Repudiated Claim 17 May 2022 at 9:38AM in Insurance & life assurance 6 replies 202 views

Georgio1953

I have met a lady who is elderly 89, she is vulnerable lonely and fragile, but deemed by social services of sound mind, she has been in bed since November 21 recovering from covid, she is by her own admission a Hoarder, you can't move around her home, back around xmas 21 her kitchen ceiling collapsed, and from viewing this it would appear to be a long term leak she now has no operational kitchen, the electrics are shut down throughout the house apart from a temp supply to her lounge, she made a claim on her policy and this has been repudiated, leaving this lady in a complete state of shock with no funds to make repairs, surely there is a bigger picture to this and the insurers should have a duty of care towards her, she would have been blissfully unaware of any ongoing leak, there is no family or support network to step in

[Deleted User]

Insurance doesn't typically cover issues cause by ongoing lack of maintenance. Their 'duty of care' extends to the limitations of the policy.

It sounds as if she needs external support, though from where, I have no idea. I would start back with social services.

Sandtree

Unfortunately being a vulnerable customer doesn't mean the rules of the policy gets changed for you... that would be unfair on other customers, shareholders and others if it was truly a retrospective industry wide edict.

Ultimately if she doesn't feel the terms of the policy have been appropriately applied she is free to raise a complaint and if unhappy with their response to the complaint, or no response is received after 8 weeks, then it can be escalated to the Ombudsman.

Has the leak been repaired? No home insurance will cover leaks themselves unless you put a nail through the pipe which I am guessing she didn't. Is it just the result of the ceiling being down that you are saying her kitchen is inoperable or did the falling plasterboard cause other damage? If she has accidental damage cover then it MAY respond to the result damage the ceiling did when it fell even if the fall of the ceiling itself isn't covered. 

eddddy

Presumably, she owns her home, as opposed to renting it.

To be honest, this sounds like you might need to report this to social services.  Or are they already aware?

They won't get involved with a dispute with the insurance company, or help with fixing the kitchen ceiling - but they have a duty to ensure that she is safe and well. They might decide she needs visits from carers, or hot meals delivered - they might even help with arrangements for clearing-out the hoarding.

But if the house in uninhabitable, they might recommend that she moves into a care home.

Assuming she owns her house, the council would probably put a charge on it to recoup the cost of carers, care home, etc.

Smithcom

Georgio1953 said:

I have met a lady who is elderly 89, she is vulnerable lonely and fragile, but deemed by social services of sound mind, she has been in bed since November 21 recovering from covid, she is by her own admission a Hoarder, you can't move around her home, back around xmas 21 her kitchen ceiling collapsed, and from viewing this it would appear to be a long term leak she now has no operational kitchen, the electrics are shut down throughout the house apart from a temp supply to her lounge, she made a claim on her policy and this has been repudiated, leaving this lady in a complete state of shock with no funds to make repairs, surely there is a bigger picture to this and the insurers should have a duty of care towards her, she would have been blissfully unaware of any ongoing leak, there is no family or support network to step in

Ignoring the 'hoarder issues' for one second, if a leak is ongoing, unbeknown to the householder, I would expect a Household policy to respond, in respect of subsequent damage caused.   There should be FOS (Financial Ombudsman Service) guidance on this matter, which should be available on their website.

With the vulnerable nature of the policyholder, I would expect a 'fair' review of the claim by the insurer, to see if their decision is incorrect.

There are potential complexities with this matter, but it may be able to be resolved.

Is it a 'Household Name' insurer?  

You're welcome to message me, if you would like to discuss further.   There's certainly no guarantees or silver bullets.

SC

elsien

eddddy said:

Presumably, she owns her home, as opposed to renting it.

To be honest, this sounds like you might need to report this to social services.  Or are they already aware?

They won't get involved with a dispute with the insurance company, or help with fixing the kitchen ceiling - but they have a duty to ensure that she is safe and well. They might decide she needs visits from carers, or hot meals delivered - they might even help with arrangements for clearing-out the hoarding.

But if the house in uninhabitable, they might recommend that she moves into a care home.

Assuming she owns her house, the council would probably put a charge on it to recoup the cost of carers, care home, etc.

It’s not that simple. People who are hoarders but have capacity around their support needs can decline any offers food/carers etc. Plus if the house is in that sort of state then care agencies will decline to go in on safety grounds - there is a duty to protect their staff. 

I’m presuming she’s up and about out of bed now, given that you’ve met her.
What are her views with regards to selling up and moving elsewhere - I’m guessing that’s a no but would she consider sheltered housing, for example.
She may be willing to accept help from specialist hoarding services (that might need a social services referral) and in extreme cases environmental health can go in and condemn the property. Although the only person I’ve come across in those circumstances had an inheritance and could move on. 

But no-one is going to be paying for repairs to her home. 

First question though - does she want social services involved? Other than money for repairs, what would she like to happen? 

Going back to the insurance, there is normally a question about whether the property is in a good state of repair. If it isn’t and she’s not declared that, that in itself might invalidate the policy, aside from insurance not covering maintenance issues. If she feels she has been wrongly turned down, she can make a formal complaint to the insurer. 

Georgio1953

Hi and thank you all for your comments.

ZX81 - Yes social services you think would step up, but they deem her to be of sound mind and will not intervene, whilst to me she seems a troubled soul living in her own world and she tells me she just wants to die.

Sandtree - I have discussed the ombudsman with her but she does not understand or take anything on board, I can't keep her attention long enough to make any headway.  We have repaired her leak which was the float in her tank which had failed, the overflow went out on to the flat roof of the kitchen which has a mountain of vegetation on it, the ceiling joists are totally perished, the kitchen wall and base units are done for hanging of the wall.

Eddy - She owns her own home and as already stated social services see little wrong with her, I don't think they have had the patients to sit and chat with her, I'm no expert but in my opinion she has some mental health issues, I think for mainstream people the house would be considered total uninhabitable and a complete fire risk, but to her it's normal, however the fire services have installed some smoke alarms and advised her, but nothing has changed and nothing will

Smithcom - The claim was repudiated by the loss adjuster and the insurers are a very well known brand, I will PM you with a little more info.

Elsien - It's been her life long home, she's going nowhere unless it's in a box, social services are not interested in the welfare of this lady, that is very clear from.my own enquiries.

Thank you all for your input