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ombudsman news

issue 115

January/February 2014

winter weather

Each winter, we usually see a steady number of cases involving bad weather and insurance claims. These often involve broken boilers and burst pipes, but we do see cases that involve extreme weather conditions – like storms or heavy snowfall.

Although the individual circumstances of these cases vary, similar issues come up each year and our approach is well established. You can find more information about our approach in the buildings insurance section of our online technical resource.

In the case studies that follow, we have included examples of situations where:

  • an insurer decided that damage to a building was caused by its age and poor condition – rather than by a storm;   
  • an insurer said that a storm had not been the main cause of damage to a greenhouse; and
  • a consumer complained that his claim involving a burst pipe was rejected on the grounds that the house was “unoccupied” in the period before the pipe burst.

Finally, although it’s more “seasonal” than weather-related, we have included a case study about a consumer who left her keys in her car while she got out to drop off a Christmas present. “Keys in car” cases like this tend to be associated with the winter months – when people are warming up their cars in the morning. But we do see cases like this throughout the year, so we have included a slightly different example to illustrate the issues that these cases raise.

You can find out more about our approach in the motor insurance: keys in car section of our online technical resource.

issue 115 index of case studies

  • 115/9 – consumer complains that insurer refused to pay claim for storm damage to their roof and belongings
  • 115/10 – consumer complains that insurer rejected claim for storm damage – on the grounds that the damage was caused by wear and tear
  • 115/11 – consumer complains that insurer rejected car theft claim – on the grounds that she left her car unattended
  • 115/12 – consumers complain that insurer rejected claim for snow damage to greenhouse – because timbers already had rot damage
  • 115/13 – consumer complains that insurer rejected his claim for a burst pipe
  • 115/14 – consumers complain that insurer refused to cover repair costs after pipe burst

115/9
consumer complains that insurer refused to pay claim for storm damage to their roof and belongings

Mr and Mrs A made a claim under their home insurance policy for storm damage. They said that “as a result of the recent storm and also the wet and stormy weather over the past few months”, water had been seeping into their home from the roof, causing damage to their decor and belongings.

Their insurer appointed a roofing specialist to inspect the roof and the reported damage. The specialist noted that new guttering had been installed quite recently – and that some of the roof tiles had been cut back so that the guttering would fit. In the specialist's view, it was this that had led – over time – to water starting to come through the roof.

On the basis of the specialist's report, the insurer turned down the couple’s claim. It told them that there was no evidence the damage had been caused by an “insured event” (in other words, by something that was covered under the policy).

Mr and Mrs A were very unhappy with this. They sent the insurer a letter from the contractor who had installed their new guttering. The contractor stated that this work “could not have caused or contributed to” the problem with the roof.

The insurer told Mr and Mrs A there was nothing in the contractor's letter that would make it to reconsider the claim. So they decided to come to us.

complaint not upheld

We explained to Mr and Mrs A that, as with any insurance, their policy only covered any loss or damage that was caused by a specific insured event – for example, storm, fire, theft and so on.

In this particular case, there was no dispute over the fact that there had been a storm shortly before the damage was reported. What we needed to decide was whether the insurer had acted reasonably when deciding that it was not the storm that had caused the damage.

After reviewing all the evidence, we concluded that it was unlikely that a one-off storm had caused the damage. Generally, any water damage caused by an identifiable storm tends to be confined to a specific area. In this case, the damage was more widespread.

We agreed with the insurer that the damage was more likely to have occurred gradually over time, as the result of general bad weather and perhaps also because of poor workmanship. And we noted that, when they made their claim, Mr and Mrs A had themselves said that the damage had been caused by the “wet and stormy weather over the past few months”.

We sympathised with Mr and Mrs A. They had thought that the damage would have been covered regardless of what had caused it. But in these circumstances, we did not uphold the complaint.

115/10
consumer complains that insurer rejected claim for storm damage – on the grounds that the damage was caused by wear and tear

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.

115/11
consumer complains that insurer rejected car theft claim – on the grounds that she left her car unattended

It was Christmas Eve and Miss L was running some last-minute errands in her car. She pulled up outside the newsagent where her nephew worked to drop off his present – leaving her car keys in the ignition and the engine running. While Miss L was inside the shop, a man drove away with her car.

After reporting the incident to the police, Miss L made a claim on her car insurance policy. However, the insurer refused to pay out. It said that a condition of the policy was that “you must do all you can to protect your car” – and in leaving her car outside the newsagent, Miss L had breached that condition. The policy also specifically excluded theft where a car had been left unattended with its keys inside.

Miss L disagreed with the insurer’s decision. She told them that she had taken steps to protect her car – parking it up on the pavement so it was off the main road and nearer to the newsagent. She said she had only been inside for a couple of minutes – and was keeping an eye on her car through the shop window. When the insurer insisted that Miss L had acted “recklessly”, she referred the matter to us – though her solicitor.

complaint not upheld

First of all, we asked to see a copy of the police report – to check Miss L’s account of events from the time. We saw that she had told the police that she had been in the newsagent for about two minutes – which was consistent with what she had told the insurer. We noted, however, that she had told the police that she hadn’t actually seen the man get into her car.

When we raised this point with Miss L’s solicitor, they accepted that she probably hadn’t kept her car under constant observation. However, they argued that when Miss L took out her insurance policy, the insurer should have specifically pointed out the “keys in car” exclusion. They referred to an issue of ombudsman news where we had made this point ourselves. And they told us that because Miss L’s insurer couldn’t prove they had highlighted the exclusion, we should uphold her complaint. 

But we explained that we would never automatically uphold a complaint without looking into the individual circumstances. The important issue in this case was whether Miss L would have acted any differently if the insurer had pointed out the exclusion.

We took the view that, in parking on the pavement and acknowledging the need to keep her car in view, Miss L had been aware of the risk that her car could be stolen.  And based on what we had seen and heard, we decided that – as she was busy running errands on Christmas Eve – Miss L would probably have delivered the present in exactly the same way, whether or not the exclusion had been highlighted.

We were sorry to hear that Miss L’s Christmas break had been taken up with dealing with the theft of her car. But we agreed with the insurer’s position, and we did not uphold the complaint.

115/12
consumers complain that insurer rejected claim for snow damage to greenhouse – because timbers already had rot damage

In late November – after three days of heavy snowfall – Mr and Mrs F woke up to find that their greenhouse had collapsed overnight. Mrs F phoned their insurer to make a claim on their buildings cover. Shortly afterwards, the insurer’s loss adjuster visited Mr and Mrs F’s home to inspect the damage.

A week later, the insurer told Mr and Mrs F that their claim had been declined. It said that the loss adjuster had found that the greenhouse had pre-existing rot damage – which she felt affected the integrity of its structure. On the basis of this evidence, the insurer had decided that the snowstorm had only exacerbated an existing problem – and that the greenhouse wouldn’t have collapsed if it had been in a good state of repair.

Mr and Mrs F complained to the insurer and asked it to reconsider. When it refused, the couple got in touch with us.

complaint upheld

We noted that the insurer accepted there had been a “snowstorm” – and that the greenhouse’s collapse would be covered by Mr and Mrs F’s policy as “storm damage”.  The point it was disputing – which we needed to look into – was whether the snowstorm had been the main cause of the damage.

Mr F told us that the loss adjuster said to him that “bad weather doesn’t make greenhouses collapse” – before she’d started her investigation. He said that she had stuck a knife into the greenhouse’s walls several times to find a piece of damp timber to back up her view.

We asked the insurer for a copy of the loss adjuster’s report. When we looked at the report, we found some inconsistencies. For example, the report said that it hadn’t been possible to inspect all four sides of the greenhouse – because the broken glass had made it unsafe to do so. But the report’s overall conclusion was that rot damage had been found in the timbers of all four walls.

The insurer also told us that, as well as the walls, the roof timbers of the greenhouse had been rotten before the snowfall. But according to the insurer’s own file notes, it was “hard to establish” whether the photographs the loss adjuster had taken actually showed the roof timbers at all. And the insurer couldn’t provide us with any other information about the condition of the roof.

The loss adjuster’s report was the only expert evidence available to us about the condition of the greenhouse. But we weren’t convinced that it was reliable. We also thought the condition of a building’s roof timbers would have a significant bearing on the likelihood of its collapsing under snow. And without anything to back up its view about the prior condition of Mr and Mrs F’s greenhouse roof, we didn’t think it was reasonable for the insurer to reject the claim on those grounds. 

We told the insurer to meet Mr and Mrs F’s claim, adding 8% interest on the settlement – and to pay Mr and Mrs F £150 for the inconvenience it had caused them.

115/13
consumer complains that insurer rejected his claim for a burst pipe

Although Mr F owned his own house, he had started spending more time at his partner’s house. While he was away from home, one of the pipes froze and subsequently burst – which cause extensive damage to the house and to Mr F’s belongings. He called his insurer to tell them what had happened, and to make a claim.

The insurer sent a loss adjuster round to Mr F’s house to assess the damage – and to find out more about what had happened. The loss adjuster spoke to Mr F about his circumstances and tried to find how often Mr F actually lived in the property. According to the loss adjuster, Mr F said that he was spending roughly three nights each week at home, and the other four at his partner’s house. He said that this could be backed up by his neighbours. Mr F also said that he turned off the heating when he wasn’t at the property.

But when the loss adjuster spoke to Mr F’s neighbours, one said that the house had been unoccupied for some time. The other said that the house wasn’t wholly unoccupied, but that Mr F certainly wasn’t there three days a week.

The loss adjuster also asked for utilities bills for the period leading up to the pipe bursting. When he saw the bills, he thought they were low – suggesting that the property hadn’t been used.

When the loss adjuster reported this to the insurer, they turned down the claim on the grounds that it was likely the property had been unoccupied for over 60 days – the limit set out in Mr F’s policy.

Mr F was unhappy with the insurer’s decision, and he complained. But when the insurer refused to reconsider, Mr F got in touch with us.

complaint upheld

When we asked Mr F to tell us about what had happened, we noted that some of the things he said were different from the information that the loss adjuster had given to the insurer. For example, Mr F said that he hadn’t told the loss adjuster that he lived in the house, but that he had stayed there occasionally, and that his partner’s children sometimes stayed there too. He said that he went home regularly to collect the post.

He also told us that one of his neighbours bore him a grudge, and said that this was why the loss adjuster might have been told that the house was “unoccupied”. He also said that just because the utility bills were low didn’t mean that he was never at the house.

When we looked at the utility bills that the insurer had used, we found that they were taken from meter readings from mid-summer to mid-autumn. We noted that energy use from this period would have been lower than during the period in question – which was during the winter. But even so, we thought that the fact that there had been small balances to pay on gas and electricity showed that there had been some activity at the house.

We also noted that there were no names or signatures to back up Mr F’s neighbours’ statements.

Taking everything into account, we weren’t satisfied that the insurer had enough evidence to show that Mr F’s house had been “unoccupied” during the 60-day period before the pipe had burst. So we told the insurer to reconsider the claim.

115/14
consumers complain that insurer refused to cover repair costs after pipe burst

Mr and Mrs B owned a house that they let out to tenants. When their tenants’ contract was over – in November – Mr and Mrs B arranged for decorators to do some work on the house, and for their lettings agents to come and make sure that everything was in order for the new tenants.

Ten days after the decorators had finished working at the house, a neighbour called Mrs B to tell her that she could hear running water. Mrs B went straight over to the house, and she found water everywhere. She rang a plumber, who came round to the house that morning. The plumber told Mrs B that a pipe had burst. Mr B called their home insurer to let them know what had happened, and to make a claim.

The insurer investigated the claim. They wrote to Mr and Mrs B, saying that the burst pipe was “an uninsured event”. They explained that the couple’s claim could not be met because the house had been “unoccupied, untenanted or not having been actively used” for the 20 days leading up to the leak.

Mr and Mrs B complained to the insurer. They said they agreed that the house had been “unoccupied” and “untenanted”. But they said that it had been “actively used”. They pointed out that the decorators had been busy in the house in the days before the pipe had burst.

Mr and Mrs B said they thought the three conditions of “unoccupied, untenanted or not having been actively used” were exclusive – that is, as long as one was untrue then the claim should be met. But the insurer said that it only required one of the three conditions to be true for it to turn down a claim.

Unable to reach an agreement with their insurer, Mr and Mrs B brought the matter to us.

complaint not upheld

We checked what had happened and when – to make sure that both parties agreed on the timeline. We established that the previous tenants had left the house on 28 November, and that the decorators and the lettings agent had been in the property – on and off – up to 12 December.

We noted that Mrs B had been alerted to the problem by a neighbour on 22 December. So at least 20 days had passed between the tenant leaving the house and the pipe bursting.

Mr and Mrs B and the insurer agreed that the house had been “unoccupied and untenanted”. But they disagreed about whether the house had been “actively used”. We decided that a fair interpretation of this would be “not idle” – and we took the view that the decorating work being carried out meant that the house was “not idle” for the 20 days leading up to the pipe bursting. So we could understand why Mr and Mrs B thought their claim should be paid.

However, we had to decide whose interpretation of the clause in the policy – that is, “unoccupied, untenanted or not having been actively used” – was the right one. Mr and Mrs B thought that if any of the three terms in the clause were untrue the claim should be met. The insurer said the clause is intended to mean the opposite – that if any of the three terms were true, they could turn down the claim.

We decided that the clause should be interpreted to mean that if any of the terms were true, the insurer would have grounds to turn down a claim. In this case, there was no disagreement over whether the house had been “unoccupied” and “untenanted” – so we thought the insurer had applied the policy term correctly.

We could understand why Mr and Mrs B were so disappointed, but we thought the insurer had acted fairly in the circumstances of their case.

image: ombudsman news

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.