Upheld: unfair claim decline; unreasonable delay in claim investigation; failure to conduct adequate inspection complaint against UK Insurance Limited
Financial Ombudsman decision DRN-6394983 of 2026-06-03T00:00:00+00:00. unfair claim decline; unreasonable delay in claim investigation; failure to conduct adequate inspection complaint against UK Insurance Limited. Outcome: Upheld.
Decision detail
| Reference | DRN-6394983 |
|---|---|
| Decision date | 2026-06-03T00:00:00+00:00 |
| Firm | UK Insurance Limited |
| Product | Home insurance |
| Claim type | unfair claim decline; unreasonable delay in claim investigation; failure to conduct adequate inspection |
| Outcome | Upheld |
| Remedy | UKI must reimburse C for all repair costs relating to the storm damage upon receipt of receipts, together with 8% simple interest per year from the date C paid the costs to the date of settlement. UKI must provide a certificate showing any taxation deducted. UKI must pay an additional £500 compensation for inconvenience caused by the avoidable 10-month delay. UKI must assess the damage to the wood chip underlay once the area is fully dry to determine whether it is attributable to UKI's delays and take appropriate steps to resolve any such damage. |
Summary
C, a limited company, claimed under its commercial property insurance policy for water ingress damage following a storm in December 2023. UKI declined the claim based on investigations by appointed contractors who identified multiple roof defects but no single obvious cause. The ombudsman found UKI's decision unfair because: (1) storm conditions clearly occurred with wind speeds of 56-58mph; (2) the damage was consistent with storm damage; and (3) the storm was the main cause, as evidenced by Mr T's contractor's detailed investigation showing that wind-induced movement of the glass balustrade had dislodged coping stones and destroyed the mortar seal. The ombudsman also found UKI acted unreasonably by taking 10 months to conduct an on-site inspection, maintaining for that period that Mr T must prove causation, and failing to support Mr T despite his documented difficulties finding a contractor in a remote island location. UKI was ordered to reimburse repair costs with interest and pay £500 additional compensation.
The Ombudsman's reasoning
The ombudsman applied the three-question test for storm damage claims: (1) Did storm conditions occur? Yes - wind speeds of 56-58mph with severe gale force gusts were recorded. (2) Is the damage consistent with typical storm damage? Yes - water ingress following high winds is consistent with storm damage. (3) Was the storm the main cause? Yes - the ombudsman found the loss adjuster's desktop assessment unreliable and placed greater weight on Mr T's contractor's detailed investigation, which identified that movement of the glass balustrade due to high winds had dislodged coping stones and destroyed the mortar seal, allowing water penetration. The ombudsman also found UKI acted unreasonably by: (a) maintaining for 10 months that it was Mr T's responsibility to prove the cause rather than conducting their own inspection; (b) taking 10 months to appoint a contractor for an on-site visit despite knowing a desktop assessment was insufficient; (c) relying on a breach of the roof inspection condition without demonstrating it was material to the loss; and (d) failing to support Mr T despite his documented difficulties in finding a contractor in a remote location.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| UK Insurance Limited, all decisions | 3,730 | 33% |
| Home insurance, all decisions | 21,293 | 38% |
Source
Read the original decision on the Financial Ombudsman Service website