Not upheld: Home insurance claim disputes complaint against AXA Insurance UK Plc

Decision detail

Summary

B, a property management company, claimed under an AXA property insurance policy for damage caused by a leak from an external gutter affecting a residential block of flats. AXA declined the claim, concluding the damage resulted from gradual escape of water over a prolonged period rather than a sudden insured event, citing policy exclusions. The Investigator and Ombudsman both found AXA's decision fair, as photographs and claim records showed extensive mould growth and staining consistent with prolonged moisture exposure, and the contractor's report did not establish when the downpipe became disconnected or prove sudden damage. The Ombudsman also rejected B's argument that a loss adjuster site visit was necessary, finding AXA had sufficient evidence to assess the claim remotely.

The Ombudsman's reasoning

The Ombudsman concluded that the available evidence, particularly the extent of mould growth, staining, and dampness visible in photographs and documented in claim records, was consistent with moisture being present for a prolonged period rather than a recent one-off event. Although the contractor's report identified how water was entering the building (disconnected downpipe), it did not establish when the disconnection occurred or demonstrate the damage arose suddenly. The Ombudsman found AXA's reliance on the condition of the damage itself, combined with other evidence, was persuasive that the damage resulted from gradual deterioration excluded under the policy terms. The Ombudsman also found that insurers are entitled to reach decisions based on documentary and photographic evidence without requiring an in-person inspection where sufficient information is available.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website