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Help! Claim refused after flooding

2

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  • Hi

    Well, we've had this update from our Insurer.....

    Good afternoon, upon review of the evidence provided from the surveyors visit, we will maintain the decline of your claim, we believe that the correct decision has been made. This is due to the damage not being consistent with a one-off insured event. Whilst we appreciate this is not the outcome you were wanting; we are unfortunately now closing the claim. Kind regards

    I've no idea as to how they can ascertain that the damage was not consistent with a one-off insured event and have asked them to elaborate on this point.
    Would it be best for us to go directly to the Financial Ombudsman at this stage?
  • BarelySentientAI
    BarelySentientAI Posts: 2,448 Forumite
    1,000 Posts Name Dropper

    I've no idea as to how they can ascertain that the damage was not consistent with a one-off insured event and have asked them to elaborate on this point.

    That's entirely consistent with the story you've already told.


    Would it be best for us to go directly to the Financial Ombudsman at this stage?
    You would have to have sufficient evidence to prove that the damage was due to "a one-off insured event".

    You've already discovered that "poor workmanship" was excluded, so if that's the cause then it isn't an insured event. You would also need to consider the policy definition of flood at least, and possibly other parts too.

    The Ombudsman isn't just going to think "oh, sounds a bit harsh, here's some money".  There needs to be an actual, documentable, factual error in something - whether that's interpretation of policy wording, physical evidence etc...
  • Sea_Shell
    Sea_Shell Posts: 10,032 Forumite
    Tenth Anniversary 1,000 Posts Photogenic Name Dropper
    So did all the water come from the neighbours down pipe and direct rainfall or was it also coming through the retaining wall etc?

    Next door's down pipe starts on their side of the rear flat roof, but feeds into our land drain ( they now have a vented soil pipe in place where I presume the down-pipe once was).
    She is in a home and hasn't been living here for a couple of years, so am reluctant to raise it with her family.

    The pipe had become dislodged and was gushing onto our 'latent-defected' concrete path, pushing debris that blocked the drain covers.
    as we'd cleared the drains twice since September, it was easy and straightforward to get them functioning. Its never happened before (in far worse conditions over the last 21 years), which leads me to suspect the down-pipe - and water not getting into the land drain was the main factor here.

    In light of your insurers response, it may be time to "bite the bullet" and contact the owners (or their family) of the next door house that has the faulty downpipe, and hold THEM responsible for the damage through lack of maintenance.

    It sounds that this dislodged pipe had contributed, or exacerbated, the flooding issue, by directing excess water onto your property, and flushing debris into your drains, blocking them.

    Just because they've gone into a home, surely doesn't mean they can just leave the property to degrade in such a way that it causes damage to their neighbour's house.  

    Harsh....maybe.    But just one of the "joys" of home ownership.    Responsibility.

    Just thinking out loud.
    How's it going, AKA, Nutwatch? - 12 month spends to date = 2.60% of current retirement "pot" (as at end May 2025)
  • DullGreyGuy
    DullGreyGuy Posts: 18,613 Forumite
    10,000 Posts Second Anniversary Name Dropper
    Hi

    Well, we've had this update from our Insurer.....

    Good afternoon, upon review of the evidence provided from the surveyors visit, we will maintain the decline of your claim, we believe that the correct decision has been made. This is due to the damage not being consistent with a one-off insured event. Whilst we appreciate this is not the outcome you were wanting; we are unfortunately now closing the claim. Kind regards

    I've no idea as to how they can ascertain that the damage was not consistent with a one-off insured event and have asked them to elaborate on this point.
    Would it be best for us to go directly to the Financial Ombudsman at this stage?
    So this is a totally different issue then than a design flaw.

    It appears that they are saying the damage the property has sustained looks to have happened over time and not a single event a couple of days/weeks ago. 

    So what was the actual damage the flood caused? Have you looked closely to see if there are signs of rot or something else suggesting it's not a one off? 

    With a prior case that passed my desk it appeared as if water was regularly coming in behind the kitchen but not overwhelming the kitchen so the customer claimed not to be aware whereas there was then a much more major flood and it came out from under the kitchen kickboards so the customer reported it. In this case the inspection was done within days of the reported flood but our adjustor found thick layers of mushrooms (dead and growing) and clearly that illustrated long term water ingress. 


    To go to the ombudsman you need to either 1) have a final response from the insurer or 2) 8 weeks have passed since the complaint was registered. If their response is a final response it will be clear from the letter and it will inform you of your right to go to the ombudsman if you disagree. 

    It's not clear if they've dealt with it as a challenge to the decision or a complaint. 
  • Thanks everyone.

    DDG - they are still maintaining that its due to poor workmanship, but have not referenced the concreted path whatsoever, more so the downpipes.
    its a tad odd as I tried to point out to the Assessor our neighbours pipe that became dislodged, but he was more focussed on the path not allowing the water to drain away.

    As the water had risen to approximately 18 inches deep, it found its way into our living room and hall. The lounge carpet was ruined, as was the sofa with no legs. These were the items we listed as damaged, but we're unsure as to the condition of the old tiles and skirting boards. I was under the assumption that this is what would be assessed and was utterly devastated when this wasn't even looked at, the case was dismissed as soon as the rear of the property was viewed.

    I guess we'll have to wait the 8 weeks for the final decision - which I'm fairly confident as to what this will be - and then approach the FOS.
    in the meantime, we'll have to try and secure a loan to start the process of getting our home back - as well as changing Insurer!

  • The other option you might wish to consider is to appoint a Loss Assessor.  They have similar skills to the assessor you had from the insurer (usually titled a Loss Adjuster) but act on your behalf (and are paid by you).  Because of their background, they are usually very good at understanding the wording of policies and translating between insurer-speak and your language and will usually describe themselves as "fighting your corner with the insurer"..
  • Thanks Barely.

    I think I've watched too many Disney films with my girls when they were younger.

    Such a shame that life isn't based on trust, goodwill and doing the right thing. It says so much about us that an Assessor can deem the desired outcome to whoever is paying.

    Time for some whisky, tobacco and Frankie Boyle to wash away the voice of that snowman from Frozen!!
  • It says so much about us that an Assessor can deem the desired outcome to whoever is paying.

    They don't, really.  Adjusters are fair and don't set out to do anyone out of what they are entitled to.  I am well aware of cases where the insurer's adjuster has told someone to claim for something that they didn't realise could be included - it would have been very easy just to keep quiet about that point.

    Equally though, an insurer can't just throw money around for things that really aren't covered - a lot of complaints against insurers end up with the Ombudsman deciding that the customer has misunderstood what they thought they were insuring and how.

    There is an amount of subjectivity in all decisions, however, and that's where someone who knows the right words and precedents could be able to sway a discussion towards a particular interpretation.  As you said earlier, your expertise isn't in this sort of thing so you can't possibly be expected to know the ins and outs of it all.
  • DullGreyGuy
    DullGreyGuy Posts: 18,613 Forumite
    10,000 Posts Second Anniversary Name Dropper
    Sir_Leslie_Phillips said:
    It says so much about us that an Assessor can deem the desired outcome to whoever is paying.
    Many adjustors are external and technically they have a conflict of interests because their fee is proportional to the size of the claim so actually its in their interests to have paid high value claims than to negotiate the settlement downwards. For repudiated claims they sometimes get nothing more than a fixed fee.

    A former client provided these services to insurers and it was funny the amount of claims they settled for £4,999.99 or £9,999.99 when had they settled for just 1p more they'd have gotten an extra £100+ in fees. 
  • Apologies All - think the emotion of it all - and the whisky - somewhat fuelled my poorly considered posting last night!
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