Upheld: Motor insurance, claim handling complaint against AmTrust Specialty Limited

Decision detail

Summary

Mrs H claimed on her unoccupied property insurance policy with AmTrust following a water escape from a pipe in January 2025. AmTrust declined the claim in February 2025, citing Mrs H's breach of a policy condition requiring either water supply shutdown and drainage or continuous heating between November and March. AmTrust acknowledged the decline was premature as they had not established the cause of the pipe damage at their site visit. The ombudsman upheld the complaint, finding AmTrust must fairly explore whether the condition breach was material to the loss before declining. AmTrust was directed to reconsider the claim and pay £450 compensation for the distress and inconvenience caused by the delays and poor communication.

The Ombudsman's reasoning

AmTrust must demonstrate that the failure to comply with the policy condition was material to the loss claimed. While AmTrust showed freezing temperatures occurred and Mrs H breached the condition, they failed to inspect the cause of the pipe damage before declining the claim. The ombudsman found it reasonable for AmTrust to reconsider the claim by obtaining either a plumber's invoice (if repairs were done) or arranging an expert inspection (if not). The delays caused by the premature decline, combined with poor communication and the conduct of the assessor, resulted in distress and inconvenience to Mrs H over a prolonged period.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website