Buildings Insurance claim refused - Help
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linaraman
Posts: 27 Forumite
My leaking Jacuzzi bath & pump caused damage to the floor joists which needs replacing, but my insurance company decided to reject my claim. Please help me to understand how to challenge their decision and where can I find reliable independent loss adjuster to hire?
My buildings insurance is with Legal & General who has appointed BV Solutions to assess my claim. Their representative inspected the property and rejected my claim marking it as un-insured loss due to sealant/grout failure. At the time of his appointment the bath was already removed to stop the leak and stored in the garden as the bath tub was leaking from the Jacuzzi jet nozzles situated against the wall. The work was carried out by the local plumber on Sunday who marked the whirlpool bath tub beyond economic repair (I have a report stating this). There is also additional report from the Home Emergency Team who attended immediately after the fault was reported to the insurance company. Their report is also confirms the primary damage was caused by the leak of bath tub jet nozzles and faulty pump (see attachment). However the surveyor still adamant that the cause of the damage is broken sealant that goes round the bath.
This is the only bathroom in the household and we are family of 5 living with no washing facility at the moment and it's been a month since the bath was removed.
I have filled a complaint with Legal and General last week, but it will take 6-8 weeks to receive their final decision.
Ideally I would like to appoint my own independent loss adjuster who can inspect the property, assess the primary cause of damage and calculate repair costs, so that I can present this to the insurance company and if require present their findings and other evidence to the Financial Ombudsman should I need to escalate my complaint further.
Any comments will be highly appreciated! I don't want to waste my time and money if I'm wrong and shouldn't be challenging them.
My buildings insurance is with Legal & General who has appointed BV Solutions to assess my claim. Their representative inspected the property and rejected my claim marking it as un-insured loss due to sealant/grout failure. At the time of his appointment the bath was already removed to stop the leak and stored in the garden as the bath tub was leaking from the Jacuzzi jet nozzles situated against the wall. The work was carried out by the local plumber on Sunday who marked the whirlpool bath tub beyond economic repair (I have a report stating this). There is also additional report from the Home Emergency Team who attended immediately after the fault was reported to the insurance company. Their report is also confirms the primary damage was caused by the leak of bath tub jet nozzles and faulty pump (see attachment). However the surveyor still adamant that the cause of the damage is broken sealant that goes round the bath.
This is the only bathroom in the household and we are family of 5 living with no washing facility at the moment and it's been a month since the bath was removed.
I have filled a complaint with Legal and General last week, but it will take 6-8 weeks to receive their final decision.
Ideally I would like to appoint my own independent loss adjuster who can inspect the property, assess the primary cause of damage and calculate repair costs, so that I can present this to the insurance company and if require present their findings and other evidence to the Financial Ombudsman should I need to escalate my complaint further.
Any comments will be highly appreciated! I don't want to waste my time and money if I'm wrong and shouldn't be challenging them.
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Comments
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What part of the policy do you think the claim should be covered under?0
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My building insurance policy states that I am covered if the escape of water was from the bath tub or burst pipes. But they have marked it as sealant/grout failure which is not covered by my policy.0
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If the jet nozzles allowed water floral outside the bath then that is a sealant failure surely? If the pump leaked then the same applies.
Seals have leaked.0 -
Well, the bath was properly built in, so there is no way you can spot something was leaking underneath the bath. My argument is the leak was detected from the bath tub (which is covered under the policy) and not because of the failed sealant that goes around the bath. It was definitely not flowing from the top due to sealant failure around the bath. The bath was manufactured with jet nozzles built in and they all come like this. This isn't something you would re-seal it or change during the lifetime of the tub.0
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you can try and appeal/ complaint to the insurers."It is prudent when shopping for something important, not to limit yourself to Pound land/Estate Agents"
G_M/ Bowlhead99 RIP0 -
Is a sealant failure specifically excluded from your policy?0
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Yes, the sealant failure which goes around the bath (stops water flow down the walls)is excluded from the policy. The sealant was always at present, but was removed by us only to be replaced as we could see it was broken in few areas. After we removed the sealant and then the front bath panel we saw the actual damage to the floor. When the insurance surveyor came round to inspect it, the sealant wasn't there and when the plumber removing the bath tub, the tiles started to crumble.0
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Regardless of the source of the water (pump / jet nozzles etc.) the damage to the subfloor has surely been caused by the grouting not doing its job, and therefore would not be covered IMO.
The best way of appealing the declinature would be to get an independent report confirming that the escape of water would have occurred even if the grouting had been properly performed. Personally, it sounds like L&G have acted fairly and reached the correct decision from the information provided thus far.
FYI - appointing a loss adjustor isn't what you need (or mean!) - if you're thinking of appointing anyone to oversee your claim (i.e., a loss assessor) you'd need to have a claim going through first and foremost.0 -
The first issue is that the jacuzzi nozzles have leaked, and you have a faulty pump - those won't be covered under your policy, as there is no insured event that has occurred here (IE the damage to the jacuzzi and pump hasn't been caused by one of the perils stated your policy).
The second issue is that the water from the pump has been able to penetrate the joists causing damage. The only thing this could come under is escape of water, but there are exclusions to this part.
It seems this is where the insurers are probably saying grout / sealant failure, because water shouldn't be able to get under the sub floor to the joists as it should be water tight.
Usually when there is a leak, the water sits on top of the water tight surface, and this is how you spot you have a leak, if the sealant / grouting has eroded / failed allowing the water to go down into the joists, then this wouldn't be covered as, although the water came from the bathtub, the failure of the sealant is what has allowed the water to go down that far.
You will almost certainly also have exclusions for damage caused gradually over a period of time as well.
If you aren't happy with this, you need to complain to the insurer and wait for their final response (they get up to 8 weeks), and then go to the FOS - who will only look at whether the insurers response is reasonable and fair or not.
You don't need a loss adjuster, or a loss assessor (as you don't currently have a claim and will cost you, a cost you cannot get back from the insurer), you should ask a builder / plumber to look at WHY and HOW the water has been able to penetrate down to the joists.0 -
Thank you, I will think of the best course of action. I guess will have to wait for L&G to get back to me with their final decision and take it from there.0
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