How we can help if you have a complaint about a claim and your insurer says the problem is gradual damage.
Home and buildings insurance policies usually set out what’s covered by listing a number of ‘insured events’. These are things like:
- accidental damage
Your policy will also have ‘exclusions’. These explain when you won’t be covered. Policy exclusions often include damage that’s happened gradually. Gradual damage is also called a ‘gradually operating clause’ exclusion.
Types of complaint we see
You might complain to us if your insurer has declined a claim because:
- they think the damage was caused gradually
- they don’t think the damage was caused by an insured event
- gradual damage is a policy exclusion
You might be unhappy because you:
- don’t think the damage is gradual
- didn’t know the damage was happening gradually
Some insurers will also specifically exclude rot, which usually occurs gradually, from policies.
We often see complaints about storm damage claims. Insurers sometimes reject these claims because they think the damage was caused by bad weather over time – not a single storm.
How to complain
Talk to your insurer first so they have the chance to put things right. They have to respond within eight weeks. If they don’t respond, or you’re not happy with their response, let us know.
Bringing a complaint to us is straightforward and won’t cost you anything. We’ll check if your complaint is something we can deal with, and if it is, we’ll investigate.
What we look at
If your insurer has relied on a policy exclusion to decline your claim, we won’t automatically agree this is fair. We’ll think carefully about what’s fair and reasonable under the circumstances and look at whether you could have known about the damage.
We’ll look at the policy to check:
- what’s covered
- what’s excluded
- what parts of the policy the exclusion relates to
We’ll need to decide if the damage was caused by an insured event. If it wasn’t, there’s no claim. If it was, we’ll need to decide if the damage was caused gradually. It’s the insurer’s responsibility to prove this if they’re relying on an exclusion to deny your claim.
We’ll look at all the evidence, including expert reports and photos of the damage. Your insurer might decline your claim if gradual damage is excluded in your policy and:
- the damage was caused by an insured event but happened gradually
- you could have done something to prevent the damage but didn’t
Your insurer might decline a claim because they think the damage was caused by wear and tear. If we agree, we’re unlikely to tell them to pay the claim. This is because everything wears out eventually and insurance can’t protect you from that.
Accidental damage isn’t normally covered as standard. You usually have to add it to your policy and pay for it separately.
If you have a gradual damage complaint under accidental damage cover, we’re unlikely to tell your insurer to accept your claim. This is because doing so could make insurers pay for a wide range of situations they never intended to cover.
Some policies don’t restrict cover to a list of insured events. These are called ‘all-risks’ policies. They usually cover damage, subject to a number of exclusions.
All-risks policies give more extensive cover and are usually more expensive than standard policies. So we don’t think it’s fair for customers to be worse off than with a standard policy.
For claims on all-risks policies, we’ll decide whether the damage was caused by an insured event – for example, flooding. If so, we'll take the same things into account that we normally do for a complaint about gradual damage.
If the damage wasn’t caused by an insured event we’d just consider whether the damage was gradual or not.
Putting things right
If we find you’ve been treated unfairly, we’ll ask the insurer to put things right. This usually involves putting you back in the position you’d be in if things hadn’t gone wrong. It will depend on the nature and type of complaint.
For example, if we think the damage was caused by an insured event and didn’t happen gradually, we’ll probably tell your insurer to pay the claim.
Or if the damage did happen gradually, we might still tell the insurer to pay. We’re likely to tell the insurer to pay if:
- we think you couldn’t have been aware of the damage happening gradually
- you made the claim or took reasonable action as soon as you knew about the problem
We may also ask the insurer to compensate them for any distress or inconvenience you’ve experienced as a result of the problem.
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Information for financial businesses
You can read more information about gradual damage in the business section of our website. This includes technical details and information to help you resolve complaints.