Not upheld: claim declined - coverage interpretation complaint against Society of Lloyd's

Decision detail

Summary

Miss J and Mr T claimed on their building warranty for damage to a retaining garden wall that had bowed. Society of Lloyd's declined the claim on the basis that the wall does not provide support to the structure as defined in the policy. The complainants argued the decision was unfair, citing previous poor claim experiences, inadequate investigation, and that the wall was connected to the house. The ombudsman upheld the insurer's decision, finding that while the wall meets the house and shares a footing, it is a separate construction that does not provide support to the structure as defined in the policy terms, and therefore does not fall within the scope of cover.

The Ombudsman's reasoning

The ombudsman applied the policy definitions carefully, noting that the Housing Unit includes retaining walls only where they are part of or provide support to 'the Structure'. The Structure is narrowly defined to include load-bearing retaining walls. The garden retaining wall, while meeting the house and sharing a footing, is a separate construction that merely meets the house wall without being tied into it. It supports the soil and offers the house some protection but does not provide support to the house structure itself or its load-bearing elements. Therefore, the wall does not fall within the definition of Housing Unit and the claim was properly declined.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website