Not upheld: Home insurance claim disputes complaint against Highway Insurance Company Limited

Decision detail

Summary

Ms C claimed under her buildings insurance policy for storm damage to her outbuilding roof. HICL declined the claim based on a surveyor's report concluding the damage was due to pre-existing wear and tear and gradual damage rather than the storm. Ms C disputed this and provided a roofer's report stating the roof would not have collapsed without the storm. The ombudsman found HICL's surveyor's report more credible and persuasive, noting the photos showed rotten timbers and crumbling masonry indicating pre-existing damage. Applying the proximate cause test, the ombudsman concluded the wear and tear was the proximate cause, not the storm, and therefore HICL fairly declined the claim under the policy exclusions.

The Ombudsman's reasoning

The ombudsman applied the proximate cause test, determining that the storm was not the proximate cause of damage because the roof and outbuilding showed clear signs of pre-existing wear and tear and gradual damage. The ombudsman found HICL's surveyor's report more persuasive than Ms C's later roofer's report because it was contemporaneous with the claim, included supporting photos, and was logically reasoned. The ombudsman concluded that a well-built, structurally sound building should withstand all but the most severe weather, and the evidence showed the roof was not in good repair. The policy expressly excluded wear and tear and gradual damage, which took precedent over the storm damage.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website