The Co-op uses small print to refuse a payout on a claim for injuries and out of pocket expenses after their policyholder hit another driver head-on
Lisa Cooper, from Henlow, Bedfordshire had bought a £500-a-year comprehensive policy with Direct Line, and she claims she chose the policy because it had motor legal cover included in the premium.
I have to admit that I find it strange that someone would make a purchasing decision based on legal cover, especially when interest free payments, quality of cover and consumer reviews outweigh an add-on which costs an insurer less than £5 to provide. I’m digressing, but it is worth a debate for another day though.
Back to Lisa’s case and her insurance claim. Miss Cooper was driving on her way to audition for a local amateur dramatic society, when she was hit head-on by another motorist who was on the wrong side of the road.
The crash left Miss Cooper shocked and unable to move. A passer-by dragged her out of her vehicle and an ambulance was required to take her to hospital. Miss Cooper spent the next five weeks off work, resulting in her having to use her savings.
Miss Cooper took comfort from the fact she was fully insured, and that any out of pocket expenses would be recovered once she had claimed off the third party insurer, The Co-op.
But despite her initial confidence, 18 months on from the accident Miss Cooper is still fighting the Co-op. But why is there a problem with what should be a straightforward claim?
Answer… The devil is in the small print of the insurance policy documents. One vital part I deliberately failed to mention was that the other driver had fallen unconscious at the wheel moments prior to the accident.
The Co-op is arguing that their policyholder cannot be held responsible for causing the crash or accused of negligence, therefore enabling them to deny liability. The law states an injury claim can only be paid if the other driver can be proven to be legally negligent.
This does raise a question over the UK’s investment in technology which will enable vehicles to be driverless as the Co-op has used a rarely used legal defence called ‘automatism’ — this is where someone cannot be held responsible for their actions if they had no knowledge of them.
This decision has meant that £7,000 of losses has not be repaid, even though Direct Line has submitted an itemised claim to the Co-op. The full breakdown of costs included travel to hospital appointments, phone calls, months of missed pay and the cost of replacing her clothes which were cut off her after the collision.
Miss Cooper says: ‘The accident turned my whole life upside down in so many ways. None of this was my fault, but I feel that I am the one who has been made to suffer.
‘You hear about insurers handing millions out to fraudsters, so I can’t understand why they are fighting so hard to avoid paying out to a loyal customer.’
So far Direct Line has paid £700 for her written-off ten-year-old car and has also paid for physiotherapy. But other than this Lisa says she has been left to foot every other penny, including her £150 excess.
Direct Line told Miss Cooper the Co-op had proved its customer was not negligent because they were unconscious at the time of the accident and could not have known what they were doing.
Over the past 18 months The Co-op has been examining its policyholder’s medical records and any police reports to prove its case. The Co-op concluded that the other driver, who had no existing or previous medical conditions – but is now understood to have since been diagnosed with a medical condition – could not be deemed to be negligent because they could have done nothing to prevent the accident.
Direct Line says it asked the Co-op to make a goodwill payment as Lisa had been waiting for an answer for so long. Considering the ‘ethical’ approach the Co-op claims it takes in the way it operates its business, they continue to refuse to pay a penny.
Miss Cooper says: ‘The impact of the crash on me can’t be over-estimated. It shook up my life in so many ways. I’d hoped to move home but couldn’t because I’d used up my savings.
‘But not getting my excess back for an accident that was not my fault is the thing that really rankles most. It seems as though the Co-op has done everything possible to avoid paying out. It’s a terrible way to do business, not a better one.’
A Direct Line spokesman says: ‘During this investigation, the other driver obtained independent medical evidence as part of their defence to establish they hadn’t been negligent.
‘This has been reviewed by a case handler and also a manager of the law firm and unfortunately, they have come to the conclusion that any legal action would be unsuccessful. As insurers, we have to rely on legal advice from our appointed experts.
Direct Line spokesman continued: ‘Mrs Cooper can, of course, pay for a second opinion from another law firm, and if they are of the opinion that her claim is likely to succeed, then we can reconsider further cover under the policy.’
A Co-op spokesman said: ‘The claim put forward on behalf of Mrs Cooper was correctly declined on the grounds that our customer lost control at the wheel due to an unforeseen medical complaint which led to loss of consciousness while driving.’
However, it is not all bad news for Lisa as The Co-op has had a change of heart. The Co-op spokesman concluded by saying: ‘Cases like this are highly unusual, and due to the need to work with relevant authorities to fully verify the cause of the accident, we do recognise that this has led to delays which we do regret.
‘In recognition of the unusual circumstances surrounding the accident and the personal impact this has caused we are making an offer to settle her claim without admission of liability.’