Not upheld: claim declined - alleged misrepresentation of risk and causation dispute complaint against Great Lakes Insurance UK Limited

Decision detail

Summary

Mr L claimed on his commercial property insurance policy with Great Lakes following water damage he attributed to a storm. Great Lakes declined the claim, arguing the damage was not caused by a storm and had occurred gradually over time due to wear, not as a sudden accidental event. An Investigator recommended partial upheld status, suggesting interior damage should be covered proportionately. The Ombudsman issued a provisional decision agreeing with Great Lakes that the damage occurred gradually over time through a deteriorating roof, not as a sudden event, and therefore was not covered under the policy's accidental damage clause. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman agreed with Great Lakes that the damage was not caused by a sudden storm event meeting the policy definition, and that the water damage to the interior must have occurred gradually over time through the damaged roof, rather than as a single accidental event. The extent of damage across multiple floors and the structural impact (ceiling collapse) indicated sustained water ingress over time, not a sudden unforeseen event. The policy specifically excludes gradual wear, and the loss adjuster's report reasonably supported this conclusion.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website