Partially upheld: Home insurance claim disputes complaint against UK Insurance Limited

Decision detail

Summary

Mr E purchased a car at auction and took out motor insurance with UKI. Two months later, after having gearbox work done, he hit a pothole and subsequently claimed for damage to the gearbox, flywheel, and bodywork. UKI declined the claim as fraudulent, arguing Mr E must have known of pre-existing damage from MOT advisories completed before his purchase. The ombudsman found the evidence insufficient to prove Mr E definitely knew of the pre-existing damage, noting he stated he only checked MOT fails and would not have bought the car if aware of the issues. While the ombudsman did not confirm the damage was caused by the pothole, it upheld the complaint in part, requiring UKI to remove fraud markers and reconsider the claim under remaining policy terms.

The Ombudsman's reasoning

The ombudsman found insufficient evidence to prove Mr E definitely knew about pre-existing damage to the gearbox and flywheel. While MOT advisories existed, Mr E stated he only checked for fails and did not review all advisories, and consistently maintained he would not have bought the car if aware of these issues. The ombudsman noted that poor previous repairs could have masked damage that was then revealed by the pothole impact. The ombudsman applied the standard that where evidence is lacking or contradictory, consideration should be given to what is more likely to have happened. The ombudsman concluded the evidence was insufficient to support a fraud finding, though this does not mean the damage was necessarily caused by the pothole or that the claim must be paid.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website