Upheld: Home insurance claim disputes complaint against AXA Insurance UK Plc

Decision detail

Summary

Ms S claimed on her home buildings insurance for a failed macerator. AXA's initial call handler indicated the claim would likely be covered under accidental damage and advised Ms S to retain repair reports and estimates for cost validation. Ms S then arranged repairs without further investigation of the underlying cause. AXA subsequently declined the claim on grounds of wear and tear. The ombudsman found AXA's handler should have clearly explained that Ms S needed to demonstrate an insured cause before arranging repairs, and that this failure prejudiced her position. The ombudsman upheld the complaint and ordered AXA to settle the claim under accidental damage cover with interest and £100 compensation.

The Ombudsman's reasoning

The ombudsman found that while the exact cause of the macerator failure was unknown, AXA's claim handler should have clearly explained that Ms S needed to demonstrate the damage resulted from an insured event before arranging repairs. The handler's indication that the claim would likely be covered and focus on cost validation rather than cause of damage prejudiced Ms S's position. An insured cause (such as an object flushed down the toilet) could have applied but could no longer be investigated due to the motor's disposal. Therefore, AXA should settle the claim under accidental damage cover.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website