Insurance claim after fire rejected

m00npig

Hello,

I understand we're bang to rights here and there is unlikely to be anything we can do but wanted to know if anyone has been through this before or has any advice as we're rapidly approaching the very real prospect of losing our house.  We had a fire in our house three weeks ago where the smoke damage has affected the whole house and made it uninhabitable.  The complication is that the fire was started by my son.  During his arrest he was mentally assessed by social services and diagnosed with depression which we had seen no signs of previously.

The loss adjustor submitted a claim for £50000, which I now believe to be vastly overestimated, but the insurance company rejected the claim due to the definition of "you" being "you or anyone living in the house" and if the damage is caused maliciously by "you" they will not meet the claim.  Despite obviously being disappointed by this we took it on the chin.  I got a claim for a clean up of the house and could afford that.  We are currently in temporary accommodation and can just about afford that.  Gas supply and structure has been passed as safe but today an electrician is telling us he will need to inspect all of the wiring which also involves getting into cavities/voids which might mean taking the floors up or ceilings down.  At the very least this is another £400 for two days works but it could get much worse and we are close to running out of money.  The mortgage company won't offer us any extra lending due to taking a payment holiday earlier in the year which I purely took as a precaution and now heavily regret.

I truly believe if the insurance company would pay out ~£10000 we would have a chance to fix this mess.  I spoke to a loss assessor but he said the "you" definition is pretty watertight.  I am hoping the depression diagnosis might carry some weight and plan on complaining to the insurer as I have nothing to lose.  If anyone has been here before or can offer advice it would be sincerely appreciated as the combination of this and the charge against my son and the concerns about his future are really starting to close in on us.

Thanks

tacpot12

I think you need some expert evidence as to whether your son's behaviour might not have been malicious. You can expect your insurer to also seek their own expert advice, but you might be able to argue that they should pay half if you can sow some seeds of doubt. 

Aretnap

Very sorry for your situation.

I've found a few Ombudsman decisions on this subject and it seems to be quite a complicated area. Mental illness can, it seems, negate the "deliberate damage" clause of an insurance policy, but it has to be fairly severe mental illness. Have a look here

https://www.financial-ombudsman.org.uk/decisions-case-studies/ombudsman-decisions

and search for DRN8726677, DRN3852008 and DRN0545107. (Two of those complaints were upheld, one was not)

All of those decisions involved adults; if your son is fairly young that is probably another point in your favour. Cartainly you have nothing to lose by making a complaint and arguing the point.

jimbo6977

Definitely worth pursuing this via formal complaint to your insurer followed by referral to FOS if necessary. Mental ill health, especially where undiagnosed, especially in a minor... 

m00npig

Many thanks for the replies, especially Aretnap for those links which give a glimmer of hope.

Annemos

Good luck m00npig 

My experience with Insurance companies is that the Loss Adjuser can seize on the most obvious way to deny a settlement. 
They are very experienced in this and go to the print in the policy as their starting point. They hope it will work. They are using a broad-brush approach that they apply to everybody and they may not look at your own actual facts and circumstances, until they are forced to.  

I found that I had to put in a lot of effort to research other Ombudsman cases and find information that I thought would help me in my particular case. So, I googled for information about other people who had had a similar event. (This is what you are also doing via this site.) 

1) Once you have that, you can formally complain to the Loss Adjuster company first. That did work on the first element of my claim. (The Complaints Line of my policy would not deal with me until I had formally complained to the Loss Adjuster company first and given them a chance to resolve it. ) 

2) But then something else went wrong. I tried again to complain to the original Loss Adjuster, but I was not happy with the outcome.

3) This led to me issuing another Formal Complaint and this time it was submitted to the actual Complaints Line of the company that sold me the policy.  (You can see where to go for that in your policy documents.) That then led to me being given a new Loss Adjuster working for the Complaints Company this time. This is now in process. 

4) If this does not succeed to my satisfaction, my next step is the Financial Ombudsman. 

So, in my case I found out that we do in theory have to go through the process. And this is required, I believe, before the Ombudsman Service will step in. 

The trouble is, each time I did one of those complaint elements,  I was tied in to an eight week response time, that they are allowed to use. 

tacpot12

I would keep going with the repairs as best you can afford them. Keep the receipts and hopefully the insurer will eventually reimburse you. 

Annemos

We also had a young mother in our village who had a fire in the upstairs and I think she was not insured. It was a candle that set light to things. She was alone with 2 little boys. 


She needed a certain amount to get the urgent repairs done. One of her family set up a funding page for the family members to contribute. (Can't remember if it was GoFundMe.) 

'They also posted it on the local village facebook site and so I saw it and made a small contribution. So did many others. She did raise enough momey to start off again. 

Could that also help out if you need to? 

Dr_Crypto

How old is your son? Was he sectioned or admitted to hospital in some way? If he was so mentally ill as to be hospitalised you could attempt to show he lacked intent so the damage wasn’t malicious. If he’s just been diagnosed as depressed and given 50mg sertraline and sent back to his GP it’s going to be a lot harder to show that.

Aretnap

m00npig said:

Many thanks for the replies, especially Aretnap for those links which give a glimmer of hope.

A couple more reasons for optimism:

(1) If your son is relatively young,  children and teenagers have less responsibility for their actions than adults to begin with, so logically the degree of mental illness needed to negate the "deliberate" clause should be lower than for an adult. 

(2) All the cases I linked to involved damage caused by a (joint) policyholder. In your case it was caused by a third party to the contract who happens to be a family member. Not sure whether it makes any difference in a strict legal sense, but I would think that an ombudsman is more likely to start from a position of sympathy when the person who caused the damage will not benefit (not directly, at least) from the payout. 

Dr_Crypto

The linked FoS cases are interesting. The same officer has dealt with two of them and reached seemingly opposing conclusions. In the first the joint policyholder’s (estranged?) husband  completed suicide by setting himself and the house on fire. He was not sectioned just days before the event. Despite some issues with the medical evidence the insurer was ordered to pay.

In the second the joint policyholder wife set the house on fire in a suicide attempt. She then fled the house and was later sectioned. The insurer made a significant ex gratia payment but was not ordered to pay anymore. 

I can’t see much difference between the cases except that in the first the suicide was completed and in the second it wasn’t.