Not upheld: claim decline and settlement dispute complaint against Admiral Insurance (Gibraltar) Limited

Decision detail

Summary

Ms W claimed for damage to her car's underside following an accident in February 2025, which Admiral declined as not being an insurable event. After Ms W provided expert evidence suggesting the damage could be related to the accident, the FOS investigator recommended the claim be upheld. However, Ms W did not arrange repairs and continued driving the car until a second accident in December 2025 affected the same area, which Admiral subsequently repaired under a new claim. The ombudsman found that while Admiral's evidence for declining the first claim was insufficient, Ms W had suffered no quantifiable financial loss because she never paid for repairs and the damage has now been repaired under the second claim, making it impossible to distinguish damage from the first accident from the second.

The Ombudsman's reasoning

The ombudsman acknowledged that Admiral had not provided sufficiently clear evidence to show the damage was not caused by the first accident, supporting the investigator's view. However, the ombudsman focused on whether Ms W had suffered quantifiable financial loss. Since Ms W did not pay for repairs after the first accident and continued to drive the car, and a second accident subsequently affected the same area with repairs now completed under the second claim, the ombudsman could not reliably establish what damage was caused by the first accident versus the second. Without being able to distinguish between damage from the two incidents and with no repairs paid for by Ms W following the first accident, the ombudsman concluded it would not be fair to require Admiral to pay for repairs that have already been completed under the second claim.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website