Not upheld: unfair claim decline complaint against Astrenska Insurance Limited

Decision detail

Summary

Ms S claimed on her home emergency insurance policy with Astrenska for intermittent hot water issues in September 2025. Astrenska's engineer diagnosed limescale build-up and declined the claim citing the policy's exclusion for power flushing and descaling. Ms S complained, noting a similar 2024 claim had been accepted under a different insurer and that she had a vulnerable person in her household. When Ms S obtained repairs from another provider using a power flush, she argued this proved Astrenska's diagnosis was wrong. The ombudsman found Astrenska fairly declined the claim because the remedy that fixed the problem (power flush) was explicitly excluded under the policy terms, regardless of the diagnosis, and that vulnerability considerations do not override policy exclusions.

The Ombudsman's reasoning

The ombudsman applied the policy terms as the starting point, noting the explicit exclusion for power flushing and descaling. While acknowledging both engineers identified blockages, the ombudsman found the remedy applied (power flush) was directly excluded under the policy regardless of which diagnosis was more accurate. The ombudsman concluded Astrenska fairly relied on its engineer's opinion and that vulnerability considerations do not override policy exclusions. The ombudsman also noted the previous 2024 claim was under a different insurer's policy and therefore not relevant to assessing Astrenska's fairness.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website