Not upheld: claim decline - causation dispute and late notification complaint against Great Lakes Insurance UK Limited

Decision detail

Summary

Mr and Mrs D claimed on their commercial property insurance policy for roof damage caused by Storm Bert in November 2024, which resulted in water ingress and internal damage. They did not report the claim to Great Lakes until March 2025 (approximately 4 months later), breaching the policy's 30-day reporting requirement. Great Lakes declined the claim, asserting the damage was caused by gradual wear and tear to the roof structure rather than the storm, based on photographs showing discoloured roof timbers. The ombudsman upheld Great Lakes' decision, finding that the photographic evidence supported a conclusion that the roof had deteriorated over time, that tiles would not have come loose from a structurally sound roof in a storm, and that the late notification prevented Great Lakes from conducting a timely inspection to validate the claim.

The Ombudsman's reasoning

The ombudsman applied a three-part test: whether storm conditions existed (accepted by all parties), whether damage was consistent with typical storm damage (yes), and whether the storm was the main cause (no). The ombudsman found that the discolouration of roof timbers shown in photographs indicated deterioration over time rather than recent water damage, and that tiles and wood structures are designed to withstand strong winds, so the tiles would not have come loose had the supporting structure been in good condition. The late reporting (4 months instead of 30 days) prejudiced Great Lakes' ability to inspect the property before repairs were undertaken, forcing them to rely on photographs. The ombudsman concluded the proximate cause of damage was the deteriorated roof condition, not the storm.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website