Not upheld: unfair claim decline - insufficient evidence of insured cause complaint against AXA Insurance UK Plc

Decision detail

Summary

Mrs B claimed for water damage to her home under her AXA buildings insurance policy following water ingress discovered in August 2022. AXA declined the claim, stating no insured cause had been demonstrated. Mrs B obtained multiple inspection reports suggesting a possible leaking pipe or culvert, but the most recent damp specialist report confirmed the source had not been identified and advised against costly excavation. The ombudsman found that Mrs B had not met her burden of proving an insured loss, as none of the investigations established that the damage resulted from escape of water from a fixed installation covered by the policy. The ombudsman upheld AXA's decline decision and found its £50 compensation for a delayed response regarding a demolition expert to be fair.

The Ombudsman's reasoning

The ombudsman applied the principle that it is the policyholder's responsibility to demonstrate an insured loss. The policy covers escape of water from fixed water, drainage, or heating installations. Despite multiple investigations, no clear evidence established that any of these sources caused the damage. The most recent damp specialist report explicitly stated the source had not been confirmed and advised against further excavation. The ombudsman found the likely cause to be groundwater penetration, which is not an insured peril. The ombudsman also applied DISP rules to limit consideration to only the most recent complaint matters, as earlier complaints fell outside the six-month referral window.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website