Not upheld: Travel / life insurance claim disputes complaint against ERGO UK Specialty Limited

Decision detail

Summary

F, a business, complained that ERGO declined a claim on its commercial property insurance for damage caused by forced entry and malicious damage after the property became unoccupied following tenant eviction. ERGO declined the claim because the policy restricted cover for unoccupied buildings to five specific perils (fire, lightning, aircraft, explosion, and earthquake), and the damage was not caused by any of these. F argued the policy was ambiguous because the policy booklet mentioned a 30-day exclusion. The ombudsman found the policy schedule was clear and unambiguous, and that the 30-day provision in the booklet was subject to the schedule's specific terms. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that the policy terms were not ambiguous. The policy schedule clearly restricted cover for unoccupied buildings to five specific perils. Although the policy booklet mentioned a 30-day exclusion, it stated this would only apply 'if shown as operative in the schedule', and in this specific policy the schedule made clear that cover was restricted to the five listed perils once a property became unoccupied. Since the damage was caused by forced entry and malicious damage rather than any of these five perils, ERGO acted fairly in declining the claim.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website