Terrifying: Lisa Cooper suffered a dreadful head-on crash but is finding it difficult to claim on her car insurance
Lisa Cooper had the type of car accident drivers dread — a car hit her head-on after coming on to the wrong side of the road.
She
was on her way to audition for a local amateur dramatics group and the
crash, on a summer’s afternoon, left her unable to move.
She
was dragged out of her car by a passer-by, rushed to hospital, and was
off work for five weeks while she recovered. In that time she ate in to
her savings. Her sole comfort was that she was confident her car
insurance would cover everything.
Lisa had a £500-a-year comprehensive policy with Direct Line, and she had chosen the policy because it included motor legal cover. This is supposed to recover a motorist’s costs if they are injured in a crash that is not their fault. The other motorist was insured through the Co-op.
But despite her initial confidence, 18 months on she is fighting the Co-op, the so-called 'ethical insurer', for a payout because of smallprint: the other driver had fallen unconscious at the wheel and could not be held responsible for causing the crash or accused of negligence.
She 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.'
To date her insurer 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.
She has paid a £150 excess. And she estimates she has incurred £7,000 worth of losses. This includes 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.
Direct Line submitted a claim to the Co-op with a full breakdown of costs. Then Lisa waited — and waited and waited.
Nightmare: The awful crash had a massive effect on the life of Lisa Cooper as she has been unable to work
A year and a half after the accident Lisa, from Henlow, Bedfordshire, received a letter from Direct Line saying that the Co-op was refusing to pay out.
The issue stemmed from smallprint in her Direct Line policy which says Lisa can only get a payout for an injury if the other driver can be proven to be legally negligent.
In such circumstances Direct Line will demand a payout from the other customer’s insurer. But proving your case can be fraught with difficulties.
Direct Line told Lisa 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.
The Co-op 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.
A recent case includes that of a man who strangled his wife in a camper van while in a kind of dream state — he believed an intruder was on top of her. The Co-op had spent the past 18 months examining its customer’s medical records and police reports to prove its case.
It concluded that the other driver, understood to have since been diagnosed with a medical condition and who had no history of similar collapses, could not be deemed to be negligent. This was 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. But the Co-op, which boasts on its website it is 'championing a better way to do business,' simply refuses to pay a penny.
Lisa 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.
Who's to blame: Normally an insurer will pay out if a driver can be proven to be legally negligent - where there is no fault, the situation becomes more complicated
'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.'
The Co-op says it has fully reviewed Lisa’s case and is now making her an offer.
A spokesman says: '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.
‘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.'