claim based on that opinion.
OUTsurance did not even bother to investigate to validate such opinions made by their Prescor 160 CC but they so proudly and as a money saving means they instead rejected my claim and attached Prescor 160 CC’s quotation referring me to these service providers for assistance. How can I be stupid to fix my house with stupid professionals who works on opinions not facts? So stupid. Well my concern is why are we paying our money to be rejected based on opinion of someone service provider who wants to suck more money from the insurance clients on a referral of the insurance we paying for and the ombudsman will then turn a blind eye together with ombudsman. These is just an extended time wasting administration process that will on a later stage results in favor of those you complaining again.
Thank you for contacting us regarding your claim and we are very sorry for the disappointing feedback you received in light of the matter.
Our decision concerning your claim unfortunately remains unchanged. We have discussed the rejection in detail with you. During our validation process there were discrepancies that were identified which were brought to your attention. We firmly believe that your claim is not valid in terms of our agreement with you. We have responded to your objections made to us and provided you with the information.
We are not insensitive to the financial loss you are incurring as a result of the rejection of the entire claim. However the facts of the matter were presented to the ombudsman who in turn reviewed your case and agreed with our findings.
If you would like to challenge the outcome, please forward your notice of appeal to the office of the short term ombudsman.
Regards
OUTsurance
Thank you for contacting us regarding your claim and we are very sorry for the disappointing feedback you received in light of the matter.
Our decision concerning your claim unfortunately remains unchanged. We have discussed the rejection in detail with you. During our validation process there were discrepancies that were identified which were brought to your attention. We firmly believe that your claim is not valid in terms of our agreement with you. We have responded to your objections made to us and provided you with the information.
We are not insensitive to the financial loss you are incurring as a result of the rejection of the entire claim. However the facts of the matter were presented to the ombudsman who in turn reviewed your case and agreed with our findings.
If you would like to challenge the outcome, please forward your notice of appeal to the office of the short term ombudsman.
Regards
OUTsurance
Your decision was based on the opinion of your service provider who wanted to cash from me on your watch, what did you do nothing but rather forward me the quotation.
Your service provider "Prescor 160 CC" were mandated to inspect the damages in order to determine the cause of the damages, as you have reported it but instead their report does not highlight the facts in regard to what is the cause. Their response as quoted on my review was based on their opinion and you made your decision base on that. Stop lying. How do you make an informed decision that you claim to have made based on lack of facts but just the whole stupid assumptions.
You have the quotation, am sure you can read and use it to improve you communication with your customer not to repeat the same mistake again. Hope you can wake up from your dreamland administration and start providing service that people are paying for. We don't pay money to hear your opinions, we pay money because we hope that if ever one day we encounter challenges we may get proper response that value our money.
I am not interested in challenging anything with you, you have proven the insurance you are.
Your decision was based on the opinion of your service provider who wanted to cash from me on your watch, what did you do nothing but rather forward me the quotation.
Your service provider "Prescor 160 CC" were mandated to inspect the damages in order to determine the cause of the damages, as you have reported it but instead their report does not highlight the facts in regard to what is the cause. Their response as quoted on my review was based on their opinion and you made your decision base on that. Stop lying. How do you make an informed decision that you claim to have made based on lack of facts but just the whole stupid assumptions.
You have the quotation, am sure you can read and use it to improve you communication with your customer not to repeat the same mistake again. Hope you can wake up from your dreamland administration and start providing service that people are paying for. We don't pay money to hear your opinions, we pay money because we hope that if ever one day we encounter challenges we may get proper response that value our money.
I am not interested in challenging anything with you, you have proven the insurance you are.