Upheld: Home insurance claim disputes complaint against AXA Insurance Designated Activity Company

Decision detail

Summary

Mr and Mrs M claimed under their buildings insurance policy for damage to their drainage system after their septic tank filled up again shortly after being emptied in June 2023. AXA declined the claim, arguing the damage was caused by wear and tear and the system had reached the end of its useful life. Two drainage companies' reports confirmed blockage or damage to the drainage field pipework but neither could inspect it to determine the cause. The ombudsman upheld the complaint, finding the damage met the policy definition of accidental damage (sudden, unexpected, visible, not caused on purpose) and was not caused by wear and tear or gradual deterioration, as AXA had not provided sufficient evidence to support this conclusion. AXA was ordered to reconsider the claim and pay £150 compensation.

The Ombudsman's reasoning

The ombudsman found that the available evidence demonstrated damage to the drainage field pipework that met the policy definition of accidental damage: it was sudden, unexpected, visible, and not caused on purpose. While AXA argued the damage was caused by wear and tear or gradual deterioration, the ombudsman was not persuaded by this reasoning because: (1) neither drainage company could inspect the pipework to confirm wear and tear as the cause; (2) the septic tank showed no structural failings despite its age; (3) Mr and Mrs M had maintained the system annually since 2020 and there was no clear link between the historic maintenance gap and the current problem; and (4) the problem appeared suddenly in 2023 rather than gradually. Therefore, AXA's reliance on the wear and tear exclusion was not justified by the evidence.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website