Not upheld: unfair claim decline - causation dispute complaint against Lloyds Bank General Insurance Limited

Decision detail

Summary

Mr and Mrs H claimed for water damage to their utility room under their Lloyds home insurance policy, attributing it to storm Eowyn in January 2025. Lloyds declined the claim, arguing the damage resulted from gradual deterioration rather than the storm. The ombudsman applied the three-question test for storm damage and found that while storm conditions existed, the damage was not consistent with storm damage and the storm was not the main cause. The surveyor's findings of deteriorated mortar, water pooling, and cracks indicated gradual deterioration over time, supported by the 2021 HomeBuyer report which had flagged dampness risks. The three-week delay between the storm and the claim being reported further suggested the damage was not directly caused by the storm. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman applied the three-question test for storm damage claims: (1) Were there storm conditions? Yes, storm Eowyn occurred with 76mph winds. (2) Is the damage consistent with storm damage? Not clearly - no obviously broken tiles or damaged slabs were visible. (3) Was the storm the main cause? No. The surveyor's findings of deteriorated mortar, water pooling on the terrace, and cracks in the render indicated gradual deterioration over time. The HomeBuyer report from 2021 had flagged risks of dampness on the terrace. The three-week delay between the storm and Mrs H reporting the damage, combined with her failure to mention the storm initially, suggested the damage was not immediately caused by the storm. The surveyor's inspection, which was more recent and detailed than the four-year-old HomeBuyer report, provided stronger evidence of gradual deterioration exposed by the storm rather than direct storm causation.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website