Not upheld: unfair claim decline complaint against AmTrust Specialty Limited

Decision detail

Summary

Mrs N claimed on her legal expenses insurance policy for costs to take action against a contractor who performed poor quality building work. AmTrust declined the claim under a policy exclusion that excludes construction-related disputes where the value exceeds £5,000. A professional report indicated the structure would likely require demolition and rebuilding due to substandard foundations. Mrs N provided a £3,250 quote for partial rectification and text messages about foundation inspection, but neither addressed the likely demolition and rebuilding costs. The ombudsman found AmTrust reasonably relied on the professional report and that Mrs N failed to demonstrate the claim value was below £5,000, so the complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that AmTrust was entitled to rely on the professional report which clearly indicated that demolition and rebuilding would likely be required, placing the claim value above the £5,000 exclusion threshold. The burden then shifted to Mrs N to demonstrate the claim value was below £5,000, which she failed to do. The quote she provided did not include the likely necessary demolition and rebuilding works, and the text messages lacked the detail and formal qualification needed to refute the professional report. The ombudsman concluded that Mrs N had not reasonably demonstrated the claim value was less than £5,000 or that AmTrust's conclusions were incorrect.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website