Not upheld: claim denial and exclusion application complaint against Covea Insurance plc

Decision detail

Summary

Mr K complained that Covea Insurance unfairly declined to cover window damage as part of his buildings insurance claim for storm damage. The storm had caused a roof tile to slip, allowing water ingress that Mr K claimed damaged the windows through increased moisture. Covea argued the window damage was due to gradual deterioration of seals, which is excluded from cover. The ombudsman found the photographic evidence and Mr K's own references to burst seals supported Covea's assessment that the damage was caused by wear and tear rather than the storm, and upheld Covea's decision to decline the claim.

The Ombudsman's reasoning

The ombudsman found that windows are typically part of the property structure rather than internal damage. Even if considered consequential damage from the leak, the evidence (photos showing condensation and leak marks consistent with blown seals, Mr K's own reference to burst seals) indicated the damage was caused by gradual wear and tear of the window seals rather than the storm event itself. The ombudsman was not persuaded that increased moisture alone would cause the type of damage shown, and no expert evidence supported this theory. Therefore, Covea fairly applied the wear and tear exclusion.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website