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Ombudsman Case Report (FOS)

Although Mr F owned his own house, he had started spending more time at his partner’s house. While he was away from home, one of the pipes froze and subsequently burst – which cause extensive damage to the house and to Mr F’s belongings. He called his insurer to tell them what had happened, and to make a claim.

The insurer sent a loss adjuster round to Mr F’s house to assess the damage – and to find out more about what had happened. The loss adjuster spoke to Mr F about his circumstances and tried to find how often Mr F actually lived in the property. According to the loss adjuster, Mr F said that he was spending roughly three nights each week at home, and the other four at his partner’s house. He said that this could be backed up by his neighbours. Mr F also said that he turned off the heating when he wasn’t at the property.

But when the loss adjuster spoke to Mr F’s neighbours, one said that the house had been unoccupied for some time. The other said that the house wasn’t wholly unoccupied, but that Mr F certainly wasn’t there three days a week.

The loss adjuster also asked for utilities bills for the period leading up to the pipe bursting. When he saw the bills, he thought they were low – suggesting that the property hadn’t been used.

When the loss adjuster reported this to the insurer, they turned down the claim on the grounds that it was likely the property had been unoccupied for over 60 days – the limit set out in Mr F’s policy.

Mr F was unhappy with the insurer’s decision, and he complained. But when the insurer refused to reconsider, Mr F got in touch with us.

Complaint upheld

When we asked Mr F to tell us about what had happened, we noted that some of the things he said were different from the information that the loss adjuster had given to the insurer. For example, Mr F said that he hadn’t told the loss adjuster that he lived in the house, but that he had stayed there occasionally, and that his partner’s children sometimes stayed there too. He said that he went home regularly to collect the post.

He also told us that one of his neighbours bore him a grudge, and said that this was why the loss adjuster might have been told that the house was “unoccupied”. He also said that just because the utility bills were low didn’t mean that he was never at the house.

When we looked at the utility bills that the insurer had used, we found that they were taken from meter readings from mid-summer to mid-autumn. We noted that energy use from this period would have been lower than during the period in question – which was during the winter. But even so, we thought that the fact that there had been small balances to pay on gas and electricity showed that there had been some activity at the house.

We also noted that there were no names or signatures to back up Mr F’s neighbours’ statements.

Taking everything into account, we weren’t satisfied that the insurer had enough evidence to show that Mr F’s house had been “unoccupied” during the 60-day period before the pipe had burst. So we told the insurer to reconsider the claim.

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Certified Claims Management - UK loss assessors helping with property related insurance claims, dealing with insurance company loss adjusters, maximising your payment, minimising settlement time and reducing hassle.

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Certified Claims Management are UK based specialist loss assessors in all aspects of insurance claims management and can assist in the preparation and presentation of all domestic and commercial insurance claims resulting from fire, flood, storm, water, burglary, impact damage, subsidence or blocked drains. We work to balance your insurance company's Loss Adjuster's goal of minimising the settlement offer. We are also experienced at exposing and dealing with "Bad Faith Insurance Practices". We work for both the public and businesses. Need advice? Call our team of loss assessors to discuss your insurance claim today on:

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