Summary: Miss X complained the Council delayed processing her claim to its insurers about damage to the front wall of her home. Miss X lodged her complaint in April 2019 but the Council’s insurers took until August 2021 to provide payment. The Ombudsman found fault through the Council’s delay. The Council agreed to the Ombudsman’s recommendation to apologise to Miss X and pay her £200. The Council also agreed to consider production of a guidance note or procedure for managing insurance claims.

The complaint

1. Miss X complained the Council delayed processing her claim to its insurers about damage to the front wall of her home.
2. Miss X lodged her claim in April 2019 but had to wait until August 2021 to receive payment.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. If we are satisfied with a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

5. I have considered all the information Miss X provided. I have also asked the Council questions and requested information, and in turn have considered the Council’s response.
6. Miss X and the Council accepted my draft decision.

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What I found

Council insurance claims

7. The Council website outlines what action it will take when a person makes a claim against it for damages.
8. The Council outlines it has full insurance with an external insurance provider who acts on its behalf to handle claims about damages. The Council says the external insurance provider will provide compensation if it is at fault.
9. If a person believes the Council is at fault for an injury or damage to property they can submit a claim for compensation using its “Insurance Incident Report form”.
10. The Council says it expects a decision on liability will be made within three months of a person making a claim on the premise the person provides enough information for an investigation.

Council complaints policy

11. The Council has a two-stage complaint policy.
12. At Stage 1 the Council will look to provide a response to a person’s complaint within 20 working days. If a person disputes a Stage 1 complaint response they can seek escalation to Stage 2.
13. The Council will consider a person’s Stage 2 complaint request and provide a response within 15 working days. If a person disagrees with the Stage 2 complaint response, the Council will direct the person to the relevant Ombudsman.

What happened

14. On 5 April 2019, a Council waste removal crew attended Miss X’s property to complete a bulk waste removal. Miss X says the Council crew damaged her front wall while removing the bulk waste.
15. Miss X submitted an Insurance Incident Report form to the Council for the damage to her wall on 25 April 2019.
16. A council insurance officer picked up the claim and asked the Waste Collection supervisor for input from the waste removal crew. The Council insurance officer also logged this with the Council’s external insurance provider.
17. The Council’s external insurance provider chased the Council for a report from the Waste Collection department on 13 May 2019 and 10 June 2019. The Council insurance officer also chased the Waste Collection manager on 26 June 2019.
18. The Waste Collection manager advised the crew could not recall the incident on 27 June 2019.
19. Miss X asked the Council and the insurance provider for an update on 10 July 2019. Miss X received no update.
20. On 23 July 2019, the insurance provider asked the Council for the crew and Waste Collection manager to provide a signed statement. The insurance provider advised the Council it would look to deny liability.
21. Miss X asked for an update on 30 August 2019. Miss X received no update.
22. Both the Council insurance officer and the Council’s external insurance provider chased the Waste Collection department for statements on 2 September 2019, 18 September 2019, 22 October 2019, 1 November 2019 and 26 November 2019.
23. On 27 November 2019, the Waste Collection manager told the Council officer the crew had left employment with the Council since the incident. The Council officer informed the insurance provider.
24. Miss X contacted the Council on 15 June 2020 to raise a complaint about her claim.
25. On 20 July 2020, the Council told Miss X she needed to contact the insurance provider directly and provided its contact details.
26. Miss X complained to the Council in February 2021 about the lack of response to her claim. The Council told her to contact the insurance provider directly on 8 February 2021 as its Stage 1 response. Miss X responded to the Council to advise she had contacted the insurance provider often but it was not responding to her.
27. The Council officer contacted the insurance provider for an update on 17 February 2021.
28. Miss X chased the Council for response to her complaint on 27 February 2021 and 2 March 2021. The Council officer asked the insurance provider to respond to Miss X.
29. On 3 March 2021, the Council insurance provider told Miss X it denied liability because there was no record of the Council causing the alleged damaged.
30. Miss X disputed the Council insurance provider’s responses on 3 March 2021. The Council took this as a request for escalation to Stage 2 of its complaint process.
31. The Council escalated this matter to a manager in the insurance department. The manager reviewed Miss X’s claim and recommended the insurers looked the settle the claim as it could not defend its position of no liability without a statement from the crew.
32. On 25 March 2021, the Council sent its Stage 2 complaint response to Miss X. The Council apologised for the delays and lack of updates to Miss X. The Council told Miss X about the manager’s review and reconsideration of its position on liability. The Council told Miss X its insurers would be in contact.
33. The Council discovered it had failed to tell the insurance provider on 24 May 2021 about its updated position. The Council confirmed its position with the insurance provider accordingly. The Council also told Miss X about this further delay.
34. The Council’s insurance provider agreed settlement of the damages claim and paid Miss X on 7 August 2021.

Analysis

35. Miss X complained the Council delayed processing her claim to its insurers about damage to the front wall of her home.
36. The Council says its insurers will look to provide a response to an insurance claim within three months from the date of a claim if a person provides enough information about their claim.
37. The Council has not needed to contact Miss X again for further information since her claim on 25 April 2019. This means Miss X provided enough information to enable the Council, and the insurance provider acting on its behalf, to complete an investigation into her claim. The Council’s insurance provider should have provided its response to Miss X’s claim by 25 July 2019.
38. The Council’s insurance officer picked up the claim correctly. The insurance officer logged this with the external insurance provider and contacted the Waste Collection department for a statement. I do not find fault with how the Council logged the claim.
39. The Council’s insurance provider told the Council it would need a statement from the Waste Collection crew and manager and confirmed on 23 July 2019 this would need to be a written statement.
40. The Council’s Waste Collection department took from 25 April 2019 until 27 November 2019 to provide a formal response to the insurance provider’s request for a formal statement. By this point, the Council was four months beyond its recommended timescale for providing a response to a claim. This is fault.
41. The Council’s insurers also failed to tell Miss X about its decision of finding no liability following the response from the Waste Collection manager. The insurer took until 3 March 2021 to confirm its position of finding no liability. This means it took the Council’s insurers 19 and a half months beyond its recommended three-month timescale to provide its response to Miss X’s claim. This delay is fault.
42. From 25 April 2019 to 3 March 2021, Miss X also chased both the Council and insurance provider for an update on her claim on several occasions. Both the Council and insurance provider failed to provide Miss X with any update on her claim other than the Council telling Miss X the matter was with the insurance provider or directing her to contact the insurance provider. Not providing any form of update from 25 April 2019 to 3 March 2021 is fault.
43. Within these delays, the Council took from 15 June 2020 until 8 February 2021 to provide a Stage 1 complaint response to Miss X. The Council had 20 working days, four weeks, from 15 June 2020 to provide its Stage 1 complaint response. The Council took 30 weeks beyond this timescale to provide its Stage 1 complaint response. While this does not add to the injustice already experienced through the delays this is fault from the Council.
44. When Miss X disputed the finding of no liability on 3 March 2021 the Council picked up Miss X’s concerns and investigated her concerns. A Council manager reviewed Miss X’s claim and made a recommendation based on the evidence of Miss X’s claim. The Council also provided its Stage 2 complaint response on 25 March 2021 explaining its decision, the next course of action and directing Miss X to the Local Government and Social Care Ombudsman. This response was one day outside its complaint timescales but this delay did not present any real injustice to Miss X.
45. While the Council handled Miss X’s Stage 2 escalation correctly, it failed to pass its findings over to the insurance provider until 24 May 2021. This caused a further two-month delay in handling Miss X’s claim. This further delay is fault.
46. After the Council confirmed its changed position with the insurance provider, it paid the settlement to Miss X in a timely manner.
47. Since 25 April 2019, the Council, and its insurance provider, have caused 21 and a half months of avoidable delay in handling Miss X’s claim outside its recommended timescales. This delay has caused Miss X avoidable frustration and inconvenience.
48. It is also notable from Miss X’s complaint the Council lacks a clear procedure for managing insurance claims which it passes over to its insurance provider. The Council is entitled to use an insurance provider to handle matters about claims for damages. The Council is also entitled to allow the insurance provider to follow its own procedures and practices.
49. However, the Council should ensure that claims it passes over to a contracted insurance provider are managed and resolved in a manner the Council considers acceptable. This includes ensuring the insurance provider meet its recommended timescales of three months, provides updates and responds to contacts. As noted within the Council’s Stage 2 complaint response, a person should not need to make a formal complaint to the Council to receive an update on their damages claim.
50. The Council has also noted that it has accepted liability because of a lack of evidence obtained from its investigation in 2019. The failure of the Council to investigate Miss X’s claim within the recommend timescale has left the Council with no choice but to accept liability. While the Council may still have accepted liability had it investigated the claim in 2019, the lack of a thorough investigation has resulted in an indefensible position in 2021 according to the Council manager.

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Agreed action

51. Within one month of the Ombudsman’s final decision the Council should:
• Apologise to Miss X for the delays in handling her complaint and pay her £200 for the frustration and inconvenience caused.
52. Within three months of the Ombudsman’s final decision the Council should:
• Consider production of a guidance note or procedure for managing insurance claims it passes over to its insurance provider. The Council should consider inclusion of guidance on timescales, guidance on obtaining relevant information and evidence, guidance on obtaining updates from the insurance provider and providing updates to the claimant.

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Final decision

53. There was fault by the Council as the Council has agreed to my recommendations, I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman