Not upheld: claim decline decision and claim handling complaint against UK Insurance Limited (trading as Churchill Insurance)

Decision detail

Summary

Mr A complained that UKI unfairly declined his home emergency claim for a broken toilet flush, arguing that UKI referenced incorrect policy wording and that the situation constituted an emergency. UKI declined the claim on the basis that Mr A had other functioning toilets available and therefore the broken flush did not meet the policy definition of emergency. The ombudsman found that although UKI made an error in its written communication by referencing non-existent policy wording, the actual reason for decline was clearly communicated and reasonable. The ombudsman concluded that a non-functioning toilet when others are available does not constitute an emergency under the policy terms and upheld UKI's decision to decline the claim, making no award for the costs Mr A incurred replacing the toilet.

The Ombudsman's reasoning

The ombudsman assessed whether the broken toilet flush met the policy definition of emergency, which requires an incident that needs quick dealing to avoid the home becoming unsafe/unsecure, damage to the home, or loss of main heating/lighting/water. Although UKI made an error in referencing incorrect policy wording in its letter, the reason for decline (that the circumstances did not constitute an emergency given other functioning toilets were available) was clearly communicated in the phone call and letter combined. The ombudsman found this was a correction of a communication error rather than introduction of a new reason. The ombudsman concluded that having one non-functioning toilet when others are available does not meet the policy's emergency definition, distinguishing this from cases involving no usable sanitation.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website