Not upheld: unfair claim decline - causation dispute complaint against UK Insurance Limited

Decision detail

Summary

Miss W claimed for storm damage to her roof and chimney stack under her home buildings insurance policy with UKI. UKI declined the claim for the chimney and roof (but accepted the TV aerial claim) on the grounds that the underlying cause was deterioration and wear and tear, not the storm. The ombudsman applied the three-question storm damage test and found that while storm conditions occurred, the damage was not consistent with typical storm damage and the underlying cause was pre-existing deterioration of the chimney render, not the storm. The policy excluded wear and tear, supporting UKI's decision, and the complaint was not upheld.

The Ombudsman's reasoning

The ombudsman applied the three-question test for storm damage claims: (1) did storm conditions occur - yes; (2) is the damage consistent with typical storm damage - no, as correctly applied render in good condition should withstand such winds; (3) were storm conditions the main cause - no, the underlying cause was long-standing deterioration and wear and tear. The evidence showed the render had been deteriorating for years with previous repairs using mastic filler, and had de-bonded from the brick, indicating pre-existing weakness. The policy specifically excludes wear and tear and maintenance issues, supporting the decline.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website