Not upheld: Home insurance claim disputes complaint against Tokio Marine Kiln Insurance Limited

Decision detail

Summary

Mrs H and Mr J complained about delays and administration of their property damage insurance claim following a water escape in their apartment block in October 2019. They were unable to return to their apartment until September 2021. Tokio Marine Kiln Insurance Limited appointed agents to manage the claim, which was deemed a major complex loss with costs well into seven figures affecting multiple units. The ombudsman found that while delays occurred, they were primarily caused by the pandemic, government restrictions, the complexity of assessing and repairing damage across the entire block, and the need to reassess works as the building dried out and damp/mould issues emerged. The ombudsman did not uphold the complaint, finding that Tokio's handling of the claim as a whole for the entire building was reasonable and appropriate, and that the delays were not caused by Tokio's unfair conduct.

The Ombudsman's reasoning

The ombudsman found that while there were delays, they were primarily caused by the unprecedented circumstances of the pandemic, the major and complex nature of the claim affecting the entire building, the need for reassessment as the building dried out and damp/mould issues emerged, and the coordination required across multiple units. The ombudsman noted that handling the claim as a whole for the entire block was reasonable and appropriate, and that some units inevitably had to wait longer than others. The ombudsman concluded that the delays were not caused by Tokio's unfair handling of the claim but rather by the inherent complexity and external circumstances.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website