CCM4335 - Pre-award examinations: Action: The claim cannot be accepted

Where you do not accept the explanations provided by the customer you will make a S14 decision rejecting their claim.

You must write to the customer(s) to let them know about your decision. You should always write to them even if you have spoken to them and explained the position on the phone.

You should use the standard letter template TCC75. The letter tells the customer that you reject their claim and they will soon receive a formal notification of this.

Note: If you are rejecting the claim because the customer has not replied to your opening letter, you can not use this as the reason for rejecting the claim on the letter. You must consider the risk and evidence held and your response to the customer must reflect that.

Where the claim has been made by a couple in a joint household, only one letter should be sent addressed to both customers. When sending out joint letters the customers must still be part of a couple and residing at the same address. If they are part of a couple but residing at different addresses or no longer part of a couple, then a separate letter must still be sent to each customer.

If the customer has authorised an agent to act for them remember to send a copy of the letter to the agent.

Note: If the customer has not replied to your requests for all relevant information to enable you to make a decision, you do not need to send a closing letter as the information request letter will have explained that a decision will be made on the claim based on the information we already hold. You should take the necessary system action to reject the claim as soon as possible after you send the letter and close the case on TCW on the same day you make the decision. The system will send out a formal decision notice which will include the customer’s right of appeal. The customer then has 30 days to appeal against your decision.

If the customer appeals, see CCM4345. If the customer does not appeal you can close the case.