Not upheld: claim declined - insufficient evidence of cause of damage complaint against AXA Insurance UK Plc

Decision detail

Summary

Mr and Mrs P claimed under their commercial insurance policy for damage to a conservatory roof at their rental property, speculating that a falling object had caused a hole. AXA declined the claim after its contractor found no evidence of impact, fragments, or debris, and concluded the polycarbonate roof showed age-related embrittlement with wind movement as a probable cause. The ombudsman upheld AXA's decision, finding that Mr and Mrs P had not established on the balance of probabilities that the damage was caused by an insured peril, and that the physical evidence supported AXA's alternative explanation. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman applied the general insurance principle that the claimant must establish their claim on the balance of probabilities. The policy covered accidental damage (limited to specific items), malicious damage, and damage from falling objects. The accidental damage cover did not extend to polycarbonate roof panels. There was insufficient evidence that the tenants deliberately damaged the roof. Regarding falling objects, AXA's inspection found no evidence of impact from a falling object, and the physical evidence suggested age-related embrittlement and wind movement as more probable causes. The claimants could only speculate about the cause and could not prove it was a falling object on the balance of probabilities.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website