House insurance claim declined

bobby2020

Hi 

I recently had my ceiling come down in my flat.  There has been a few water leaks from neighbour above me over the years. 

The room where the ceiling came down hasn't had any water leaking ( as far as I can tell) 

Insurance company have declined my insurance claim. As they say this is historical and was gradual damage rather than recent leak

I've never heard of this? Was I suppose to tell my insurance company anytime there is a leak even though I'm not claiming? I never mentioned before as my excess was £450
They have asked me to send any historic photos or videos to back up my claims. I asked what do you mean historic? What timeframe are you talking about. I'm reluctant to send anything as they will use this to back up their refusal of the claim. 
Any advice on how I can take this further? 
Thanks in advance 

user1977

What do you think caused the ceiling to come down? Insurance only covers specific risks, generally sudden things like a burst pipe. If it was just old and knackered, that's not what insurance is for.

Aretnap

Home insurance generally covers damage caused to your home by certain specified one-off events - things like fires, floods, storms etc. It doesn't cover "general bad stuff that happens" and specifically it doesn't cover wear and tear, routine maintenance and things that happen gradually over time - those are just part of the joy of being a homeowner. 

Escape of water IS usually covered, but you have to be able to tie the damage to a specific event like a leak or a burst pipe. You say that there have been a few leaks at some point in the past but apparently not in the room where the damage occurred, so it doesn't sound good for your chances of tying the damage to a specific incident.

Generally the onus is on you to prove that the damage was caused by an insured event so if you don't have any evidence connecting the damage to a recent leak, or if you don't want to share your evidence with them, then you're not going to be able to challenge their rejection of the claim.

(The exception to the above is if you have an "all risks" policy, which does cover "general bad stuff" with a list of exceptions. Wear and tear and gradually operating causes will still be excluded, but with that sort of policy the onus is on the insurer to prove that the cause of the damage was excluded rather than on you to prove that it was covered. However most home insurance policies, especially the cheaper ones, are written on an "insured peril" basis where the policy gives a list of risks that are covered and the onus is on you to prove which one caused the damage).

bobby2020

user1977 said:

What do you think caused the ceiling to come down? Insurance only covers specific risks, generally sudden things like a burst pipe. If it was just old and knackered, that's not what insurance is for.

The insurers think it was water damage. But they are saying it wasn't recent. It was gradual. 

bobby2020

Aretnap said:

Home insurance generally covers damage caused to your home by certain specified one-off events - things like fires, floods, storms etc. It doesn't cover "general bad stuff that happens" and specifically it doesn't cover wear and tear, routine maintenance and things that happen gradually over time - those are just part of the joy of being a homeowner. 

Escape of water IS usually covered, but you have to be able to tie the damage to a specific event like a leak or a burst pipe. You say that there have been a few leaks at some point in the past but apparently not in the room where the damage occurred, so it doesn't sound good for your chances of tying the damage to a specific incident.

Generally the onus is on you to prove that the damage was caused by an insured event so if you don't have any evidence connecting the damage to a recent leak, or if you don't want to share your evidence with them, then you're not going to be able to challenge their rejection of the claim.

(The exception to the above is if you have an "all risks" policy, which does cover "general bad stuff" with a list of exceptions. Wear and tear and gradually operating causes will still be excluded, but with that sort of policy the onus is on the insurer to prove that the cause of the damage was excluded rather than on you to prove that it was covered. However most home insurance policies, especially the cheaper ones, are written on an "insured peril" basis where the policy gives a list of risks that are covered and the onus is on you to prove which one caused the damage).

The insurers believe it was water damage. 

I don't really have any evidence to provide them. 

oldernonethewiser

In a previous property I had a lathe & plaster ceiling come down. Insurance assessor came out and was able to see evidence of historical water damage caused by a leak at some point from the flat above which had, over time, weakened the ceiling. 

Insurance paid up, no problem. (Fortunately as it was a few grand to reinstate)

If your insurers accept it is water damage what is their reason for denying the claim?

DullGreyGuy

oldernonethewiser said:

In a previous property I had a lathe & plaster ceiling come down. Insurance assessor came out and was able to see evidence of historical water damage caused by a leak at some point from the flat above which had, over time, weakened the ceiling. 

Insurance paid up, no problem. (Fortunately as it was a few grand to reinstate)

If your insurers accept it is water damage what is their reason for denying the claim?

EoW only covers water coming from a fixed water system (ie a leaky pipe) but doesnt cover say the sealant on a bath failing and water gradually ingressing down.

Evidence of water damage doesnt mean water was the cause of the collapse (as in mass of water accumulating on the plaster which then gives way) but could be just one of a number of issues with an old ceiling.

The other consideration is Accidental Damage, OP hasnt said if they have this or not but in some cases you can get collapsed ceilings being covered even if the underlying event wasnt (eg bad weather but not bad enough to be a storm, lose roof tiles and water getting in causes ceiling to collapse... roof damage not covered as not a storm but ceiling covered as AD).

user1977

bobby2020 said:

Aretnap said:

Home insurance generally covers damage caused to your home by certain specified one-off events - things like fires, floods, storms etc. It doesn't cover "general bad stuff that happens" and specifically it doesn't cover wear and tear, routine maintenance and things that happen gradually over time - those are just part of the joy of being a homeowner. 

Escape of water IS usually covered, but you have to be able to tie the damage to a specific event like a leak or a burst pipe. You say that there have been a few leaks at some point in the past but apparently not in the room where the damage occurred, so it doesn't sound good for your chances of tying the damage to a specific incident.

Generally the onus is on you to prove that the damage was caused by an insured event so if you don't have any evidence connecting the damage to a recent leak, or if you don't want to share your evidence with them, then you're not going to be able to challenge their rejection of the claim.

(The exception to the above is if you have an "all risks" policy, which does cover "general bad stuff" with a list of exceptions. Wear and tear and gradually operating causes will still be excluded, but with that sort of policy the onus is on the insurer to prove that the cause of the damage was excluded rather than on you to prove that it was covered. However most home insurance policies, especially the cheaper ones, are written on an "insured peril" basis where the policy gives a list of risks that are covered and the onus is on you to prove which one caused the damage).

The insurers believe it was water damage.

If "the room where the ceiling came down hasn't had any water leaking", where did the water come from?

bobby2020

DullGreyGuy said:

oldernonethewiser said:

In a previous property I had a lathe & plaster ceiling come down. Insurance assessor came out and was able to see evidence of historical water damage caused by a leak at some point from the flat above which had, over time, weakened the ceiling. 

Insurance paid up, no problem. (Fortunately as it was a few grand to reinstate)

If your insurers accept it is water damage what is their reason for denying the claim?

EoW only covers water coming from a fixed water system (ie a leaky pipe) but doesnt cover say the sealant on a bath failing and water gradually ingressing down.

Evidence of water damage doesnt mean water was the cause of the collapse (as in mass of water accumulating on the plaster which then gives way) but could be just one of a number of issues with an old ceiling.

The other consideration is Accidental Damage, OP hasnt said if they have this or not but in some cases you can get collapsed ceilings being covered even if the underlying event wasnt (eg bad weather but not bad enough to be a storm, lose roof tiles and water getting in causes ceiling to collapse... roof damage not covered as not a storm but ceiling covered as AD).

I don't have accident damage unfortunately 

bobby2020

user1977 said:

bobby2020 said:

Aretnap said:

Home insurance generally covers damage caused to your home by certain specified one-off events - things like fires, floods, storms etc. It doesn't cover "general bad stuff that happens" and specifically it doesn't cover wear and tear, routine maintenance and things that happen gradually over time - those are just part of the joy of being a homeowner. 

Escape of water IS usually covered, but you have to be able to tie the damage to a specific event like a leak or a burst pipe. You say that there have been a few leaks at some point in the past but apparently not in the room where the damage occurred, so it doesn't sound good for your chances of tying the damage to a specific incident.

Generally the onus is on you to prove that the damage was caused by an insured event so if you don't have any evidence connecting the damage to a recent leak, or if you don't want to share your evidence with them, then you're not going to be able to challenge their rejection of the claim.

(The exception to the above is if you have an "all risks" policy, which does cover "general bad stuff" with a list of exceptions. Wear and tear and gradually operating causes will still be excluded, but with that sort of policy the onus is on the insurer to prove that the cause of the damage was excluded rather than on you to prove that it was covered. However most home insurance policies, especially the cheaper ones, are written on an "insured peril" basis where the policy gives a list of risks that are covered and the onus is on you to prove which one caused the damage).

The insurers believe it was water damage.

If "the room where the ceiling came down hasn't had any water leaking", where did the water come from?

Yeah not sure where water came from. So unlikely to show evidence

Just seems very unfair and a way for insurance not to pay out. They say it was water damage. I wasn't aware of the damage until the ceiling came down. 

It seems unless it's a heavy leak which makes the ceiling collapse immediately, it's difficult to claim. 

Is there anyway to recoup costs against neighbours? 

I feel I might just complain to the insurers in any case and try and reclaim costs. Seems I will just have to fix myself and see if I can recoup costs somehow. Its taken them 2 months to tell me the claim is declined 

DullGreyGuy

bobby2020 said:
Is there anyway to recoup costs against neighbours? 

To claim against the neighbours you would need to show they were negligent which is defined as "doing something that a reasonable person wouldnt or, failing to do something a reasonable person would".

In principle for something like this you would have to show that they reasonably would have known about the leak and had sufficient time/means to resolve it prior to the damage. This normally comes about when you've noticed you've got water coming through the ceiling each time they run their washing machine but despite telling them they fail to fix the leak in the washing machine.

From what you say, you were unaware of this leak and so in all probability so were they.