Not upheld: misrepresentation and non-disclosure; claim decline; policy avoidance complaint against Intact Insurance UK Limited

Decision detail

Summary

Mr S and Mrs T complained that Intact unfairly declined their roof damage claim and avoided their home buildings insurance policy. Intact declined the claim because Mr S had failed to disclose a 2016 subsidence claim when asked during the application process. Mr S argued the question was ambiguous and the prior damage was minor and unrelated to the roof claim. The ombudsman found the question was clear, Mr S made a careless misrepresentation by confirming no subsidence damage had occurred when an engineer's certificate explicitly identified subsidence as the cause of the 2016 damage, and under CIDRA rules Intact was entitled to decline the claim and avoid the policy with a refund of premiums.

The Ombudsman's reasoning

The ombudsman found that the insurance question regarding subsidence damage was clear and unambiguous. Mr S made a careless misrepresentation by confirming his home had never suffered subsidence damage when the engineer's certificate explicitly identified clay shrinkage subsidence as the cause of the 2016 damage. Under CIDRA, this constituted a qualifying misrepresentation because Intact would not have provided cover at all had it known the true position. Therefore, Intact was entitled to decline the claim and avoid the policy with a refund of premiums. The materiality of the subsidence damage to the roof claim was irrelevant under CIDRA rules.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website