Not upheld: claim declined - exclusion from cover complaint against UK Insurance Limited (UKI)

Decision detail

Summary

Mrs L claimed under her home emergency insurance policy with UKI after water entered her property through the roof following heavy rainfall in September 2025. UKI declined the claim, stating that roof damage was not listed as a covered home emergency incident under the policy, which specified only five categories of cover: plumbing and drainage, security, heating, electrical supply, and pests. Mrs L argued the policy should have covered roof emergencies and that the broad term "home emergency" was misleading. The ombudsman found that roof leaks and water ingress were not included in the insured events, and that urgency alone does not bring a claim within the scope of cover. The complaint was not upheld, and no compensation was awarded.

The Ombudsman's reasoning

The ombudsman applied the principle that for a valid claim under an insurance policy, the claim must arise from one of the listed insured events. The onus is on the policyholder to demonstrate the event is covered. The policy explicitly listed five categories of home emergencies (plumbing and drainage, security, heating, electrical supply, pests) and roof leaks were not among them. The ombudsman found that urgency alone does not bring a claim within the scope of cover, and the policy documentation did not mislead Mrs L into believing roof emergencies were covered. The ombudsman also noted that excluding water ingress from roofs is not unusual for home emergency policies.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website