Not upheld: claim repudiation for suspected fraud complaint against UK Insurance Limited trading as Direct Line

Decision detail

Summary

Miss W claimed on her home insurance policy following a fire at her property in March 2024. During claim validation, UKI identified concerns regarding alternative accommodation costs, occupancy issues, missing supporting documents, and contradictory explanations. UKI discovered that a property for which they paid alternative accommodation was owned by a company belonging to Miss W's partner, who had been living at the risk address—material information Miss W failed to disclose. After giving Miss W a right of reply, UKI repudiated the claim for fraud on 27 June 2025. The ombudsman upheld UKI's decision, finding that the discrepancies were material, Miss W's explanations were not persuasive, and her failure to provide supporting documentation or disclose the partner's financial interest supported the fraud determination.

The Ombudsman's reasoning

The ombudsman found that UKI fairly identified fraud concerns based on material discrepancies and missing supporting evidence. Miss W failed to disclose that her partner had a financial interest in a property for which UKI paid alternative accommodation, and she provided contradictory explanations, delays, and insufficient documentation. The ombudsman was not persuaded by Miss W's attempts to distance herself from the partner, as contemporaneous evidence (witness statements, family communications, and neighbour testimony) confirmed they were in a relationship at the time of the claim. The ombudsman concluded that Miss W's failure to provide persuasive evidence undermining UKI's fraud position, combined with the policy terms and Insurance Act 2015 provisions, meant UKI acted fairly and reasonably.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website