Not upheld: claim handling / unfair claim decline complaint against Accredited Insurance (Europe) Ltd

Decision detail

Summary

Mr and Mrs C complained that AIL failed to repair their toilet flush under their home emergency policy. A plumber attended on 29 May 2025 and identified that trace and access (removal of panelling) was required, which was not covered under the policy. Mr C later completed the repair himself by removing a small unclipped panel. The ombudsman found AIL fairly declined the claim because the policy explicitly excluded cover for removal of panelling and the broken flush did not meet the emergency criteria as Mr C had another working toilet available. Although the plumber could probably have removed the panel, AIL reasonably concluded that furniture dismantling was necessary for proper repair, and AIL responded promptly when the plumber's report was received. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that AIL reasonably declined the claim because: (1) the policy explicitly excludes cover for removal of panelling, which was required; (2) the broken flush mechanism did not constitute an emergency under the policy definition as Mr C had another working toilet available; (3) while the plumber could probably have removed the small panel, the limited workspace meant AIL reasonably concluded furniture dismantling was necessary for proper repair; (4) AIL responded promptly and fairly by contacting Mr C when the plumber's report was received as promised; and (5) essential facilities remained available to Mr C during the claim process.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website