Not upheld: Home insurance claim disputes complaint against UK Insurance Limited trading as Direct Line

Decision detail

Summary

Mr and Mrs L claimed for storm damage to their home under their UKI buildings insurance policy, but UKI declined the claim stating there were no storm conditions and the damage was caused by gradual wear and tear. The ombudsman found that while storm conditions did occur (67mph wind gusts) and the damage type was consistent with storm damage, the surveyor's report and photographs provided clear evidence of previous repairs, ongoing deterioration, and wear and tear to the roof flashing. Applying the three-question test for storm claims, the ombudsman concluded that the damage was caused primarily by gradual deterioration rather than the storm being the dominant cause, and since the policy explicitly excludes wear and tear and gradually occurring damage, UKI's decision to decline was fair and reasonable. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman applied the three-question test for storm claims: (1) Did storm conditions occur? Yes - 67mph gusts constituted a storm. (2) Was the damage consistent with storm damage? Yes - high winds could cause rainwater ingress and flashing damage. (3) Was the storm the main cause? No - the surveyor's report and photographs showed clear evidence of previous repairs, wear and tear, and gradual deterioration, indicating the damage resulted from pre-existing conditions rather than the storm being the dominant cause. The policy explicitly excludes wear and tear and gradually occurring damage. Therefore, UKI's decline was fair and reasonable.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website