Partially upheld: unfair claim decline complaint against Advantage Insurance Company Limited

Decision detail

Summary

Ms A claimed on her home insurance policy for damage to two internal doors—one damaged while moving furniture and one while using resistance bands. Advantage declined both claims, arguing the damage was inconsistent with Ms A's descriptions and unlikely given the door construction. The ombudsman upheld the decline of the upstairs door claim because Ms A could not identify the external cause required by the policy. However, the ombudsman upheld Ms A's complaint regarding the downstairs door, finding her testimony clear and consistent while Advantage's alternative explanations were unconvincing. Advantage was directed to reconsider the downstairs door claim and pay £150 for distress and inconvenience.

The Ombudsman's reasoning

The ombudsman applied the balance of probabilities test, noting that neither party was present when the damage occurred. For the upstairs door, the ombudsman found Advantage acted fairly because Ms A failed to identify an external cause as required by the policy. For the downstairs door, the ombudsman found Ms A's testimony was clear, consistent, and compelling, and that Advantage's varying explanations and hypotheses (animal teeth, scraping/dragging/prying) were not persuasive. The ombudsman concluded Advantage's evidence did not contradict Ms A's plausible account of the resistance band incident.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website