Not upheld: Other regulated complaint complaint against Motors Insurance Company Limited

Decision detail

Summary

Mr C claimed for a replacement tyre under his Tyre Insurance policy with MIC after sidewall damage was discovered during a routine service. MIC declined the claim, stating Mr C had not confirmed the circumstances causing the damage and that it appeared to be wear and tear. Mr C disputed this, citing his onboard computer showing no low-pressure warnings and arguing the damage was accidental. The ombudsman found that the policy terms explicitly require claimants to explain what caused the damage, and as Mr C failed to meet this requirement, MIC's decision to decline was fair and reasonable. The ombudsman did not uphold the complaint.

The Ombudsman's reasoning

The ombudsman agreed with the investigator that Mr C carries the burden of proof to demonstrate the sidewall damage was caused by circumstances covered under the policy. The policy terms and conditions explicitly require claimants to provide details of what caused the damage as a requirement to validate the claim. While both garages provided expert opinions, neither provided a complete and persuasive picture. MIC's request for clarification on the cause of damage was reasonable and in line with policy requirements. MIC acted fairly in declining the claim when Mr C could not confirm the circumstances causing the damage.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website