Upheld: unfair claim decline - insufficient evidence of exclusion complaint against AXA Insurance UK Plc
Financial Ombudsman decision DRN-6392855 of 2026-05-29T00:00:00+00:00. unfair claim decline - insufficient evidence of exclusion complaint against AXA Insurance UK Plc. Outcome: Upheld.
Decision detail
| Reference | DRN-6392855 |
|---|---|
| Decision date | 2026-05-29T00:00:00+00:00 |
| Firm | AXA Insurance UK Plc |
| Product | Home insurance |
| Claim type | unfair claim decline - insufficient evidence of exclusion |
| Outcome | Upheld |
| Remedy | AXA Insurance UK Plc must: (1) Reimburse Mr L the costs incurred to repair the garage door, less any applicable policy excess; (2) Pay 8% simple interest on this sum from the date Mr L paid it to the date of settlement; (3) Pay Mr L £250 to recognise the distress and inconvenience caused by the unfair claim decline and the extended period the matter remained outstanding. |
Summary
Mr and Mrs L complained that AXA unfairly declined their buildings insurance claim for storm damage to their garage door in December 2024. AXA's surveyor concluded the damage was caused by natural breakdown of materials rather than the storm. The ombudsman upheld the complaint, finding that while a storm meeting the policy definition occurred and the damage was typical of storm damage, AXA failed to adequately prove that wear and tear was the main cause. The expert opinion lacked sufficient explanation and supporting detail about the characteristics indicating wear and tear. AXA was directed to reimburse repair costs plus interest and pay £250 compensation for distress and inconvenience.
The Ombudsman's reasoning
The ombudsman applied the three-question test for storm damage claims: (1) was there a storm - yes, wind speeds of 51-63 mph met the policy definition; (2) is the damage typical of storm damage - yes, a garage door and frame forced away from fixings is consistent with high winds; (3) is the storm the main cause - no, AXA failed to adequately demonstrate this. The expert opinion was insufficiently explained, lacking detail about what features indicated wear and tear or long-term deterioration. While the expert mentioned dents and a bent gear mechanism, they provided no supporting commentary explaining how these characteristics showed wear and tear was the main cause, nor did they explain other damage such as guide rails and sensors. AXA bore the burden of proving wear and tear was the main cause to justify declining the claim under the exclusion, and failed to meet this burden.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| AXA Insurance UK Plc, all decisions | 3,723 | 35% |
| Home insurance, all decisions | 21,293 | 38% |
Source
Read the original decision on the Financial Ombudsman Service website