Not upheld: Travel / life insurance claim disputes complaint against U K Insurance Limited

Decision detail

Summary

Mr and Mrs A claimed for storm damage to their conservatory roof under their home insurance policy with UKI. UKI declined the claim, stating the damage was caused by gradual wear and tear rather than the storm. The ombudsman considered expert evidence from both UKI's surveyor and Mr and Mrs A's roofer, finding that while storm conditions existed, pre-existing faults made the roof susceptible to damage. The ombudsman upheld UKI's decision to decline the claim as wear and tear was the main cause, not the storm, and this was excluded under the policy terms.

The Ombudsman's reasoning

The ombudsman applied the three-question test for storm damage claims: (1) were there storm conditions (yes, accepted by UKI), (2) is the damage typical of storm damage (yes), and (3) was the storm the main cause (no). The ombudsman found both experts identified roof issues but preferred the surveyor's opinion that pre-existing wear and tear made the roof susceptible to damage, with the storm being the 'straw that broke the camel's back' rather than the main cause. The policy excludes gradual wear and tear, so the claim was properly declined.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website