Not upheld: claim decline - failure to demonstrate covered loss complaint against Accredited Insurance (Europe) Ltd

Decision detail

Summary

Mrs L claimed under her home insurance policy for damage to an underground pipe that collapsed and caused sewage flooding in her kitchen in January 2026. Accredited declined the claim, stating the damage was not caused by something external and identifiable as required by the policy's accidental damage definition. Mrs L complained, arguing Accredited had not properly investigated whether neighbouring demolition and construction work caused the damage and that the claim decline lacked fair causation analysis. The ombudsman found the claim decline was reasonable as neither engineer report identified an external and identifiable cause, and the onus was on Mrs L to demonstrate a covered loss. The ombudsman did not uphold the complaint, finding no compensation was warranted despite minor service delays and unclear communication.

The Ombudsman's reasoning

The ombudsman found that under the policy definition, accidental damage must be caused by something external and identifiable. The onus was on Mrs L to demonstrate the damage was covered. Neither engineer report identified an external and identifiable cause, and Accredited's expert engineer found no evidence of accidental damage. While Mrs L speculated about neighbour's construction work, she provided no persuasive evidence this caused the damage. Accredited did not rely on an exclusion but rather concluded Mrs L had not demonstrated a covered loss. The minor service failures (delayed update and unclear communication) did not warrant compensation as the claim decline itself was reasonable.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website