Upheld: claim decline, policy avoidance, alleged misrepresentation complaint against Hiscox Insurance Company Limited
Financial Ombudsman decision DRN-6370066 of 2026-05-19T00:00:00+00:00. claim decline, policy avoidance, alleged misrepresentation complaint against Hiscox Insurance Company Limited. Outcome: Upheld.
Decision detail
| Reference | DRN-6370066 |
|---|---|
| Decision date | 2026-05-19T00:00:00+00:00 |
| Firm | Hiscox Insurance Company Limited |
| Product | buildings and contents insurance |
| Claim type | claim decline, policy avoidance, alleged misrepresentation |
| Outcome | Upheld |
| Remedy | Hiscox must: (1) reconsider the claim; (2) revoke the request for trace and access costs and refund if already paid with 8% simple interest; (3) remove cancellation/avoidance records from all databases; (4) pay £700 for distress and inconvenience; (5) calculate what Hiscox would have insured Ms R for in August 2024 and August 2025 and refund any premium overpayment with 8% simple interest. |
Summary
Ms R held a buildings and contents insurance policy with Hiscox and submitted a claim following an escape of water. Hiscox declined the claim and avoided the policy, alleging Ms R had misrepresented information about occupancy duration and building works costs at point of sale. The ombudsman found that the questions asked were not clearly defined and that Ms R's answers were reasonable based on information available to her at the time of the phone sale. Although Ms R should have notified Hiscox when she exceeded the 90-day occupancy period stated in the policy, the ombudsman determined that by the time of the loss, full cover would have been reinstated as the external building works were complete. Accordingly, the complaint was upheld and Hiscox was directed to reconsider the claim, remove avoidance records, pay £700 compensation, and refund any insurance premium overpayments.
The Ombudsman's reasoning
The ombudsman applied The Consumer Insurance (Disclosure and Representations) Act 2012 (CIDRA), which requires consumers to take reasonable care not to misrepresent information. For a qualifying misrepresentation, the insurer must show it would have offered the policy on different terms or not at all. The ombudsman found that: (1) regarding the 90-day occupancy question, there was no evidence Ms R knew at point of sale she would be out longer than 90 days, as she anticipated eight weeks of building work; (2) regarding building works costs, the question was not clearly defined and Ms R's £75,000 estimate based on BCIS data for the extension alone was reasonable and not incorrect. The ombudsman concluded no misrepresentation occurred at point of sale. Regarding the policy period, while Ms R should have notified Hiscox after exceeding 90 days occupancy, by the time she returned to the property and the leak occurred, the external works were complete and full cover would have been reinstated. Therefore, Hiscox acted unfairly in declining the claim.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Hiscox Insurance Company Limited, all decisions | 222 | 21% |
Source
Read the original decision on the Financial Ombudsman Service website