Not upheld: fraudulent claims and policy cancellation complaint against ERGO UK Specialty Limited

Decision detail

Summary

Mrs L complained that ERGO unfairly declined three water damage claims under her contents insurance policy and cancelled her policy, accusing her of fraudulent claims. ERGO had identified that identical photographs of damaged items and identical damage patterns had been previously submitted to Mrs L's former insurer, and that the damage appeared to be from ink rather than water. The ombudsman found ERGO's concerns justified and was not persuaded by Mrs L's explanations that the trainers were replacements, the mould had reappeared, or the leather jacket photograph was included in error. The ombudsman upheld ERGO's decision to decline the claims and cancel the policy on the basis that the claims were fraudulently or exaggeratedly presented.

The Ombudsman's reasoning

The ombudsman found that ERGO had raised justified concerns based on the use of identical photographs across multiple claims with different insurers, identical damage patterns, and the appearance of ink rather than water damage. The ombudsman was not satisfied that Mrs L's explanations (replacement trainers, reappeared mould, accidental photograph inclusion) were credible given the weight of evidence. The ombudsman noted that even if some items were genuinely damaged, the exaggeration or false presentation of other items in the same claim allows an insurer to refuse the entire claim. The ombudsman concluded it was more likely than not that Mrs L made fraudulent or exaggerated claims.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website