Not upheld: Home insurance claim disputes complaint against AXA Insurance UK Plc

Decision detail

Summary

Mr S1 claimed under his property insurance policy for roof damage he attributed to a storm in August 2024. AXA declined the claim, concluding that while the storm may have contributed to the damage, the main cause was gradual wear and tear and structural defects. The ombudsman applied the three-question test for storm claims and found that although a qualifying storm occurred (56 mph winds) and the damage was typical of storm damage, the evidence showed the damage resulted from multiple contributing factors rather than the storm alone being the main cause. The ombudsman gave greater weight to AXA's specialist chartered engineer assessment over Mr S1's reports, finding it reasonable for AXA to decline the claim where damage is not solely attributable to an insured event. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman applied the three-question test for storm damage claims: (1) was there a storm - yes, wind speeds of 56 mph met the policy definition; (2) is the damage typical of storm damage - yes, structural damage from 56 mph winds is plausible; (3) is the storm the main cause - no, the evidence showed the damage resulted from a combination of factors including gradual deterioration and structural defects. The ombudsman found AXA's chartered engineer report more reliable than Mr S1's reports because it was a specialist structural assessment, whereas one of Mr S1's reports did not clearly explain its conclusions. The ombudsman concluded that where damage arises from multiple factors and is not solely attributable to a storm, it is reasonable for an insurer to decline cover.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website