Consumer’s boiler stops working but insurer disagrees that it’s an emergency

Freda contacted her home emergency insurer when her boiler stopped working. She had no hot water or heating. She is 87 and lives on her own.

Her insurer's engineer found the problem was caused by a frozen external overflow pipe. He told her to throw hot water out of her window onto the pipe. Freda told him she couldn’t do this because of her arthritis. He said he couldn’t help because the claim wasn’t covered. He told her to get someone else to help.  

Freda complained to her insurer about the poor service she’d had from the engineer. She thought the engineer could have helped her. She had to get a neighbour to help instead, a couple of days later. She was without heating or hot water in the meantime.  

The insurer said the claim wasn’t covered under Freda’s policy. They said that the policy defined an emergency as ‘sudden and unexpected’. They said the damage to the pipe wasn’t sudden or unexpected. They said this because the pipe wasn’t insulated and the damage would have happened anyway. 

Unhappy with the insurer’s response, Freda contacted our service to investigate her complaint. 

We looked at the policy terms. We acknowledged the definition of emergency, but we disagreed with the insurer. We thought that the boiler stopping working was an emergency, because it was sudden and unexpected for Freda. We didn’t think it was reasonable to expect her to know that the frozen pipe had caused the problem, as this hadn’t happened to her before. 

We also looked at Freda’s individual circumstances. We noted that the fix was simple for someone to do on their own, but that Freda was elderly and lived alone. We felt it would have been reasonable for the engineer to fix the problem. 

We were satisfied that the insurer was wrong to reject the claim. We also felt that leaving Freda to sort the problem herself was poor customer service. We told the insurer to pay Freda compensation for the distress and inconvenience this had caused.