Complaints

• Initial Complaint

  17/09/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have a claim with SGI on June 28,2024. In June this year, I found that neither the furnace nor the air conditioner in my home could operate normally. I checked my insurance policy and called to make sure that the damage to my two home appliances was within the scope of the claim! After the filing of the case on June 28, I followed the email notice of the insurance company, allowing me to find a maintenance company to repair myself first, and then the insurance company will pay! I found a qualified company to repair and replace the two equipment, and provided all the information and reports! However, the insurance company only paid the cost of my air conditioning, but it has been delayed for 2 months, and has not paid the cost of replacing the boiler. On the grounds that my maintenance company's report is not clear, I have asked for more detailed reports again and again! My maintenance company has provided many more detailed reports for review with an SGI review body called the ***. I even offered to send experts to my house to inspect the old boiler if they could not determine the exact reason for the replacement, but they did nothing! Now, they even disregard the law and ******** email me to unilaterally close my claim! *** ****** ******** **** **** ** *** ***** **** * ************* *** ***** *** ** *** ******* *** ******* *** ******** *** ***** *** **** ***** ** *** ****** *** ********** ********* ** ******** ******** ** *** ****** ********** *** ** **** ***** * **** ****** **** ***** **** ******* We pay the premium on time every year, but once we settle the claim, even though all the information is complete, we are still deliberately and maliciously delayed and attacked, on the grounds of poor language, repeated difficulties and discrimination. Originally, we have been physically and mentally exhausted in order to repair these equipment, and we are faced with high costs. I cannot afford such high costs! Please help us and appreciate it!

  Business response

  23/10/2024

  ** ******** *** ***** ** **** *** *** **** **** ** ***** **** *** ****** ** *** **** **** ** *** ********** **** * ********** ***** ** ******** ** *** ******* ****** ********* ** **** **** ** ****** *** **** ** *** *** ** *** *** ********* ** *********. The initial conversation with the insured was completed on July 5^th and the claim verification form (CVF) sent out on all claims was sent. We received a copy of the CVF, photo and quote from SGI which outlined an issue with the flame sensor and subsequently the control board. As per the technician the flame sensor was unable to communicate with the control board. The insureds technician replaced the parts however the unit was still not working suggesting further issues with unit.

  The insured replaced the unit on July 5^th at a cost $******** + tax. We had requested the technician provide more information as to the continued cause of the furnace issue. It was noted by the technician that there is an issue with signal strength between the flame sensor and the control board (both of which had previously been replaced). The technician noted potential causes of the continued issues but not that they were tested rule out these issues. The technician noted as per the manufacturers recommendation that the unit be replaced as the cost to determine the additional issues would be extensive and may exceed the cost of the replacement.

  The claim was denied because of the failure not being identified. As per our policy wording

  Equipment Breakdown means a sudden and accidental:

  a) mechanical breakdown;

  b) electrical breakdown; or

  c) bursting, cracking or splitting

  of covered home equipment that results in direct physical damage and requires repair or replacement of all or part of the damaged covered home equipment.

  As the technician was unable to identify the failed part we were unable to respond to coverage. The furnace was manufactured in 2006 and is less than 15 years old the policy responds to the lower cost of repair or replacement of the failed part. The replaced flame sensor and control board were confirmed not to be the issue as the unit continued to not function and we are unable to approve full replacement until the failed part is determined.

  I can understand the insureds frustration with the length of time her claim took however, the increase in time was in part due to the initial claim verification form having insufficient information to be able to proceed. This then required more information to be provided by the insureds technician on more than one occasion.

  *** ***** ********* *** ***** ******* **** **** * ** ********* **** *************** *** *** ****** ******* ****** ******* *** *** ***** ********** **** *** ***** ** *** ******* ****** **** ** ********* **** ** *** ********* **** ****** *** *** ******** *********** ** ** *** ******** *** *** ******** ** **** *** ********* ** ***** **** **** ***** ******** ** **** ***** ******* *** *** *** ** **** *** ** *** ***** **** **** **** *** *** ********* ** *** **** **** ** ** ******

  * ** *** **** ** ******* ** *** ******** ***** ** ********** ********** *** ******** ****** ** *** **** **** *** ******* *****

  I hope this better answers your questions.

  Kind regards,

   

  **** ****
  Personal Lines & Cyber Claims Supervisor
  
  *** ****** *** *** *** ***** *** ******** ** *** *** ********** ************ ******* ************  ************ ******

  Customer response

  23/10/2024

  
  Complaint: ********
  
  I am rejecting this response because:

  As a consumer, 1.I think if the insurance company wants to know more clearly, it should ask the maintenance company directly so as to solve the problem better, but they didn't do it!2.I have mentioned many times in my email that I expect them to send people to check the old furnace that is stored in my garage.just like the photos I submitted. 

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