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ombudsman news

issue 107

January/February 2013

bad weather

Each year, we see a steady number of cases that involve bad weather and insurance claims. As well as complaints involving storm damage and flooding, we also see issues with home emergency cover for things like broken boilers and burst pipes. And after particularly harsh winters, we sometimes see cases about damage caused by extreme cold or heavy snowfall.

Our approach to cases involving flooding is well established (for a detailed explanation, please see the flooding section of our online technical resource).

Most buildings insurance policies cover financial loss caused by storm damage. The cases we see often centre on what actually constitutes a "storm". In our view, a storm usually involves violent winds, sometimes accompanied by heavy rain, hail or snow. But we do also see situations where a property has been "storm damaged" even though there hasn't been a particularly strong wind - but where there has been, for example, heavy snowfall.

The case studies that follow focus on some of the more common situations that we see, including:

  • disputes between consumers and insurers about the root cause of damage to property;
  • a consumer unhappy about the quality of repairs carried out on behalf of their insurer; and
  • a consumer unhappy that their insurer took too long to get their property repaired.

issue 107 index of case studies

  • 107/1 - insurer rejects claim because damage was caused by poor workmanship
  • 107/2 - insurer refused to pay for repairs needed because of poor workmanship by its contractor
  • 107/3 - insurer rejected claim because damage "wasn't caused by a storm"
  • 107/4 - consumer complains that insurer's delay meant he had to move out for longer than necessary
  • 107/5 - consumer complains her insurer turned down her claim about a leaking garage
  • 107/6 - insurer rejects claim for storm damage because there was "no identifiable storm"

107/1
insurer rejects claim because damage was caused by poor workmanship

After heavy snowfall, Mr and Mrs P noticed that water had come through to their ceiling from their flat felt roof. They contacted their insurer to make a claim for the damage to the ceiling and the roof.

A few days later, a loss adjuster came to inspect Mr and Mrs P's roof. A couple of days after that, the insurer phoned Mr and Mrs P to tell them that it wasn't prepared to pay for any of the damage to be repaired. The insurer said that the damage was not covered under their policy because it had been caused by "poor workmanship" in the way the roof had been constructed and sealed. The insurer pointed out that Mr and Mrs P's policy said "You are not covered under your policy for any loss or damage caused by or resulting from poor workmanship, poor design or faulty materials".

Mr and Mrs P complained to their insurer. They said they hadn't been kept fully up to date about when the loss adjuster was coming. And when he did arrive, they didn't think he had inspected the roof properly. They also said the roof was only a year old and that they hadn't had any problems with it before - so the water must have leaked through the roof because of the weight of the snow.

The insurer rejected their complaint, and Mr and Mrs P brought the matter to us.

complaint not upheld
We listened to everything that Mr and Mrs P and the insurer told us, and we asked them to send us any evidence they had to support what they were saying.

We looked at the loss adjuster's report and at the photos he had taken. Although Mr and Mrs P didn't think the loss adjuster had inspected the roof properly, the photos were good quality and we were satisfied that they showed he had carried out a reasonable inspection of the roof.

We also looked at records that showed that the insurer had been in contact about the loss adjuster's visit.

We checked the loss adjuster's experience of assessing this type of damage - and we were satisfied that he had the relevant experience for this kind of work.

We noted that Mr and Mrs P's flat roof had only been a year old when the leak had happened, so we would have expected it to still have been watertight at this stage.

We concluded that the damage was likely to have been caused because the roof had not been fitted properly in the first place. This was a workmanship issue which was not covered under Mr and Mrs P's policy.

We explained to Mr and Mrs P that their insurer was not responsible for anything that could go wrong with their roof. We also explained that our job was to look at whether the insurer had been right to decide that their claim was not covered by their policy. We had concluded that the insurer had acted fairly in turning down their claim.

But we did appreciate that the couple were dissatisfied with the quality of the roof - especially as it was only a year old. So we suggested that they get in touch with the builder who had constructed the roof to discuss what had happened - and to ask them to look into it.

107/2
insurer refused to pay for repairs needed because of poor workmanship by its contractor

During torrential rain, the river near Mr and Mrs F's house burst its banks. Unfortunately, their house was flooded. Mr and Mrs F contacted their insurer and made a claim for the repairs. The insurer accepted the claim and the repair works were carried out - apparently without any problems.

The following winter, Mr and Mrs F noticed that their house felt damp and draughty. They contacted their insurer again and said they were concerned about the quality of the flood repairs. The insurer said that Mr and Mrs F had chosen the contractors themselves - and that it had just paid for the repairs. So the insurer wouldn't accept responsibility for any problems arising from poor workmanship.

Unhappy with this response, Mr and Mrs F made a complaint. But the insurer said it had no record of ever having hired the contractors who had carried out the work. And it told Mr and Mrs F that it still wasn't prepared to pay for any additional repair work.

Mr and Mrs F were certain that their insurer had chosen and instructed the contractors. So they referred their dispute to us.

complaint upheld
Mr and Mrs F's insurance policy only covered them for the cost of repairing damage caused by an "insured event" - for example, storm damage. It did not cover problems arising from poor workmanship. But we took the view that if the insurer had hired a contractor who had done a bad job, Mr and Mrs F should not have to pay to sort it out. We looked at all the paperwork from the claim and we found that although the insurer itself hadn't hired the contractor, it had let its third-party claims-handling company decide who should be hired to do the repair work.

We couldn't find any evidence to show Mr and Mrs F had any say in this. But we did see correspondence between the claims-handling company and the contractor confirming arrangements for the work.

All this led us to conclude that it had been the insurer's decision to instruct the claims-handling company to do work on its behalf - including the decision on hiring the contractor. So we decided that the insurer was responsible for the consequences of any decisions made by the claims handler. But the insurer had refused to accept any responsibility for problems arising from poor workmanship. We told the insurer to pay for a survey to inspect the damage - and to pay for any repairs that were needed to put things right.

107/3
insurer rejected claim because damage "wasn't caused by a storm"

Mr B lived near the coast. After severe rain, his roof was damaged and he noticed water coming into the extension on his house. Mr B was concerned that his roof might need to be replaced, so he phoned his insurer to get some advice on what to do next.

The person he spoke to took all his details. Shortly afterwards, the insurer wrote to Mr B to tell him that it was rejecting his claim. It said there hadn't been a storm in the local area - and that because the roof was old, the damage was more likely to have been caused by wear and tear than by a storm.

Mr B complained to his insurer. He said he had maintained the roof well - and that he had only noticed the leak after exceptionally wet weather. Mr B asked the insurer to reconsider its position.

When the insurer wouldn't change its position, Mr B brought his case to us.

complaint upheld
When we looked at the evidence, we noted that the weather reports the insurer had used actually related to a period several weeks before the time Mr B had said the roof had been damaged.

But we still needed to establish whether there had been a storm on the date Mr B had given to the insurer. So we looked at the local weather reports for his area. The reports said there was a "wind storm locally". We also took into account the fact that the weather readings had been taken inland, and that the weather conditions by the coast can be worse than those further inland.

So we decided the weather probably had been severe enough to be considered a single storm - and to have caused the damage to Mr B's roof.

In these circumstances, we told the insurer to consider Mr B's claim in line with the terms of his policy.

107/4
consumer complains that insurer's delay meant he had to move out for longer than necessary

Just before Christmas, Mr E's house was damaged by flooding. He was left without running water, heating and electricity. Mr E phoned his insurer on his mobile to let them know what had happened - and to get some advice on what to do next.

The insurer arranged to phone Mr E back the next day. But nobody phoned him, and he had to ring them himself.

Mr E went to stay with relatives over the Christmas and New Year period. But to be nearer to work - and to his own damaged property - he had to move back to the area. So he moved into a local B&B.

In late January, the insurer sent a contractor to start the drying-out work on Mr E's house. When the contractor arrived, he did not have the right equipment with him.

He came back in mid-February, and Mr E was told it would take six to eight weeks for the house to be dried out completely. Over the next few months there were more delays to the repair work. Mr E had to ring his insurer several times to find out what was happening - and to ask it to send someone to keep working on the repairs.

Mr E finally moved back into his house in July. When he looked back on what had happened, he decided to make a complaint. He told his insurer he wasn't happy with how it had handled his claim - or how long it had taken to arrange repairs to his house.

The insurer agreed that it hadn't handled Mr E's claim well - and it offered to pay him £500. But Mr E felt £500 was not enough. He pointed out that his house had been without running water, heating and electricity for many months, and that he had needed to live in a B&B.

When the insurer refused to reconsider its offer, Mr E referred his case to us.

complaint upheld
We looked at the evidence sent to us by the insurer and by Mr E. We found that Mr E had needed to chase up the insurer several times to find out what was going on and how the repairs were progressing. This had happened repeatedly over the seven-month period.

In cases like this, we have to decide how much of the time was justifiably taken up by the drying out process - which we appreciate can take several weeks - and whether the situation had been exacerbated by delays and unsatisfactory explanations to the consumer. In this case, we decided that the insurer had taken far longer than it should have done to help Mr E - and that the delays had lengthened the whole process by about two months.

In addition to covering Mr E's accommodation costs, we told the insurer to put things right by paying him £1,200 compensation for the inconvenience it had caused him.

107/5
consumer complains her insurer turned down her claim about a leaking garage

After a winter of bad weather, Mrs R noticed a large pool of water on the floor at the back of her garage. The roof looked fine, and she couldn't see how it could have come through the garage door. Mrs R could only assume that the water had somehow come up through the floor - and she was worried that the foundations of her garage had somehow become waterlogged.

She phoned her insurer and told them what had happened. And she asked them to send someone to sort the problem out. The insurer sent out its loss adjuster to assess the situation. On the basis of his report, the insurer turned down Mrs R's claim. It said that the pool of water had not been caused by an "insured event". It also said there was no damage to the building itself - so there was actually nothing to repair under the policy. Mrs R complained to the insurer. She said she couldn't understand why the insurer wouldn't accept that there was a problem. The insurer refused to change its decision, so Mrs R brought her case to us.

complaint not upheld
We explained to Mrs R that an insurance policy only covers the events specified in the policy - and that for an insurer to accept a claim, it has to be satisfied that damage has been caused by one of those events. We looked carefully at Mrs R's policy documents to see what she was covered for. We noted that the "escape of water" section covered damage caused by "water escaping from a fixed installation" - like guttering or drains.

Mrs R had said that the damage to her garage had been caused by severe weather conditions - so we did not think that the "escape of water" section of the policy was relevant in this situation.

We also looked at whether Mrs R might have been able to make a claim for storm or flood damage. We considered whether there were storm or flood conditions leading up to when Mrs R noticed the pool of water in the garage.

We looked at the weather reports for the local area. Although there had been some rainfall, there hadn't been any flooding or conditions that could be considered a storm.

And we did not think that the pool of water itself could be considered a flood. We didn't know what had caused the pool of water to appear in Mrs R's garage - and nor did her insurer.

But we appreciated that Mrs R was concerned. So we suggested that she contact a surveyor to come and inspect her garage. If it turned out that there was damage, we told Mrs R that she might be able to pursue it with her insurer. We did not uphold the complaint.

107/6
insurer rejects claim for storm damage because there was "no identifiable storm"

After a very wet autumn, Ms B's flat roof started leaking water into her kitchen. She told the insurer that her roof had been damaged by a storm, and that she wanted to make a claim for the damage that had been caused by the water. Ms B's insurer sent their loss adjuster to her house to assess the damage.

When the insurer reviewed the loss adjuster's report, it decided to turn down Ms B's claim. It made its decision on the basis that the damage could not have been caused by a storm - because there hadn't actually been a storm on the date Ms B had told them about. Its investigations had shown that the roof was old, and that the damage had been caused by wear and tear. But the insurer didn't get in touch with Ms B to let her know about its decision.

Ms B phoned her insurer a number of times to find out what was happening with her claim. Although she had several conversations with people on the insurer's helpline, it took her two months to find out that her claim had been turned down.

Ms B complained to the insurer. She said it had made a mistake when it had noted down the date of the storm. She insisted there had been a storm on the date she had given them, and that this had damaged her roof and some of her cupboards and appliances.

She also pointed out that she had waited two months to find out about the insurer's decision. The insurer didn't agree to pay for the damage, but it did offer to pay Ms B £75 compensation for the inconvenience she had been caused by its poor customer service. Ms B was unhappy with the insurer's decision. Rather than accepting its offer, she decided to bring her case to us.

complaint not upheld
When we reviewed Ms B's insurance policy documents, we found that she was covered for "financial loss caused by storm damage". So we needed to decide whether the damage to Ms B's roof had been caused by a storm - and not just by prolonged bad weather or by general wear and tear to the roof.

We needed to establish the exact point at which Ms B's kitchen had been damaged. So we listened to recordings of the conversations between Ms B and her insurer, and we concluded that the damage was likely to have occurred in early December. Next, we looked at the local weather reports for the relevant week in December.

The reports showed there had been heavy rainfall. But we take the view that a storm usually involves violent winds, often with rain, hail or snow. In this case, the rainfall had not been particularly heavy and there had only been a light wind - so we concluded that there had not been a storm locally during that week.

We checked Ms B's policy to see whether it included cover for accidental damage, but it did not.

In these circumstances, we concluded that the insurer had acted fairly in turning down Ms B's claim. While we sympathised with her situation, we concluded that the wet weather had brought to light existing problems with her roof - and so the damage wasn't covered under her policy. And we thought the insurer's offer of £75 was fair compensation for the poor customer service she had received.

image: ombudsman news issue 107

ombudsman news gives general information on the position at the date of publication. It is not a definitive statement of the law, our approach or our procedure.

The illustrative case studies are based broadly on real-life cases, but are not precedents. Individual cases are decided on their own facts.