Upheld: unfair claim decline based on policy exclusion for commercial use complaint against Domestic & General Insurance Plc

Decision detail

Summary

Ms R complained that D&G unfairly declined her claim for laptop repairs under an accidental damage insurance policy. D&G declined the claim based on a policy exclusion for items used for commercial purposes, citing Ms R's emails where she mentioned using the laptop for 'work'. Ms R clarified that she is unemployed and uses the laptop for study work and voluntary work, not paid commercial work. The ombudsman upheld the complaint, finding that D&G's reliance on the ambiguous term 'work' without further investigation was unfair, especially as Ms R provided supporting evidence of her unemployed status and studies. D&G was directed to accept the claim and pay £100 compensation.

The Ombudsman's reasoning

The ombudsman found that the use of the term 'work' in Ms R's emails was ambiguous and did not definitively prove commercial use. Ms R provided a plausible explanation that she was referring to study work and voluntary work, supported by evidence of her unemployed status and studies. D&G failed to clarify what Ms R meant by 'work' before declining the claim and had no other evidence to support that the laptop was used for paid work or commercial purposes. Therefore, it was unfair and unreasonable to decline the claim based solely on this ambiguous terminology.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website