My nightmare experience with Sheila's Wheels/Esure Home Insurance

KB_Edinburgh

Hi Guys,

My house was flooded over the Christmas period because of burst pipes due to the extreme winter we had. I was away on business and then on holidays for 4 weeks, and when I came back home in January, I found my house badly damaged with water everywhere, fallen ceiling etc. I left my central heating on but it locked out for some reason, and the extreme cold caused the pipes (mains and heating) to burst. I left the mains water on (I was told once it was needed to keep the pressure in the system).

I called my insurer (Sheila's Wheels, with Esure as the underwriters) straight after I discovered the incident in January and told them all of the details. They appointed Cunnigham Lindsey as their loss adjusters and since January I have been waiting for an outcome. Last week, after several requests and complaints, they came back to me saying they refuse my claim on the grounds of an exclusion clause in the insurance contract which says:
- The insurer is not liable for flooding caused by burst pipes if the insured leaves his/her property between the months of November and March for more than 5 days, and does not keep the heating on AND turns the mains water off.
I have been told this clause was added last June and that I received the terms and conditions by post. To be honest, I am not sure this rule makes sense since some boilers need the mains water to work (not mine apparently, but I did not know that).

What makes me really angry is the fact that it took them 3 months to come back to me saying they are not going to pay a penny for all of my troubles. The state of my house got worse during this period (I could not do anything while my case was considered) and I have been living in a B&B since January as my house is completely uninhabitable! The repair bill is looking to reach £30,000+ !!!

Do you think this is fair?

I am going to seize the Ombudsman but I am not sure what will happen. I've appointed a loss assessor a month after the accident since both Sheila's Wheels and Cunnigham Lindsey were messing me about (sending letters to the wrong addresses, forgetting to post letters between themselves etc.) Both of them apologised for these delays and mistakes but this does not change my predicament, alas.

I feel betrayed and depressed....

dacouch

What has your loss assessor suggested

FlameCloud

It is a very odd exclusion, and without going into too much depth more than one adjuster I know has been caught out by different time limts for unoccupancy.

The exclusion is in the policy however, so there is little your assessor can do if Esure want to take it to the FOS, and given the claim value and knowing them they almost certainly will.

When did your policy start? The only way to get around the exclusion would be if the policy started prior to June, they cannot simply amend the terms of the policy.

KB_Edinburgh

dacouch wrote: »

What has your loss assessor suggested

He suggested I take it to the Ombudsman on the grounds of unreasonable terms.

KB_Edinburgh

FlameCloud wrote: »

It is a very odd exclusion, and without going into too much depth more than one adjuster I know has been caught out by different time limts for unoccupancy.

The exclusion is in the policy however, so there is little your assessor can do if Esure want to take it to the FOS, and given the claim value and knowing them they almost certainly will.

When did your policy start? The only way to get around the exclusion would be if the policy started prior to June, they cannot simply amend the terms of the policy.

I took home insurance with them in August 2009, which was then renewed in August 2010. I was told this new clause was added last June.

FlameCloud

Good luck with it, what are you doing in the interim? The FOS can take months to rule on something.

The policy wording has changed though, in November it read-

'while your home is not being lived in
for more than five days at a time
during the months of November to
March inclusive unless you keep your
home heated throughout and shut off
the water supply at the mains'

The new wording is-
while your home is not being lived in
for more than five days at a time
during the months of November to
March inclusive unless you keep your
home heated throughout. You should
also shut off the water supply at the
mains if it is safe to do so'

somalt

Gosh, that is a very specific exclusion.
Sounds like they beefed up their policy wording after frost claims at the start of the year.

It's poor that they took so long to tell you. Were they meeting any of the costs of being in the B&B? If not you might be able to get some money towards them due to the delays, especially if you can prove they told you not to do any work.

You should bear in mind that the ombudsman will take a while and think on what to do while you wait.

Can you prove you left the heating on, they might still stick to the argument that the mains water should have been off, limiting the damage, but you might get them to contribute to some of the repairs.

The other way to go would be if you were notified of the change of terms, ie were they drawn to your attention sufficiently clearly. Did you actually get the documents changing it? If so on reading them was it clear what it meant? If you didn't get them your insurer would have to prove they were sent.

You should get your assessor to check your documents to see if there is a separate unoccupancy exclusion, because if you do get this 5 day exclusion over ruled, your insurer may rely on that one instead.

It's worth complaining, you can't lose anything by giving it a go.

KB_Edinburgh

FlameCloud wrote: »

Good luck with it, what are you doing in the interim? The FOS can take months to rule on something.

The policy wording has changed though, in November it read-

'while your home is not being lived in
for more than five days at a time
during the months of November to
March inclusive unless you keep your
home heated throughout and shut off
the water supply at the mains'

The new wording is-
while your home is not being lived in
for more than five days at a time
during the months of November to
March inclusive unless you keep your
home heated throughout. You should
also shut off the water supply at the
mains if it is safe to do so'

I started work on the property this week. It will take 6-8 weeks to finish the job (I will have to remortgage or borrow from family and friends to cover the cost). In the meantime, I am still staying at a B&B :-( What really makes me angry is the fact that taking the insurance made things worst for me!!! Had I not taken insurance, I would have started work in January, saving a lot of unncessary work (the builder told that had the dryers gone in in January or February, I would have saved thousands of pounds), rent and troubles! Sheila's Wheels had all the information in January but they messed me about for 3 months to tell me I have no grounds for claiming insurance! Surely, they should pay for the damage cause by the delay in their response, no?

PS. The new wording looks more reasonable. BTW, I found a contradiction in the booklet they sent me when I renewed the insurance. In the key facts they do mention the former clause above, but in the hints section, they say: "if you do not want to leave your heater on, make sure you that your drain the central heating system down and turn off the water supply at the mains", which clearly suggests that leaving the heater on and turning the mains off are not mutually inclusive, yet in the exclusions, they say I should do both! Do you think this contradiction helps my case?

KB_Edinburgh

somalt wrote: »

Gosh, that is a very specific exclusion.
Sounds like they beefed up their policy wording after frost claims at the start of the year.

It's poor that they took so long to tell you. Were they meeting any of the costs of being in the B&B? If not you might be able to get some money towards them due to the delays, especially if you can prove they told you not to do any work.

You should bear in mind that the ombudsman will take a while and think on what to do while you wait.

Can you prove you left the heating on, they might still stick to the argument that the mains water should have been off, limiting the damage, but you might get them to contribute to some of the repairs.

The other way to go would be if you were notified of the change of terms, ie were they drawn to your attention sufficiently clearly. Did you actually get the documents changing it? If so on reading them was it clear what it meant? If you didn't get them your insurer would have to prove they were sent.

You should get your assessor to check your documents to see if there is a separate unoccupancy exclusion, because if you do get this 5 day exclusion over ruled, your insurer may rely on that one instead.

It's worth complaining, you can't lose anything by giving it a go.

Thanks mate. They said they won't pay for anything, not even for my B&B bill due to the delay in their response!

peter_fenton

Morning KB Edinburgh, no burst pipes in my Edinburgh home but I have a similar problem with Sheila's Wheels, Esure and Cunnigham Lindsey. We had £20,000 worth of jewelry stolen by our mentally ill son, we were told by the insurer/loss adjuster that we would have to prosecute for the claim to go ahead. Our son was arrested and is about to be saddled with a criminal record. Our contents cover is for £60,000 plus, so we assumed that my wife would at least get her jewelry replaced. However, esure informed us that we were under insured by 50%. It seems that the content insurance of £60,000 is split into three parts: household, high risk and named. We were sent a cheque for £10,000. It looks like we have been robbed twice.

TSx

peter_fenton wrote: »

Morning KB Edinburgh, no burst pipes in my Edinburgh home but I have a similar problem with Sheila's Wheels, Esure and Cunnigham Lindsey. We had £20,000 worth of jewelry stolen by our mentally ill son, we were told by the insurer/loss adjuster that we would have to prosecute for the claim to go ahead. Our son was arrested and is about to be saddled with a criminal record. Our contents cover is for £60,000 plus, so we assumed that my wife would at least get her jewelry replaced. However, esure informed us that we were under insured by 50%. It seems that the content insurance of £60,000 is split into three parts: household, high risk and named. We were sent a cheque for £10,000. It looks like we have been robbed twice.

Whilst I sympathise with your plight, this is a risk you take when you arrange cover yourself and don't check it is suitable to cover all your possessions.

Looking at what help we could possibly provide, can you confirm

What the sum insured for your contents is?
What the high risk limit is?
How much was the claim for high risk items?

They can apply average to a claim where there is underinsurance, but they need to do it fairly.