Urgent Assistance Needed: Utility Warehouse Denies Claim Despite Engineer's Report

garichd

Hello Community,

I hope this message finds you well. I am reaching out to seek advice and assistance regarding a recent issue I've encountered with Utility Warehouse and a homecover insurance claim.

Background: I reported a leak issue in my home to Utility Warehouse, and they requested an upfront policy excess payment of £60 before sending an engineer. After paying, the engineer visited my property and provided a detailed report. According to the engineer, the leak is from the shower waste pipework or the shower trap, falling under the category of internal waste water pipes.

Policy Coverage: The policy coverage explicitly includes "Repairing leaks to internal waste water pipes" under Section D – Drains, indicating that my claim should be eligible. Moreover, while Section C - Plumbing notes an exclusion for "Leaks from household appliances, sinks, baths, or showers where the leak only occurs when the item is in use," my argument is that the internal waste water pipes will only leak when the connected appliance (shower) is in use.

Claim Denial: Despite the engineer's findings and the policy coverage, Utility Warehouse closed the case today with the message, "Job Complete - Your engineer has indicated they have finished the repair and no further work was required." When I contacted them, they denied my claim, citing the exclusion in Section C as the basis for denial.

Seeking Guidance: I am reaching out to the community for advice on how to proceed. I am puzzled by the conflicting information provided by the engineer's report and the denial from Utility Warehouse. I want to ensure that I follow the correct procedures and understand if there are any additional steps I can take to escalate the matter.

Forum Experts: If there are any insurance or legal experts in the community, your insights would be highly appreciated. What would be the best course of action in this situation, considering the exclusion in Section C? Should I follow up with Utility Warehouse, and if so, what specific steps can I take? Additionally, is there a formal complaints process that I should adhere to before considering escalation to the Financial Ombudsman?

Thank you in advance for any guidance or assistance you can provide. I value your expertise and insights.

Link to Utility warehouse policy wording :

https://s3-eu-west-1.amazonaws.com/uw-prod-insurance-assets/documents/boiler/policy_wording.v2.pdf

tacpot12

I think you need to go to the Insurance Ombudsman. The Section C exclusion for "Leaks from household appliances, sinks, baths, or showers where the leak only occurs when the item is in use" means what it says: that if the appliance, sink, bath or shower leaks when the item is in use, then you cannot claim, but it is not the shower item that is is leaking, it is the drain that is leaking. They are (possibily deliberately) misunderstanding their own policy wording.

Their wording is there so that they don't have to cover a leak from inside a washing machine, or a cracked sink/bath/shower pan. This is reasonable, and you should confirm that you accept that they don't cover an appliance/sink/bath/shower pan that is leaking, but that you expect them to cover a drain that is leaking.

Your alternative to the Insurance Ombudsman is the small claims court. If you have legal expenses cover as part of your home insurnace, call the legal helpline to see if they can advice on which route is likely to be better. 

DullGreyGuy

Do you have a link to the policy book online? Looking at their Home cover (not sure if it is Home or Home Emergency or something else) it doesn't have corresponding sections to the ones you mention. 

garichd

DullGreyGuy said:

Do you have a link to the policy book online? Looking at their Home cover (not sure if it is Home or Home Emergency or something else) it doesn't have corresponding sections to the ones you mention. 

@DullGreyGuy
Thank you for responding. The original post includes a link to the policy booklet, and I am also providing it below for your convenience.

https://s3-eu-west-1.amazonaws.com/uw-prod-insurance-assets/documents/boiler/policy_wording.v2.pdf

DullGreyGuy

garichd said:

DullGreyGuy said:

Do you have a link to the policy book online? Looking at their Home cover (not sure if it is Home or Home Emergency or something else) it doesn't have corresponding sections to the ones you mention. 

@DullGreyGuy
Thank you for responding. The original post includes a link to the policy booklet, and I am also providing it below for your convenience.

https://s3-eu-west-1.amazonaws.com/uw-prod-insurance-assets/documents/boiler/policy_wording.v2.pdf

I'm blaming the Lemsips... I'm tripping on anti-flu stuff today.

Section C is about cover for Plumbing Systems (its a defined term) which is states its all the inbound water pipes (ie clean water only). Your claim is in relation to the drain and so Section C is irrelevant. 

Section D is mainly to be about cover for drains (not a defined term) and if you read the header its really about blocked drains (see page 5)

The detail of section D however does mention it also covers leaks from internal waste water pipes (again not defined term). Section D however also has the same exclusion as C that it doesn't include leaks that only occur whilst the appliance is in use nor any escape of water that's not causing damage or risk nor any damage caused by escape of water from showers, sanitary ware etc

Whilst they have quoted the wrong section's exclusion the right section has the same exclusion. There is the potential to argue what "in use" means as presumably if you turn off the taps and step out it is then no longer in use but the trap will still be leaking... not continually forever but at least for a little while longer as all the water escapes. It's a bit tenuous but that's the advantage of clauses without defined definitions. 

The complaints process is on page 7, you could simply argue at this point that whilst the exclusion under C is good to know for the future if you ever have a Plumbing System leak that your claim was under D as it was a drain but you are likely to get a basic apology saying it was an error in referencing C but D has the same exclusion. 



 It's ultimately a typical Home Emergency policy, only covers things that are an emergency to deal with and if you can avoid the problem by not using a certain tap it doesn't count as an emergency. 


Was there any damage from the leak? It may be a consideration for claiming on your Home insurance if there was. They won't cover repairing the leak (but may cover finding it and reinstating after) but would cover the resultant damage unlike this policy. 

garichd

DullGreyGuy said:

I'm blaming the Lemsips... I'm tripping on anti-flu stuff today.
...............

Thanks, @DullGreyGuy. 

Wishing you a speedy recovery. I'm also feeling unwell. Regarding the term "defined term," if it pertains to whether the term is defined in the "Definitions" section, "Drains" is indeed defined under "Definitions" 11.10. I'm uncertain whether this information is beneficial for my situation.