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    • linaraman
    • By linaraman 7th Dec 17, 5:21 PM
    • 26Posts
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    linaraman
    Buildings Insurance claim refused - Help
    • #1
    • 7th Dec 17, 5:21 PM
    Buildings Insurance claim refused - Help 7th Dec 17 at 5:21 PM
    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.
Page 1
    • FutureGirl
    • By FutureGirl 7th Dec 17, 6:03 PM
    • 1,018 Posts
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    FutureGirl
    • #2
    • 7th Dec 17, 6:03 PM
    • #2
    • 7th Dec 17, 6:03 PM
    What part of the policy do you think the claim should be covered under?
    • linaraman
    • By linaraman 7th Dec 17, 6:17 PM
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    linaraman
    • #3
    • 7th Dec 17, 6:17 PM
    • #3
    • 7th Dec 17, 6:17 PM
    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.
    Last edited by linaraman; 07-12-2017 at 6:51 PM.
    • unforeseen
    • By unforeseen 7th Dec 17, 6:41 PM
    • 1,988 Posts
    • 2,504 Thanks
    unforeseen
    • #4
    • 7th Dec 17, 6:41 PM
    • #4
    • 7th Dec 17, 6:41 PM
    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.
    • linaraman
    • By linaraman 7th Dec 17, 6:51 PM
    • 26 Posts
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    linaraman
    • #5
    • 7th Dec 17, 6:51 PM
    • #5
    • 7th Dec 17, 6:51 PM
    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.
    • csgohan4
    • By csgohan4 8th Dec 17, 7:13 AM
    • 4,019 Posts
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    csgohan4
    • #6
    • 8th Dec 17, 7:13 AM
    • #6
    • 8th Dec 17, 7:13 AM
    you can try and appeal/ complaint to the insurers.
    "It is prudent when shopping for something important, not to limit yourself to Pound land"
    • FlameCloud
    • By FlameCloud 8th Dec 17, 9:27 AM
    • 1,785 Posts
    • 854 Thanks
    FlameCloud
    • #7
    • 8th Dec 17, 9:27 AM
    • #7
    • 8th Dec 17, 9:27 AM
    Is a sealant failure specifically excluded from your policy?
    • linaraman
    • By linaraman 8th Dec 17, 10:54 AM
    • 26 Posts
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    linaraman
    • #8
    • 8th Dec 17, 10:54 AM
    • #8
    • 8th Dec 17, 10:54 AM
    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.
    Last edited by linaraman; 14-12-2017 at 4:23 PM.
    • Blibble
    • By Blibble 9th Dec 17, 10:51 AM
    • 252 Posts
    • 113 Thanks
    Blibble
    • #9
    • 9th Dec 17, 10:51 AM
    • #9
    • 9th Dec 17, 10:51 AM
    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.
    • FutureGirl
    • By FutureGirl 9th Dec 17, 11:08 AM
    • 1,018 Posts
    • 415 Thanks
    FutureGirl
    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.
    Last edited by FutureGirl; 09-12-2017 at 11:12 AM.
    • linaraman
    • By linaraman 9th Dec 17, 2:21 PM
    • 26 Posts
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    linaraman
    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.
    • Mungo76
    • By Mungo76 11th Dec 17, 8:48 AM
    • 70 Posts
    • 28 Thanks
    Mungo76
    As already mentioned, complain.

    You have a report carried out at the time of loss stating the pump has leaked, they have a report after the bath had been fitted suggesting without sight of the bath or the leak that it was a sealant issue.

    What the insurers are trying to piece together is the fact the nozzle water has sprayed back onto the wall, causing a run down effect. it can look like a seal issue, especially if the water sprays up, hits the seal (which is doing its job, but the wrong way around stopping water coming up and out rather than through and down) and running down, to the sub floor joists.

    Have the insurers seen the reports, have they asked to inspect the bath? you have proved an insured peril has occurred and on a good basis, they need to disprove rather than rely on a balance of probabilities that it occurred another way if there is hard evidence.
    • linaraman
    • By linaraman 11th Dec 17, 8:06 PM
    • 26 Posts
    • 0 Thanks
    linaraman
    Thank you Mungo. I am on the same page as you, because insurance company based their decision or probability and assumption only, and as you said, I have hard proof. However, I have decided to appoint independent loss assessor, the company was highly recommended to me who work on no win no fee basis. They are professionals and they know what they are doing. They also know very well the surveyor that was sent by my incurance company to inspect the leak and they running number of cases to prove them wrong. They will also calculate the repair costs, which I'm sure will be much higher then what the insurance company would have approved in the first place as well as submitting non- financial claim on my behalf as due to their unreasonable decision to decline my claim we've been left with no washing facility for 5 weeks now and this will go beyond Christmas. I just hope I have made the right decision.
    • FutureGirl
    • By FutureGirl 11th Dec 17, 8:10 PM
    • 1,018 Posts
    • 415 Thanks
    FutureGirl
    'No win no fee' will refer to them getting a % of the cost of the claim - you will probably still have to pay some kind of cost for their work even if the claim is rejected.
    • linaraman
    • By linaraman 12th Dec 17, 2:49 PM
    • 26 Posts
    • 0 Thanks
    linaraman
    Signed the paperwork and it says there is nothing to pay if they don't win. I assume they wouldn't be taking the job on knowing there is a slim chance of winning. It's a no brainer for me as at the moment my claim is rejected and because of that I am already in trouble should I want to change the insurance company, as to the mandatory question if I ever had an insurance claim declined I will have to answer yes, which will probably double my premiums. So, by all means, I have to win this now and loss assessors I have employed are the only people can help me.
    • Quentin
    • By Quentin 12th Dec 17, 4:24 PM
    • 33,585 Posts
    • 17,466 Thanks
    Quentin
    Never seen this "mandatory question"

    Think you are mistaken,!!
    • glentoran99
    • By glentoran99 12th Dec 17, 4:28 PM
    • 4,931 Posts
    • 3,937 Thanks
    glentoran99
    Never seen this "mandatory question"

    Think you are mistaken,!!
    Originally posted by Quentin


    Think he/she is getting confused with the question, "have you ever been refused insurance"
    • rs65
    • By rs65 12th Dec 17, 8:43 PM
    • 5,295 Posts
    • 2,511 Thanks
    rs65
    Signed the paperwork and it says there is nothing to pay if they don't win. I assume they wouldn't be taking the job on knowing there is a slim chance of winning. It's a no brainer for me as at the moment my claim is rejected and because of that I am already in trouble should I want to change the insurance company, as to the mandatory question if I ever had an insurance claim declined I will have to answer yes, which will probably double my premiums. So, by all means, I have to win this now and loss assessors I have employed are the only people can help me.
    Originally posted by linaraman
    What happens if your complaint is now successful? Do you have to pay the loss assessor their fee?
    • linaraman
    • By linaraman 14th Dec 17, 11:16 AM
    • 26 Posts
    • 0 Thanks
    linaraman
    Well yes, if the complaint is successful I will have to pay them a fee, but I was explained, that they ensure I will be paid the fair amount of money to cover repairs, as on many occasions people don't get paid enough and end up fighting over the repayment amount with insurance company. They will also be submitting a non-financial claim to the insurance company on my behalf, as they have refused my claim unreasonably, which resulted a family of 5 living with no washing facility for over 5 weeks and by the looks it will go beyond Christmas now. I think this is very unfair..
    • Blibble
    • By Blibble 14th Dec 17, 7:31 PM
    • 252 Posts
    • 113 Thanks
    Blibble
    Well yes, if the complaint is successful I will have to pay them a fee, but I was explained, that they ensure I will be paid the fair amount of money to cover repairs, as on many occasions people don't get paid enough and end up fighting over the repayment amount with insurance company. They will also be submitting a non-financial claim to the insurance company on my behalf, as they have refused my claim unreasonably, which resulted a family of 5 living with no washing facility for over 5 weeks and by the looks it will go beyond Christmas now. I think this is very unfair..
    Originally posted by linaraman
    Best of luck to you. This will not work.

    What exactly is a "non-financial claim" - are you after a letter of apology?
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