Not upheld: Home insurance claim disputes complaint against Lemonade Insurance N.V.

Decision detail

Summary

Mrs M claimed under her home insurance policy with Lemonade for water damage to her bathroom roof reported in November 2024. Lemonade declined the claim, stating that storm conditions were not met and the damage appeared to be caused by wear and tear (failed rendering), which is excluded under the policy. The ombudsman upheld Lemonade's decision, finding that weather data showed maximum wind speeds of 34mph during the relevant period, considerably below the 55mph threshold required by the policy for storm cover. The ombudsman concluded it was reasonable for Lemonade to determine the damage was caused by wear and tear rather than storm conditions, and therefore the claim was properly declined.

The Ombudsman's reasoning

The ombudsman found it reasonable for Lemonade to decline the claim because: (1) weather data from both Lemonade and FOS showed maximum wind speeds of 34mph, considerably below the 55mph threshold required by the policy for storm cover; (2) the loss adjustor's conclusion that a loose flash caused the water ingress, if true, would likely be due to wear and tear given the low wind speeds; (3) the poor condition of the rendering identified by Lemonade was a possible cause of damage that, if responsible, would constitute wear and tear rather than storm damage; and (4) the policy specifically excludes damage due to wear and tear.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website