Not upheld: claim refusal - damage assessment and policy term application complaint against Aioi Nissay Dowa Insurance UK Limited (ANDI)

Decision detail

Summary

Mr L claimed for four areas of damage to his car under a minor damage protection insurance policy with ANDI. ANDI declined damage A at the triage stage for exceeding the 3mm depth limit, but initially authorised damages B, C, and D pending on-site technician assessment. When the repair technician inspected the car, he declined damage B because it was within one metre of damage A, making the combined area exceed the 30cm limit specified in the policy, and repairing it would require blending which was not permitted. The ombudsman upheld ANDI's decision, finding that the policy terms were clear, Mr L had agreed to them, and the technician's on-site assessment correctly applied the policy conditions.

The Ombudsman's reasoning

Minor damage protection policies are specifically designed for 'smart repairs' and have strict specifications. The policy terms clearly limited what damage could be repaired, including proximity rules and size limits. ANDI's acceptance of the claim appropriately caveatted that the repair technician would make the final decision on-site. The technician's physical inspection revealed that damage B could not be repaired in compliance with policy terms due to its proximity to damage A and the combined area exceeding 30cm. ANDI correctly interpreted and applied the policy terms, and the technician's decision was within ANDI's commercial discretion and standard industry practice.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website