Not upheld: unfair claim decline complaint against Aviva Insurance Limited

Decision detail

Summary

K, a business, held a commercial property insurance policy with Aviva covering a let property. Following a storm, K claimed for water damage to the property. Aviva declined the claim, arguing the damage was gradual rather than caused by the storm. K disputed this, claiming the tenant never made statements supporting gradual damage and that the storm must have been the main cause. The ombudsman applied the three-question test for storm damage and found that while a storm occurred and the damage was typical of storm damage, the loss adjuster's report and photographs evidenced gradual damage over time, meaning the storm was not the dominant cause. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman applied the established three-question test for storm damage: (1) was there a storm (yes, undisputed); (2) is the damage typical of storm damage (yes, undisputed); (3) was the storm the dominant cause (no). The loss adjuster's report and photographs showed evidence of gradual damage including mould, wall and flooring damage, supporting the conclusion that the storm was not the main cause but rather highlighted pre-existing damage. Even discounting the disputed tenant statement, the photographic and loss adjuster evidence alone supported Aviva's position that damage occurred gradually over time.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website