Need advice house insurance refused 81 year old man dying of cancer!

naedanger

Keep_pedalling wrote: »

I agree you would not know this, my house is 75 years old and there is no way I can tell if there is a latent defect waiting to show itself next week. The issue is that the policy clearly states that it does not cover building defects, so would that not give Aviva a legitimate reason not to pay out?

Different polices provide varying levels of cover, and if I don't take out a policy that covers hidden defects then surely I can't claim for them when they become apparent.

Well does the policy say it will cover wind/storm damage? If so when will it pay out on this peril?

Surely they can always argue if something gives way it must be a defect as buildings should be built and maintained to a level that will survive storms. (If it is virtually impossible to claim the policy should not be stating it covers storm damage.)

If the property has been maintained to a reasonable level, the owner was not aware of any structural problem and the damage was caused by high winds/storm then the insurance company should be sorting out the problem or confirming it will pay for the repairs.

The financial ombudsman states "[w]e take the view that, when judging what the policy provides, a customer is entitled to rely - at least to some extent - on the policy headlines. Where a policy description is not borne out by the small print, we will consider whether the customer could have had any reasonable expectations of cover on the wider basis. We look at what a reasonable person would have concluded about the nature of the cover from the information available to them. Would they readily have understood the restricted nature of the policy on offer or would they have gained the clear impression that wider cover would be provided." My view is that a reasonable person would not expect a policy covering storm damage to exclude cover caused by high winds because of a structural defect that no typical customer would know existed.

naedanger

Aviva_company_representative wrote: »

Hi Kesaluner

Thanks for your post and I'm so sorry to hear about the situation your Uncle has been put in related to his home insurance claim.

If you'd like me to arrange for someone to contact either your Uncle or yourself on his behalf, so they can discuss his further options and answer any questions he has, please email the following details to social@aviva.co.uk -

Your Uncle's full name
Your Uncle's date of birth
Your Uncle's postcode
Policy number
Your full name
Whether you have permission to discuss the details on his behalf
Your Money Saving Expert username

I hope this helps and I look forward to hearing from you soon.

Kind Regards

Stephanie

Aviva Social Media Team

Aviva Social Media Team, I realise you cannot comment on the details of a specific case.

However I am concerned about the policy your company operates when assessing whether a claim for storm damage is valid.

Is your general policy to exclude claims where you assess there has been faulty construction if those faults would not be apparent to a typical customer?

neilmcl

naedanger wrote: »

I can see why you would have posted what you did when you thought the OP was letting his terminally ill family member work on the problem.

However now you realise you mis-read surely it makes a big difference. (The criticism you first made isn't valid if his father is capable of working safely, and you should leave your apology unqualified by the "but does it make a difference" etc.) His father was basically doing what you advocate in your second paragraph.

Again, apologies to the OP for misreading his post.

dacouch

shaun_from_Africa wrote: »

But as the link I showed earlier stated. poor construction should only be a reason to refuse to pay out if the insured person could have been reasonably expected to know about that poor construction.

The house I currently live in is about 45 years old and I have lived there for 12 years so if the builder used substandard materials or poor building practices, how would I be expected to know about this?
Even if I actually saw the house being built, I'm not a builder myself so wouldn't have a clue if the correct standards were being met.

Knowingly failing to disclose material facts is a legitimate reason for an insurer to refuse to pay out. Unknowingly failing to declare those facts isn't.

You're miss interpreting ICOBS 7.3.6

It does not mean an Insurer cannot reject any claims barring the ICOBS exceptions, it means the Insurer cannot refuse a "valid" claim eg something that is covered by the policy.

This link from the Ombudsman gives a better explaination of how they handle storm claims along with maintainence issues using the "But for" test http://www.financial-ombudsman.org.uk/publications/technical_notes/storm-damage.html

This passage is relevant to the OP's situation...

"http://www.financial-ombudsman.org.uk/publications/technical_notes/storm-damage.html"

shaun_from_Africa

dacouch wrote: »

This link from the Ombudsman gives a better explaination of how they handle storm claims along with maintainence issues using the "But for" test http://www.financial-ombudsman.org.uk/publications/technical_notes/storm-damage.html

But according to the OP, the claim hasn't been refused because of maintenance issues. It was refused because they have stated that the house was incorrectly built and this alone isn't a valid reason to refuse a claim.

naedanger

dacouch wrote: »

You're miss interpreting ICOBS 7.3.6

It does not mean an Insurer cannot reject any claims barring the ICOBS exceptions, it means the Insurer cannot refuse a "valid" claim eg something that is covered by the policy.

This link from the Ombudsman gives a better explaination of how they handle storm claims along with maintainence issues using the "But for" test http://www.financial-ombudsman.org.uk/publications/technical_notes/storm-damage.html

This passage is relevant to the OP's situation...

"http://www.financial-ombudsman.org.uk/publications/technical_notes/storm-damage.html"

The link you have given is very interesting.

I wonder if Aviva's real argument is either:
(1) there was no storm damage because there was no storm (and effectively the damage was old age/poor initial construction that they have explained) or
(2) there was a storm but the damage would have happened within a relatively short period of time anyway.

If they are then the OP needs to gather evidence to rebut their argument.

If however Aviva is not disputing there was a storm or that the damage would not have happened otherwise (in a relatively short period of time) then I don't think they will be able to deny the claim because of poor construction 60 years ago.

Keep_pedalling

naedanger wrote: »

The link you have given is very interesting.

I wonder if Aviva's real argument is either:
(1) there was no storm damage because there was no storm (and effectively the damage was old age/poor initial construction that they have explained) or
(2) there was a storm but the damage would have happened within a relatively short period of time anyway.

If they are then the OP needs to gather evidence to rebut their argument.

If however Aviva is not disputing there was a storm or that the damage would not have happened otherwise (in a relatively short period of time) then I don't think they will be able to deny the claim because of poor construction 60 years ago.

I think they could, looking at the wording on my own insurance documents there is no mention of timescales involved. As the big bad wolf found, wind alone cannot take out a brick wall. If that wall is not the only one vulnerable to collapse then we could be talking about a total rebuild here, so even if they would cover the repair of the damaged wall as storm damage preventative repair to the rest of the house would not be covered.

If the rest of the building is not safe then it may be worth contacting the local council about some emergancy accommodation for the OPs uncle.

naedanger

Keep_pedalling wrote: »

I think they could, looking at the wording on my own insurance documents there is no mention of timescales involved.

Did you read the link?

hollydays

naedanger wrote: »

Aviva Social Media Team, I realise you cannot comment on the details of a specific case.

However I am concerned about the policy your company operates when assessing whether a claim for storm damage is valid.

Is your general policy to exclude claims where you assess there has been faulty construction if those faults would not be apparent to a typical customer?

You are making a lot of assumptions here

naedanger

hollydays wrote: »

You are making a lot of assumptions here

No, I have made only one assumption, which is that they are unable to comment on the detail of specific cases. If I am wrong they can still answer my general question.