Not upheld: Home insurance claim disputes complaint against Lemonade Insurance N.V.

Decision detail

Summary

Mr H claimed for damage from a burst pipe and resulting kitchen ceiling collapse in May 2025. After Lemonade's delays in arranging repairs, the parties agreed to a cash settlement, but Mr H's contractor quote of £53,000 exceeded Lemonade's offer of £36,000. During investigation, Mr H admitted to fabricating repair quotes and alternative accommodation invoices totalling £11,500. Lemonade declined the entire claim citing the fraud condition. The ombudsman found Lemonade acted fairly, as under insurance law an exaggerated claim allows the insurer to refuse the entire claim including genuine elements.

The Ombudsman's reasoning

The ombudsman found that Lemonade fairly concluded the fraud condition was breached on the balance of probabilities. Under insurance law, when a claim is exaggerated through dishonest means, the insurer can refuse the entire claim including genuine elements, as the insured is attempting to obtain something to which they are not entitled. Lemonade's investigation was thorough, it raised inconsistencies with Mr H, and Mr H admitted to fabricating evidence and obtaining £11,500 he was not entitled to. The ombudsman was satisfied Lemonade acted fairly within the policy terms.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website