Not upheld: claim decline - interpretation of accidental damage exclusion complaint against HCC International Insurance Company Plc

Decision detail

Summary

Mr and Mrs T claimed for damage to tiles and flooring in their home that occurred while they were on holiday in summer 2024. HCC initially declined the entire claim but later agreed to cover the flooring damage as accidental while continuing to decline cover for the damaged tiles, attributing the tile loss to de-bonding of adhesive. The FOS investigator upheld the complaint, but the ombudsman's final decision did not uphold it. The ombudsman concluded that the tile damage was most likely caused by gradual debonding from environmental factors (such as sunlight exposure) over time, constituting wear and tear rather than accidental damage, and therefore HCC's partial claim decline was fair and reasonable under the policy terms.

The Ombudsman's reasoning

The ombudsman applied the balance of probabilities standard and carefully considered the loss adjuster's professional report. Although the loss adjuster recommended acceptance of the claim, the ombudsman found that the factual findings supported a conclusion that the tiles were dislodged due to gradual debonding from environmental factors (such as sunlight exposure) over time, which constitutes wear and tear rather than sudden accidental damage. The policy definition of 'Accidental Damage' explicitly excludes damage caused by wear and tear. The ombudsman concluded that HCC's interpretation of the policy was fair and reasonable, particularly given that HCC had already accepted the flooring damage as accidental. The absence of prior warning or visible signs of failure does not preclude wear and tear as the underlying cause.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website