Not upheld: claim decline - gradual causes exclusion complaint against Admiral Insurance (Gibraltar) Limited

Decision detail

Summary

Mr and Mrs N claimed on their home insurance policy with Admiral for external roof damage and internal water damage following storm Eowyn in January 2025. Admiral declined the claim citing gradual causes rather than storm damage. The ombudsman applied the FOS three-part test for storm damage and found that while storm conditions did occur, the evidence showed the roof had pre-existing moisture damage and deterioration. The timber exhibited inconsistent colouring suggesting prolonged moisture exposure, there was evidence of historic repairs, water pooling, and a 2020 survey had noted the roof's limited lifespan and prior leak issues. The ombudsman concluded the proximate cause was gradual deterioration, not the storm event, and therefore Admiral fairly declined the claim.

The Ombudsman's reasoning

The ombudsman applied the FOS three-part test for storm damage claims. While storm conditions did occur and the external damage was consistent with storm damage, the crucial third question was whether the storm was the proximate (dominant, effective, efficient) cause. The ombudsman found that the timber showed signs of moisture exposure inconsistent with only the small volume of rain that fell around the loss date. The inconsistent colouring of timber, evidence of historic repairs, water pooling, and the 2020 survey noting the roof's limited lifespan and prior leak issues all supported that the roof had pre-existing deterioration. The ombudsman concluded that a well-maintained roof would have withstood the wind damage, therefore the proximate cause was gradual deterioration over time rather than the one-off storm event. This also fairly supported declining the internal water damage claim.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website