Upheld: Travel / life insurance claim disputes complaint against AXA Insurance UK Plc

Decision detail

Summary

A limited company (5) complained that AXA Insurance UK Plc unfairly declined a buildings insurance claim for water ingress causing internal wall damp. AXA's loss adjuster concluded the damage was caused by either roof problems or render failure (wear and tear) and declined the claim. The ombudsman found that 5 holds an 'all-risks' policy requiring only proof of damage, not a specified insured peril, and that AXA failed to provide persuasive evidence that exclusions applied. The loss adjuster's investigation was brief and inconclusive, identifying render failure only as 'possible' and providing no roof inspection evidence. The ombudsman upheld the complaint, requiring AXA to establish the cause of water ingress, reassess the claim fairly, and pay £150 compensation for inconvenience.

The Ombudsman's reasoning

The ombudsman found that 5 holds an 'all-risks' policy, not an 'insured perils' policy. Under an all-risks policy, the policyholder only needs to show damage has occurred; the insurer must then prove an exclusion applies. Water ingress causing internal wall damage constitutes covered damage. AXA's evidence for the wear and tear exclusion was insufficient: the loss adjuster's notes were brief, identified render failure only as 'possible' rather than proven, provided no roof inspection evidence, and the render photograph did not conclusively show significant wear and tear. Until the cause of water ingress is established, AXA cannot fairly apply the wear and tear exclusion. The internal damage must be reassessed as part of the overall claim.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website