Home emergency insurance

What we look at

• If the insurer doesn’t think the claim is an emergency

  We see complaints where the insurer has declined a claim because they don’t think an emergency has happened.  

  In cases like this, we’ll start by looking at the policy terms and conditions. Most home emergency policies will define what an emergency is.  

  When we look at your complaint, we’ll check if the insurer has applied the definition of an emergency reasonably. If we think the policy definition is unusual or very specific, we might consider a separate complaint about the way the policy was sold.  

  We also need to take your individual circumstances into account. We’ll consider things like: 

  • the time of year the emergency happened 
  • if the emergency affected any other family members  
  • if you are vulnerable 
  • any other personal circumstances 

  Some situations might be an emergency for one consumer but not another.

• If you think the insurer has applied excess incorrectly

  Most home emergency policies say you have to pay an excess on your claim. If you think the insurer has applied this incorrectly, we’ll check the policy terms carefully to see if they’ve acted unfairly.

• If you’re not happy with a temporary repair

  Most home emergency policies only stop the actual emergency. This means that a repair might be temporary. Some policies cover permanent repairs if the cost is the same as a temporary repair. You might complain because you: 

  • don’t think the temporary repair sorted out the emergency 
  • thought your policy covered permanent repairs, not temporary ones 
  • think your insurer should have covered a permanent repair because it would have cost the same as a temporary one 

  In cases like this, we’ll look carefully at the policy wording to decide what’s fair.

• Delays and cancelled appointments

  If you complain about a delayed or cancelled appointment, we’ll look at the circumstances of your case to decide what’s fair. We’ll check:  

  • when you made the claim 
  • when the insurer arranged the appointment 
  • how long you had to wait 
  • your personal circumstances – for example, if you’re vulnerable or live with a vulnerable person 

  If your appointment was cancelled, we’ll investigate why this happened. If your appointment was delayed, we’ll check: 

  • how the delay affected you 
  • if the insurer knew there would be a delay and explained this to you 
  • if the insurer tried to manage the delay, for example, by giving you the option to call a local tradesperson and claim for the cost afterwards 
  • if the delay caused any more damage 
  • if the delay meant you couldn’t have essential services like heating or water 
  • how long the delay lasted 

• Damage caused by the emergency (‘consequential damage’)

  'Consequential damage' is the damage that happens as a result of the emergency. Most home emergency policies are only meant to cover stopping the emergency. They don’t usually cover consequential damage. 

  For example, let's say a burst pipe has caused damage to the kitchen units and floor. You’re covered for a plumber to come and fix the leak as soon as possible, but not for anyone to repair the kitchen units or floor. However, your home insurance policy may cover this. 

  If you complain about consequential damage, we’ll check your home emergency policy terms carefully. We don’t normally hold a home emergency insurer responsible for consequential damage. But if they cause further damage through their actions – say when carrying out repairs – we might ask them to: 

  • contribute to repair costs 
  • pay compensation 

  You might complain that your insurer failed to stop the emergency because they: 

  • rejected your claim unreasonably 
  • delayed coming out to assess the problem 

  You may then have had to claim on your home insurance policy instead. This could have meant: 

  • you had to pay an excess 
  • your home insurance policy went up 

  In cases like this we’ll check whether the home emergency insurer should have dealt with your claim or responded more quickly.  

• If your boiler is beyond economic repair

  Some policies have special rules for if your boiler becomes beyond economic repair or needs parts that are no longer available.  

  If your insurer says your boiler is beyond economic repair, this means the cost of the repair is more than the boiler is worth. So your boiler needs to be replaced. Most home emergency policies will offer a cash settlement of around £250 to £500 towards the cost of a new boiler, in these circumstances.  

  If you have a complaint about a situation like this, we’ll check: 

  • how clear your policy terms are – and whether they have explained what might happen if your boiler can’t be repaired 
  • how your insurer has valued your boiler 
  • the breakdown of the repair estimate and whether it’s reasonable 

• If you fixed the emergency yourself

  Some people try to sort out home emergencies by getting a local tradesperson to do the repairs without speaking to their insurer first. Then they try to claim the cost back from the insurer.  

  Most policies won’t let you do this, and insurers usually reject the claim. But if we think your claim would have been covered anyway, we don’t think it’s fair for the insurer to reject it. In cases like this, we’d ask the insurer to prove that they would have rejected it anyway.  

  If we don’t think it’s fair for the insurer to reject your claim, we’d normally ask them to pay you the cost of the repair. This might not be what you paid. Instead, it will be what it would have cost the insurer to fix the problem if you had gone to them first.

• If you think your policy was mis-sold

  If your complaint is about a mis-sale, we’ll look at who sold the policy. We’ll also look at whether or not you were given advice when you bought it. 

  If the business that sold the policy provides advice, they have a responsibility to make sure the policy is right for you.  

  If you bought the policy without advice, you should have been given enough information to decide if the policy was right for you. At the point of sale, the business must provide information that’s: 

  • clear 
  • fair 
  • not misleading  

  It’s important that you understand the information you’re given. This is because most policies will explain what’s required of you at the start of the policy or if you claim.  

  In cases like this, one of the first things we check is that you’re eligible to use the policy. If you’ve got the wrong cover, you won’t be able to benefit from it. For example: 

  • if you’re a private tenant and you bought home emergency cover, you may not need it because it’s usually the landlord’s responsibility to sort out emergencies 
  • if you’re a landlord and you bought a policy designed for private homeowners 
  • if you have an unusual type of heating system not covered by your policy 

  If you’re completely ineligible for your policy and bought it anyway, we’ll normally still ask the insurer to refund your premiums plus interest. We’ll do this even if it was clear at the point of sale that you were not eligible. This is because you’ve been paying for a product you can’t use. Your insurer has been getting premiums when they’ll never have to pay a claim. 

  Some people say their policy was mis-sold after a rejected claim. But this doesn’t mean they would not have been able to benefit from the policy. If we decide that you'd have been able to benefit from the policy, we probably won’t think it was mis-sold. 

  Exclusions and limitations

  Most policies have things they won’t cover or limits to the cover they provide. These are called exclusions and limitations. For home emergency insurance, this is often things like: 

  • limitations on cover for replacement boilers 
  • restrictions around the age of a boiler 
  • types of property not covered 
  • types of heating systems not covered 
  • specific parts of heating systems not covered, for example, cylinders or water tanks 
  • limits on how much you can claim 
  • ineligible policyholders, for example, landlords
  • exclusions on shared parts of a building, for example, external drains

  If you complain about an exclusion or limitation, we’ll check whether: 

  • the exclusion or limitation was sufficiently brought to your attention during the sale 
  • you would still have bought the policy if you’d known about the exclusion or limitation 

  We’ll also check if the exclusion or limitation is clearly explained in the policy documents. If it is, we’ll probably say this is enough to prove the policy was not mis-sold. However, we might uphold – that is, agree with – your complaint if there’s evidence that both of the following are true: 

  • you were sold an unsuitable policy 
  • the business should have known the policy was unsuitable 

• Distress or inconvenience if you’re a landlord

  Sometimes, landlords experience distress or inconvenience when a home emergency claim has problems. If you’re a landlord and you complain to us, we will consider your complaint but look at it in a different way to a private homeowner's. 

  For example, an electrical fault might stop all the appliances in a kitchen working. If the insurer takes too long to sort this out, a private homeowner will experience distress and inconvenience. If we agree that the insurer has taken too long we’ll ask them to pay the homeowner compensation.  

  If you’re a landlord and you complain about the same issue, you might still suffer distress and inconvenience. This could be from having to chase the insurer or your tenant complaining to you. If we agree that the insurer has taken too long, we’ll probably ask them to compensate you. However, the amount of compensation is likely to be lower than it would for a private homeowner. This is because, as a landlord, you don’t directly experience the inconvenience of not being able to use the kitchen. 

  If you compensated your tenant or discounted their rent, you might have suffered financial loss. If you complain to us about this, we’d need to see evidence of what you paid. We’d think about whether your loss was a reasonable and proportionate response to the problem the tenant had.