Not upheld: claim decline - application of policy exclusions complaint against esure Insurance Limited

Decision detail

Summary

Mr W claimed for water damage to his home caused by poor installation of a shower tray and failed grout/sealant. esure declined the claim, citing policy exclusions for workmanship and installation issues. The ombudsman upheld esure's decision, finding that both parties agreed the proximate cause was the faulty installation, which fell within the policy's exclusions. The ombudsman reasoned that for resultant damage to be covered, the proximate cause must also be covered, and the policy was designed to protect against unforeseen damage, not pre-existing workmanship defects. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman applied the principle that for resultant/consequential damage to be covered under an insurance policy, the proximate cause must also be covered. Since both the shower tray installation issue and grout/sealant deterioration are excluded under the policy terms, esure can fairly rely on these exclusions to decline the claim. The policy is designed to protect against unexpected/unforeseen damage, not workmanship or construction issues that predate the policy. The accidental damage cover would also not apply given the damage occurred gradually over time due to installation defects.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website