Capita nonsensical legal advice for PAX policy holders

Contacted by an old Army pal yesterday who has had an unbelievable experience with their 'Legal Expenses' optional cover under the PAX (Aon UK Ltd) kit + home contents policy, sold exclusively to AF personnel, allegedly as specialists in the needs of the military!

The section of the policy concerned is the 'Employment' clause 'D1a' and 'D1b' on page 45 of the policy booklet and allegedly covers 'The cost of your bringing a legal claim in a dispute' ... 'relating to your employment as a member of the AF' and anything 'arising from your contract of employment', so for a legal advice panel you'd expect Capita to have some knowledge of the AF, perhaps some understanding of military law - AFA 06, RFA 06 or maybe some familiarity with Defence policy like PAP10 ..... err .. no!

Response to my pal who has some issues with an FTRS contract and urgent need of advice and after 3 months of no contact from them since initiating the claim - Capita's (on behalf of PAX) response:

'We have sought guidance on the the availability of specialist advice on this matter. Regrettably, we have to inform you that the advice provided under the terms of your policy is for general advice .... you will need to seek such advice on a private fee-paying basis'

The advice required is in relation to their FTRS commitment and recent changes in Defence policy for reservists, PAP10, Medical Boards, FTRS contracts, AR regulations, etc., so one might assume for an AF specific insurance policy, with a 'AF employment contract' specific advice being highlighted in the policy, that might require a legal advice panel to have some knowledge of the AF and MOD practices; apparently not?!?

There is a complicated relationship whereby the legal expenses part of the PAX policy is underwritten by Royal & Sun Alliance, but they are unable to deal with claims as it contravenes the law, so the claims service is provided by Cigna who in turn sub contract it to our old pals Capita (First Assist) who provide the legal advice panel and provide the initial assessment of the claim, before passing it to Cigna.

As always PAX wants to pass the blame to Capita, and Capita's excuse is it's not their problem, because they don't understand the AF system and of course Cigna don't speak to anyone! It's just pass the parcel whilst we collect your insurance premiums! Just glad I never had to make a claim, a total farce - caveat emptor for the callcentre chaos! Anyone else experienced this kind of Crapita?
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I'm confused whether your beef is with PAX or Capita, either way, I expect @PAXBloke will be along soon to clarify things.
Capita IS PAX and PAX IS Aon IS Royal & Sun Alliance IS Cigna for the kit and home contents insurance, like a discombobulated snake for the purpose of legal expenses claims!

Capita ('Health & Wellbeing' - Div) is subcontracted in the same way the Army contract out the recruiting and NO the @PAXBloke is not interested, because as far as PAX (Aon) is concerned they reckon it's not their problem, because it's an 'underwriter' thingy and they're just the 'broker' thingy who sells the product and takes the money!
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To clarify things, PAX is a brand name owned by AON, an insurance brokers. Their role is to find specialist companies to underwrite insurance plans, changing them if and when necessary. In the case of kit insurance, RSA presently underwrite the scheme, but AIG underwrite the personal accident insurance of the MoD scheme with Metlife carrying the optional life insurance and Abbey Legal picking up the legal side of that plan. This is how the industry works and each company is responsible for their element, but feeling passed around when pursuing a complaint is unhelpful.

As I primarily focus on the MoD scheme, I meet regularly with the legal team supporting PAX personal accident and I know them to be well versed in military regulations, AFCS, the welfare system etc. I don't have a similar relationship with the legal team on the kit and contents side. So I'll need to do some research. It would be of great help if your friend could pm me with their details for me to raise this formally.

Kind regards,

@PAXBloke still no progress it appears, Capita has remained tightlipped since their response to my pal quoted at the start of the thread, and PAX stock response was 'We, as the broker, issue and administer cover. Therefore we are not responsible for the provision of the services within the policy itself...'

Your early response at #6 in respect to the personal accident policy I know you've given sage advice about, but I would suggest the Kit and contents insurance providing the particular legal expenses cover in question is every bit the responsibility of PAX to ensure it's a service delivered in accord with the policy(as advertised), irrespective of the contracted out parts. The AF customer in relation to this specialist policy is central to PAX business, and it should get it's service delivery sorted, especially when it's delivered by a cr*p provider with evidential lack of knowledge about the AF!
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It seems the silence is abounding down Capita way!

Presumably, PAX is trying the 'starve them out' approach to insurance policy management! Appears the style is to raise any discontent as an immediate complaint, even if that hasn't been requested by the policyholder.

Of course insurers know they can waste 8 weeks, whilst appearing to 'investigate' a complaint before a policyholder can approach the Ombudsman, but they hope the claimant gives up in the meantime. They tried exactly the same with one of my troop commanders about five years ago when she was making a claim about some bodged building work.

A fair percentage probably do give up though! Indeed, how many AF personnel would bother to wait out the complaint process or contact the Ombudsman after the 8 weeks and wait for a decision? Clever strategy, even if it only works in 10 - 20% of cases, they've still saved the payout on a claim, because claimants give up. Unlikely in this case though, as my mate is a bit of a stubborn b*stard, but my nephew works in the insurance industry and told me it's a fairly standard ploy.


Ask your nephew to do a bit more reading into the minimum standards for claims handling, andConduct Risk.

Letting something go as far as the Ombudsman is expensive, especially when you factor in just how client supporting their default position is.
I didn't suggest the ploy involved letting it go all the way to the Ombudsman, the internal process may be sufficient to deter. In the case of PAX, I've now witnessed the ploy utilised twice and have seen the correspondence in both cases. It's not my dog in the fight, it's a mate's, a good one. Personally I'm a catlover - as long as they belong to someone else!

How widespead the practice is I've no clear evidence. The nephew, on the other hand, has a stepfather who is the VP of a US owned insurance company, which operates worldwide including the UK, so I believe his 'reading' is reasonably well founded even if the practice is limited to certain types of insurance risk.
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Just in case you thought I was joshing and as @The_Duke was a little disbelieving these are from the 2013 episode although they rolled over at 7 weeks into the claim, having initiated the complaint without actually being asked. I'll let you decipher the Cigna cr*p, PAX is rather more subtle - 'it's somebody else's problem'!

My mate sent me these last night. Apparently he approached the Capita legal advice people and registered the claim in mid June, but you'll note the similar pattern emerging once again. There is the complaint logged by Cigna, without actually dealing with the issue of the legal advice required, just the response at #1 - whilst PAX is once again prompt with their ineffective response! If they don't know what they're selling, STOP selling it! If they do, then get a grip and sort out the mess. AF personnel deserve better, it isn't as if it's a cheap policy!




Your friend initiated the complaint the minute he wrote, called or emailed to say that he wasn't satisfied about something. That is the trigger for complaints procedures.
That's as maybe, but it doesn't address the fundamental problem - Capita's lack of relevant knowledge about AF legal matters, Defence personnel policies, including the most basic of military employment procedures. Neither does it address PAX selling the package with the wording previously described or Cigna failing to address Capita's lack of legal knowledge needed to address the policy for AF personnel.
I am grateful for your raising this issue as the complaints data had given no indication of there being a problem in that area. It has given me the opportunity to do some digging on your friend's behalf and I hope that it'll ensure that people with the appropriate experience are at hand in the future. As you know, I picked up on this on Thursday and only had a name to take to Aon on Friday. Since then, I have been able, through your friend and the account manager at Aon, to get a better idea of what has gone on - it makes for embarrassing reading.

I have been reassured that a review of the service being provided is underway, which I will be keeping a close eye on. In the meantime, I expect your friend to be contacted shortly. Whether that constitutes progress or a commitment to the AF will depend on things improving our end.


Despite @PAXBloke giving PAX and RSA a good shoeing, it would appear Capita, Cigna and Co seem loath to maintain their commitment to AF or the AF Corporate Covenant The legal expenses 'Employment' clause in the PAX policy is the only lifeline for most military personnel unless they are exceptionally well healed, since legal advice does not come cheap. The UK legal system has a unique language and court processes that deny a lay person parity, especially when they're AF personnel having to compete with MOD / HM Treasury lawyers.
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If your friend is not happy, tell them to go through the Ombudsman process. If they haven't already followed all of the elements of the complaints procedure on the policy, they will be directed to do so first.

If they have already done that, they should follow the procedures given on the FOS website, giving chapter and verse of why they are unhappy, delays or duplication of effort/paperwork they have had to go through etc. They should also give a clear description of how they believe their case should have been handled, and what they believe the correct resolution of their complaint would be.

As I said earlier, the Ombudsman will always find a way to support the consumer over the insurer if there is any possible way to do so. I have even had to pay a small fine to someone who bought a policy without bothering to read all of the terms and conditions, subsequently cancelled it with a full refund of premium from us and THEN complained that they weren't happy!

This complaint will also contribute to the record of dissatisfaction with the product. If enough of them are raised, the regulator may well start a review as to whether there is appropriate management of the product/conduct risk associated with the product. If such a review finds against them, the primary insurer faces the potential of huge fines. They can delegate service functions to other companies, but they are held responsible for the actions of their agents.

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