Upheld: Home insurance claim disputes complaint against Tokio Marine Kiln Insurance Limited

Decision detail

Summary

Mr F claimed on his buildings insurance with TMK for ceiling damage that occurred in June 2015. TMK declined the claim based on a surveyor's report concluding the damage was due to gradual deterioration, citing the policy's gradual operating clause. The ombudsman found that while a particular peril could not be identified, the sudden and unexpected nature of the collapse, with no prior warning to Mr F, constituted accidental damage covered under the policy. The ombudsman upheld the complaint and required TMK to settle the claim for ceiling repairs.

The Ombudsman's reasoning

While the surveyor could not identify a particular peril causing the damage, the ombudsman disagreed that it was caused by normal wear and tear or gradual deterioration. The damage was in a specific area and the other ceiling cracks were not indicative of imminent collapse. The sudden and unexpected nature of the collapse, with no prior warning to Mr F, matched the definition of accidental damage covered under the policy. The policy's accidental damage section should apply.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website