Not upheld: Home insurance claim disputes complaint against AXA Insurance Plc
Financial Ombudsman decision DRN-3394443 of 2022-05-20T00:00:00+00:00. Home insurance claim disputes complaint against AXA Insurance Plc. Outcome: Not upheld.
Decision detail
| Reference | DRN-3394443 |
|---|---|
| Decision date | 2022-05-20T00:00:00+00:00 |
| Firm | AXA Insurance Plc |
| Product | Other regulated product |
| Claim type | Home insurance claim disputes |
| Outcome | Not upheld |
| Remedy | No remedy ordered. The ombudsman declined to require additional compensation beyond the £25 already offered by AXA for delays, finding no significant delays causing material loss and noting that complaint handling matters fall outside the ombudsman's remit. |
Summary
Mr and Mrs P complained that AXA unfairly declined their storm damage claim for a flat roof without full sight of relevant information, and caused communication delays. AXA's loss adjuster concluded the main cause of damage was wear and tear rather than the storm, leading to claim decline. The ombudsman applied a three-part test for storm damage and found: (1) there was a storm; (2) the damage was consistent with storm damage; but (3) the damage was caused wholly or mainly by pre-existing wear and tear, not the storm. Evidence from online images three years prior showed similar roof damage to post-storm photos, and repair work undertaken demonstrated the roof was already deteriorated. The ombudsman found AXA acted fairly in declining the claim and reconsidering when additional evidence was provided, and did not uphold the complaint.
The Ombudsman's reasoning
The ombudsman applied a three-part test for storm damage claims: (1) Was there a storm? Yes, confirmed by weather data and not disputed. (2) Was the damage consistent with storm damage? Yes, roof lifting and water ingress are consistent with storm damage. (3) Was the damage caused wholly or mainly by the storm? No. The evidence showed pre-existing damage through comparison of online images from three years prior with post-storm photos taken by the loss adjuster, which appeared similar. The repair work (UPVC soffits on aged facia boards) demonstrated the roof was already deteriorated, not well-maintained. The policy explicitly required biennial inspections and maintenance, making it reasonable for AXA to request evidence of compliance. AXA acted fairly by declining based on available information and reconsidering when additional evidence was provided. The ombudsman found no evidence of unfair treatment and noted that Mr M's dissatisfaction with the outcome does not equate to unfair treatment.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| AXA Insurance Plc, all decisions | 12 | 46% |
| Home insurance claim disputes, all decisions | 25,340 | 38% |
| Other regulated product, all decisions | 52,408 | 30% |
Source
Read the original decision on the Financial Ombudsman Service website