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ombudsman news

issue 83

February/March 2010

insurance complaints concerning domestic plumbing and heating emergencies

The household insurance disputes referred to us include a significant number of claims involving domestic plumbing and heating emergencies. Such problems frequently result in a considerable amount of distress and inconvenience for the consumers concerned. This can be greatly increased if the insurer - or its contractor - fails to take swift and effective action, particularly if the emergency arises during the winter months. In such instances, problems involving a lack of heating or the escape of water can quickly have damaging knock-on effects.

Many insurers respond promptly and sympathetically to claims involving domestic emergencies. However, the cases we see suggest that some insurers fail to appreciate the extent to which delays on their part can create real difficulties for consumers. These case studies represent some of the complaints referred to us over the past year where consumers have said that a slow or inadequate response by the insurer, or its contractors, has caused additional distress and inconvenience.

83/06
consumer complains about the handling of her claim under her gas boiler breakdown insurance policy

Mrs G complained to her insurer about the way in which it had dealt with her claim after her gas central heating boiler stopped working properly. She said that delays and poor service had caused an 'unacceptable level
of inconvenience
'.

She had first contacted the insurer after having to shut down the central heating because of 'loud and unusual' noises coming from the boiler. The engineer sent by the insurer to inspect the boiler was unable to find the cause of the problem. Two subsequent inspections by different engineers also failed to resolve matters. The insurer then told Mrs G that she needed to have a power flush carried out on the boiler - and that her breakdown cover would be suspended until that work had been done.

So Mrs G arranged for an engineer to carry out the power flush. When he had done this, he told Mrs G to call the insurer and order a replacement valve, as he said a new valve was needed before the heating could be turned on again.

Although Mrs G called her insurer that same day, it was over a week before an engineer came to fit the new valve. Once the heating was working again, she complained to the insurer.

She said she doubted that the power flush had been necessary. She thought the insurer had told her to arrange it simply because the engineers had been unable to find the real cause of the problem. And she asked for compensation for the period when she and her elderly mother had been left without any heating or hot water.

The insurer strongly refuted Mrs G's suggestion that the power flush had not been necessary. However, it acknowledged that there had been some delays and it offered £75 to Mrs G as a 'goodwill gesture'.

Mrs G said she remained 'unconvinced' that the power flush had been necessary. She also said that the offer of compensation was 'far from adequate' and that she thought £2,000 would be a more appropriate sum. Unable to reach agreement with the insurer, Mrs G referred the complaint to us.

complaint upheld in part
In the light of the available evidence, we concluded that the power flush had indeed been necessary. So we did not uphold this part of Mrs G's complaint.

We looked at what Mrs G had said about the amount of inconvenience that she and her mother had suffered during the period when their boiler was out of action. We agreed that they had been inconvenienced and understandably annoyed by the delay - and we did not think the insurer's offer of £75 had been sufficient. However, we could not see that Mrs G was justified in asking for £2,000. We said that, in the circumstances of this case, £350 was appropriate, and the insurer agreed to pay this amount.

83/07
consumer complains about insufficient offer of compensation from insurer after his boiler broke down over Christmas

Three days before Christmas, Mr and Mrs M's boiler broke down. It was covered by breakdown protection insurance, and the insurer sent an engineer out the following day to repair it. All appeared to be well until the afternoon of Christmas day, when the boiler broke down again.

The engineer sent out by the insurer two days later was unable to repair the boiler. He told Mr M that it needed a new pump. Unfortunately, the exact model required was not in stock and would have to be specially ordered. He did not know how long this would take and he said that some delay was inevitable because of office and warehouse closures over the holiday period.

Mr and Mrs M were very upset to learn this. They said they could not manage without hot water and central heating. Several members of their family were staying with them over the Christmas and New Year break, including two young children and Mr M's elderly father.

With the agreement of the insurer, Mr M rang round a few independent contractors and found someone local who said he could supply and fit the exact model of pump required. The insurer agreed to reimburse Mr M for the cost of getting the work done independently - and in due course, Mr M put in a claim to the insurer.

The insurer offered him £250, which was the full cost of supplying and fitting the new pump. Mr M was also offered £120 for the distress and inconvenience he had been caused.

Mr M did not think this was enough. He asked for £825, to compensate him for the disruption to his family's Christmas and to cover the cost of the portable heaters he had been obliged to hire. When the insurer refused to increase its original offer, Mr M referred the complaint to us.

complaint upheld
The claim for the cost of the repair was not in dispute, as the insurer had already offered full reimbursement of the £250 paid to the independent contractor. But we agreed with Mr M that £120 was insufficient compensation, in the circumstances.

We noted that, under his policy, Mr M could have claimed for alternative accommodation while he was waiting for the insurer to obtain the pump and repair his boiler. However, he had not done this and the insurer had not suggested it.

We said that the insurer should reimburse Mr M for the full cost of hiring the heaters. It should also pay him £250 for the distress and inconvenience it had caused.

83/08
insurer refuses to reimburse consumer for cost of work carried out on advice of its contractor

When Mr T's boiler broke down he contacted the insurer, under his home emergency insurance policy. A few days later, a contractor employed by the insurer inspected the boiler and said it had a faulty valve. Mr T later said he had been under the impression that the contractor would order a replacement and return in due course to fit it.

However, the following morning the contractor left a phone message for Mr T, telling him that the problem had been caused by 'sludge on the valve' and that Mr T would need to arrange a power flush to release it. The contractor said Mr T would have to get the work done at his own expense, as it was not covered by the policy.

So Mr T went ahead and had the power flush carried out, at a cost of £400. The heating engineer who did the work expressed the view that it had not been necessary, as there had been no debris in the system and the fault with the boiler remained unresolved.

Mr T then contacted the insurer. He asked it to reimburse him for the cost of the power flush, on the grounds that it had only been carried out on the advice of the contractor, and it had proved unnecessary.

The insurer refused to pay up. It said Mr T's contractor should not have continued with the power flush if he thought it unnecessary. Unable to reach agreement, Mr T referred the complaint to us.

complaint upheld
The insurer accepted that Mr T had arranged the power flush on the basis of advice from the insurer's contractor. We said that the contractor was acting on the insurer's behalf when he inspected the boiler and advised Mr T on the cause of the fault, and whether it was covered by the policy.

It was clear from the evidence supplied by Mr T's heating engineer that the power flush had not been necessary and had not resolved the problem with the boiler. So we said that the insurer should reimburse Mr T for the cost of the power flush, together with interest - backdated to when Mr T had put in his claim.

83/09
consumer complains about insurer's handling of claim for damage resulting from a leaking toilet

At the beginning of August an elderly widow, Mrs D, contacted her insurer as she thought there was a leak in her bathroom.

The contractor sent by the insurer said the problem was coming from the outlet pipe of the toilet. He confirmed that the cost of repair was covered under Mrs D's complete utilities cover insurance policy. However, he said he thought the toilet itself might be cracked - so there was a risk that it could be damaged further if any work was done on the outlet pipe. He advised Mrs D to buy a new toilet before having any repairs done.

Mrs D was concerned about the cost that this would entail. She told the contractor she did not think she could raise the money right away to pay for a new toilet. She later said she 'got the impression there was no urgency' about arranging the repairs.

Mrs D did not see any further signs of a leak over the next few weeks. But she then noticed that water marks had started to appear on her bathroom floor and that the toilet had become backed-up, which meant there was a risk of it overflowing when flushed.

She contacted the insurer, who sent out the same contractor. Mrs D warned him not to flush the toilet, but he did so and it overflowed. The contractor did not offer any help in clearing up the mess, nor did he attempt any repair. Instead, he told Mrs D to 'keep an eye on the situation' and he said he would 'call in again in a day or so'.

By that time, however, Mrs D had moved in temporarily with a neighbour. Waste water had leaked through the bathroom floor to the sitting-room below - and the smell was so unpleasant that she had been unable to stay in the house. On her neighbour's advice, she rang the insurer again to explain what had happened.

Two days later, the insurer sent a different contractor to Mrs D's house. He repaired the leak - and told her the toilet itself was not damaged and there was no need to replace it.

With her neighbour's help, Mrs D subsequently claimed for the costs she incurred in putting right the damage caused by the leak. She also complained about the insurer's poor handling of the matter - and for the distress and inconvenience the incident had caused her. When the insurer rejected her claim, Mrs D brought her complaint to us.

complaint upheld
We considered the information provided by both the insurer and Mrs D. The insurer's notes confirmed that the first contractor had flushed the toilet, despite the warning from Mrs D that he should not do this. We thought it likely that his actions had caused some damage. The insurer's notes also confirmed that the second contractor had completed a satisfactory repair without needing to replace the toilet.

If the repair had been carried out promptly when Mrs D first contacted the insurer, we thought it more likely than not that there would have been no damage to the bathroom floor or to the ceiling of the room below.

We told the insurer to reimburse Mrs D for the costs she had incurred in repairing the damage caused by the leak. We said it should add interest, backdated to when she first made her claim for the damage. We also said it should pay her £450 for the distress and inconvenience she had been caused.

83/10
consumer complains about the handling of his claim under his boiler care insurance policy

Mr A's boiler was covered by a boiler care insurance policy. He contacted the insurer under this policy after his boiler broke down in early June.

It took four visits from a gas engineer before the boiler was finally repaired - nearly a month later. The boiler stopped working again in the first week of November. This time, after inspecting the boiler, the insurer's engineer told him it was 'uneconomical' to carry out a repair. When Mr A disputed this, the engineer said it was best to take up the matter direct with the insurer.

Mr A rang the insurer as soon as the engineer left. And although he was told that someone would call him back the same day, it was nearly a fortnight before the insurer contacted him.

The insurer then confirmed that the boiler was 'beyond economic repair'. Mr A was offered a 'discretionary payment' of £100 towards the cost of a replacement. Mr A was very unhappy about this and made a formal complaint about the poor service he had received.

The insurer offered Mr A £150 to compensate him for its delay in confirming that it would not repair the boiler, after he had reported the breakdown in November. However, it was not prepared to reconsider its decision not to carry out further repairs.

Mr A then complained to us. He said he thought the insurer should either repair the boiler or pay for a replacement.

complaint not upheld
We looked at the terms and conditions of Mr A's insurance policy. These stated clearly that the insurer could refuse to repair the boiler in circumstances where it decided it was not economical to do so. In such circumstances, the insurer was not required to replace the boiler.

We accepted that Mr A had been put to some inconvenience during the period when he was waiting for the insurer to confirm whether or not it would repair the boiler. But we thought the offer of £150 compensation for this, together with £100 towards the cost of a new boiler, was fair and reasonable in the circumstances. We did not uphold the complaint.

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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.