A claim was rejected on the grounds of gradual damage exclusion, but our investigation found the cause to be accidental.

Loss of function sees rejected claim overturned

A claim was rejected on the grounds of gradual damage exclusion, but our investigation found the cause to be accidental.

What happened

Chloe noticed the water wasn’t draining away from her house as quickly as it used to and got in touch with her insurer. They sent a drainage company to inspect the pipework.

Their report said there was a partial blockage in the pipework and didn’t mention any other problems. The insurer said this meant the claim wasn’t covered because there was no physical damage to the pipework. It said the drainage was still serviceable because the blockage wasn’t completely stopping water from flowing down it. And it also said the blockage would have happened gradually; and gradual damage wasn’t covered.

How we helped

We spoke to Chloe about what had happened. She said she hadn’t been aware of any problem until a few days before she made the claim. Initially, she thought the problem could be solved by putting some sink unblocker down the pipe, but when that didn’t work, she called her insurer.

The policy said it covered ‘accidental damage to underground pipes’. It didn’t define ‘accidental damage’, so we thought the insurer should use the usual definition of accidental, which we consider to be ‘unforeseen and unintentional damage’.

We considered the blockage to be accidental damage according to that meaning, because we didn’t think Chloe would’ve expected the problem. Although there was no indication of physical damage to the pipe, we noted the policy didn’t require there to be any physical damage for the problem to be covered. And as the water wasn’t draining away as it should’ve done, we thought there was a loss of function, therefore damage.

The policy contained an exclusion which said ‘we don’t cover any damage which is gradual’. We thought it was possible the material which caused the blockage had built up over time.

Putting things right

We were satisfied that Chloe wouldn’t have been aware of the blockage until there was a noticeable loss of function. So we weren’t satisfied the damage was gradual and didn’t think it was fair for the insurer to decline the claim based on the exclusion.