Not upheld: claim decline - alleged unfair rejection complaint against Fortegra Europe Insurance Company Ltd

Decision detail

Summary

Miss H purchased furniture with an extended warranty covering accidental damage in 2022. She reported damage in November 2024 to the retailer, which referred her to Fortegra for the extended warranty claim in January 2025. Fortegra arranged a comprehensive technician inspection with photos, which concluded the damage was not from a single incident but from misuse over time. Fortegra declined the claim based on policy exclusions for damage from normal use and misuse. The ombudsman upheld the decline as fair, finding the evidence supported Fortegra's position and Miss H's submissions were contradictory regarding whether this was a single incident.

The Ombudsman's reasoning

The ombudsman applied the relevant industry rules requiring insurers to deal with claims fairly and not unreasonably reject claims. The policy terms clearly limited cover to individual incidents of accidental damage and excluded damage from misuse over time. The comprehensive technician report provided by Fortegra, supported by photos, demonstrated multiple issues occurring over time rather than a single incident. Miss H's own submissions were contradictory - she claimed a single accident but reported multiple incidents, and the retailer's technician's comments referenced overuse rather than a single incident. Therefore, the evidence did not support Miss H's claim and the decline was fair.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website