Not upheld: claims handling - refusal to pay without pre-authorization and proper evidence complaint against UK Insurance Limited trading as Direct Line

Decision detail

Summary

Mr F claimed on his motor insurance for damage caused by an electrical fire. When UKI's approved repairers refused to handle fire damage, UKI asked Mr F to find his own repairer and obtain a detailed quote for approval before work commenced. Mr F obtained a verbal quote but did not provide the garage details as agreed. After approximately four weeks, Mr F completed the repairs himself without UKI's authorization and later provided a repair statement for £3,248 without supporting evidence or breakdown. UKI refused to pay without proper invoices and cost breakdown. The ombudsman found UKI acted fairly in requiring pre-approval and proper evidence, and that Mr F breached the policy terms by proceeding without authorization.

The Ombudsman's reasoning

The ombudsman found that UKI acted in accordance with the policy terms which explicitly required approval of repair estimates before work commenced. UKI clearly communicated this requirement to Mr F and advised against using the friend mechanic due to the need for proper invoicing. Although UKI could have proactively contacted Mr F for a progress update, Mr F failed to provide the garage details he had agreed to provide, so UKI was not responsible for the delay. By proceeding with repairs without authorization, Mr F acted outside the policy terms and accepted responsibility for the costs. UKI's request for detailed evidence of costs and breakdown is reasonable and necessary to validate the claim.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website