Ceiling collapse caused by insured event, but insurer still declines claim

Contents insurance

A concealed leak was to blame for the damage caused to Beatrice's kitchen, but her insurer said it wasn’t covered because of a policy exclusion.

What happened

Beatrice’s kitchen ceiling collapsed. She discovered that a pipe between the kitchen ceiling and the upstairs floor had been leaking. Over time, the water had pooled and became heavy enough to cause the collapse.

The insurer accepted that the damage had been caused by an insured event (escape of water) but rejected Beatrice’s claim. They said the leak had been going on for some time and pointed out an exclusion in the policy for any damage caused gradually. They thought Beatrice would have been aware of the problem long before she made the claim.

The insurer also said the joists were rotten, so they thought the floor above would have indicated an issue when Beatrice walked on it. They also thought the ceiling below would have shown signs of staining long before it collapsed.

What we said

We looked at the evidence. Beatrice said she reported the claim within days of the ceiling collapse and hadn’t noticed any obvious signs of a problem before that.

We agreed that the damage was caused by an insured event and that it happened gradually. But we didn’t think Beatrice should have been aware of it. Because the leak was concealed between the floor and ceiling, simply walking on the floor wouldn't have indicated the problem. Her insurer's loss adjuster also gave us photos of the damage. We didn’t think they clearly showed any signs of water staining on the ceiling that had collapsed or remained.

We decided to uphold Beatrice's complaint and we told the insurer to pay the claim.