Help….Escape of water insurance claim

Kelsbelsrose23

I will try to keep this as short as possible. It’s not pretty, we’re having absolutely awful time with coop insurance and Sedgwick loss adjusters.
In June 2024 we discovered a HOT water leak in our utility room. 

When the house was empty my husband heard water running in the utility room when everything was turned off. 

He turned off the cold water feed and could still hear it. Turned off hot and it stopped.

Notified insurance co.

Utility room is surrounded by an open plan kitchen and dining room. There is a dividing wall between utility room and dining room end.
 
Traced and floor in utility room dug up and leak repaired, it was a pipe under the utility room floor which had burst. It had a join on the bend which had failed. 
The floor is still open to this day! 

We covered with a bit of wood as we noticed that my husband and sons asthma was bad and attributed this to spores coming out from the hole.

Not only was there damage in the utility room floor where the water was directly spraying onto the joists, but the damage had radiated out from the utility room under the kitchen floor, the dining room floor, raised the wooden flooring probably made worse by the fact that hot water caused steam which had penetrated the sub floor wooden joists and floorboards in the utility room. The kitchen tiles had cracked and the utility room wall was wet as were the units.

Other damage that we know of includes:
Utility room: Cupboards, worktop, floor tiles, skirting board, wall, doors stopped fitting.
Kitchen: floor tiles, kitchen kickboards, skirting boards, tiles, double cookers (steam damage came up through rear) both stopped working within same week) wine fridge (steam damage) also stopped working in same week. Floor tiles, drawers stopped fitting.
Dining room: wooden floor, skirting boards
plus adjoining wall between utility room and dining room was wet.

Loss adjuster visited and took readings of damp, discussed damage. 

Had a teams call with insurer to discuss what happened.
Claim approved.
Kitchen out of action. 

We’ve been told by the contractor who did the repair that we’re lucky we haven’t fallen though the floor. More floor tiles have cracked and you can feel the floor move under your feet. It’s dangerous.

No offer to resite us, instead they’re paying us a disturbance allowance of £50 per day (5 of us in home). 

They don’t pay the DA unless chased.
We haven’t had a payment since 15/11/24.
The loss adjuster communication is appalling. We haven’t made two complains and both were upheld and they’ve send us compensation of £100 for 1st complaint and £200 for 2nd.

Loss adjusters took nitrate readings from the wall between the utility room and dining room and they’re saying that the readings show nitrates which indicate pre existing damp and attributed this to a rise in the water table. Bearing in mind this was in the summer.
We have never had any problem with damp, in fact 6 yrs ago we had a new kitchen and flooring refit and the flooring was up. No evidence of damp at all. we have photo evidence of this.
The contractor sent out to take the nitrates test was at a loss to why on earth they would cover the cost of the flooring when clearly the damage to the flooring results from the water  from the leak damaging the sub floor which caused the warping and cracking of the tiles and oak? It makes absolutely no sense whatsoever.

We had the Walls reskimmed when the kitchen was fitted and the plaster would not have cured if there was damp present! 

As I say all was perfect until this leak. 

We spared no expense when we purchased the Kitchen including an island all with granite worktops. Floor tiles from Porclenosa, dining room was laid with engineered oak.
We would have never spent out a fortune and laid the kitchen onto damp! 

The insurance company are saying they will only cover the cost of the flooring (tiles and engineered oak) and skirting. 

We are fuming. 

Despite the complaints and us arguing our case, they will not budge on their decision.

They won’t commit to paying for possible repairs if any worktops or kitchen units are damaged when removing and replacing the floor. Nor the hearth which runs under the wooden flooring.

They won’t sort the wall, the kitchen units, the utility room, the cookers or wine fridge.
They sent out a contractor to bring up flooring to check the damage but luckily we were savvy enough to question who would put right the damage resulting from the investigation and they then refused to open it up. Instead they brought fans in to dry the wall. This contractor was also at a loss as to why they won’t cover all of the damage. 

So other than what we can see from the tracing videos which were conducted when the repair to the leak was done we don’t actually know the full extent of the damage under the flooring? They refuse to do any more investigation.

We have disputed existing damp.
there was no evidence of damp prior to the leak. I researched the salt readings and they could have been there since constructions. 

I looked on the gov website and we are not in an area at risk of flooding. There is no previous evidence of damp.
Surface water flood risk-Yearly chance of flooding is LOW.
Rivers and the sea-Yearly chance of flooding is VERY LOW.
Other flood risks- Groundwater- Flooding from groundwater is unlikely in this area.
Reservoirs- Flooding from reservoirs is unlikely in this area.

The loss adjuster has now said there are not enough air bricks which attributed to the damage. 

There is an air brick directly adjacent to the leak site. 

There is another on the opposite wall.
there is no damage to the wider dining room or the walls.
There is no damp on the ground floor whatsoever. 

They said that when our extension which has a concrete floor was built, that we covered an air brick which is untrue. 

However there was an extension fitted prior to us moving in. If the previous occupants had removed an air brick when they did their extension how would we know? 

Surely we were insured and have been paying premiums based on the house as it was since we moved in. How can we be liable for works prior to when we moved in? 

All work we have had done was signed off by a surveyor. 

They advised us to obtain a report from an independant damp specialist which we did and they still argued this report.

I’ve told them I am going to financial ombudsman and asked for a final response.

Anyway this gets worse.
So as you can imagine this has been super stressful.
After waiting several weeks for the final response my husband had a heart attack at Xmas. 

I notified the insurance company and LA. They send the final response and flowers to apologise and wish my husband well.

Then knowing my husband is in hospital, the loss adjuster phones him while he’s still in hospital and puts on pressure the settle for a payment of £6000 to cover flooring only and a “global Disturbance allowance payment” of £4200. I do t even know what this means.

Well that was it. I lost it. I’ve told the insurance company that I won’t deal with the LA anymore. 

Still no kitchen facilities, no end in sight, one very poorly husband…….

Ombudsman it is. 

Should I go to the press? I’m absolutely appalled. I’ve never been through so much stress.
We still haven’t had a Disturbance payment since 25th November. They’ve raised a third complaint. 

At a loss! 

Does anyone have any recommendations what to do because I don’t think o can take much more and the prospect of fighting this through the ombudsman fills me with dread.

Kelsbelsrose23

Oh and very important to note that despite the weather is now significantly worse that what it was like in the summer, the wall is almost completely dry now and all doors and drawers are now fitting so if there was pre existing damp. How would this situation improve and dry out? 

Honestly. It begs belief. We’ve been with co- op for 30 years.

Annemos

I am so sorry. This is an awful situation. Claims like this are so stressful. My sincere wishes for your Husband and his health.  (I also had a very stressful claim and ended up in the Hospital one night.)



I am not an expert on this issue, but I wanted to do a search on Nitrates on the Ombudsman Website. If you do go to the Ombudsman, it is useful to have looked at some cases to see how they are constructed. And we also get used to the correct technical terminology

My first search has come up with this case. 

It says the following:  

======================
Quote: 

All of the above reasons put forward by Aviva are to my mind quite speculative, and I haven’t found them to be backed up with supporting evidence or indicative of there likely being a pre-existing damp problem. The main piece of expert evidence Aviva has relied on is the salt report compiled in April 2022. Those results indicated that all of the material sampled was ‘dry’ with no free moisture. The report also gave the salt levels sampled from around the property, with most having none or trace amounts. But two (out of the six) samples returned low, moderate or heavy levels of chloride and nitrate. The appendix of the report explained that salts in masonry may arise from ground water and be present as a result of long term rising dampness – or could arise occasionally from other sources.

 I think it’s important to note that the report itself doesn’t conclude there’s likely to be rising damp at Miss C’s property – it talks in very general terms, and recognises there could be other reasons to explain the presence of salts in the masonry. Miss C lives in a coastal area, and higher levels of salts in the air can lead to increased amounts being absorbed into plaster. She also lives in a hard water area – so the tap water will likely naturally contain a higher level of dissolved salts too. However, no baseline readings for the levels of salts in either the walls or the tap water was included in the report commissioned by Aviva. That means the insurer has no idea whether those readings are in fact elevated. Also, given there was extensive flooding of the solum, it seems likely the leaked mains water mixed with the ground water anyway – which, again, would explain a salt presence if the walls were saturated for an extended period by that water. 

End Quote. 

https://www.financial-ombudsman.org.uk/decision/DRN-4068378.pdf

==============================



I am now doing another search and it is throwing up 24 cases  when I searched under "nitrates ESCAPE OF WATER"

https://www.financial-ombudsman.org.uk/decisions-case-studies/ombudsman-decisions/search?Keyword=nitrates+ESCAPE+OF+WATER&IndustrySectorID%5B3%5D=3&Sort=relevance

I will take a look through and see if any seem relevant to you. 

Annemos

I have picked a selection from that previous search link. Looking at some of these, I am wondering if you may need to employ your own "surveyor and damp specialist" to challenge the salts issue.  (Edit: Re-reading your Post. I think you do already have a Report of your own? Is it one done some time ago or a recent one after the pipe burst?)

====================================================

Useful discussion on Page 2 

https://www.financial-ombudsman.org.uk/decision/DRN8047766.pdf

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This one was also deemed to have had a failure of the Damp Course and the FOS ruled the Insurer pay 50% of the Claim

https://www.financial-ombudsman.org.uk/decision/DRN5372253.pdf

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A kitchen in this one. 

https://www.financial-ombudsman.org.uk/decision/DRN1472497.pdf

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This one involved a bathroom. Nitrate test was clear, but this case illustrates a discussion on compensation awards. 

https://www.financial-ombudsman.org.uk/decision/DRN-2003759.pdf

====================

Discussion on Nitrates in here 

https://www.financial-ombudsman.org.uk/decision/DRN-4661116.pdf

===========================


Another Nitrates/Salts

https://www.financial-ombudsman.org.uk/decision/DRN-4379365.pdf

===============================


Here they said the Homeowner should get their own Professional Report if they want to challenge the Nitrates Conclusion.

https://www.financial-ombudsman.org.uk/decision/DRN-3119144.pdf


============================================

Many issues in this one. Again the Homeowner had to employ a "surveyor and damp specialist" to challenge the salts issue

https://www.financial-ombudsman.org.uk/decision/DRN7283843.pdf


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Annemos

https://www.financial-ombudsman.org.uk/businesses/complaints-deal/insurance/home-buildings-insurance/settling-home-insurance-claims

There is a tab in here called Alternative Accommodation. And in here it also describes Disturbance Allowance. 

DullGreyGuy

Kelsbelsrose23 said:

Then knowing my husband is in hospital, the loss adjuster phones him while he’s still in hospital and puts on pressure the settle for a payment of £6000 to cover flooring only and a “global Disturbance allowance payment” of £4200. I do t even know what this means.

Its worth noting that the ombudsman decisions do not create a legal precedent unlike the courts and so one ombudsman reviewing a case isnt bound to come to the same conclusion as the next however there is a reasonable level of consistency in responses (especially to those who know what to look for) and so its both worth reading previous decisions to see how they generally consider a matter and to get some phrases to use in your complaint but unlike a legal argument its not worth trying to quote X -v- P 2019 (or whatever citation of a particular case). 

Global offers are something we would do regularly, back in my motor days, you may have someone claiming £10,000 for injuries, £500 for their excess, £2,000 for loss of use of their car, £4,000 for loss of earnings, £1,000 for inconvenience. At times we'd respond to each element of the claim and say yes, no or a different figure and at other times we may respond saying our global offer was £15,000 without saying how that breaks down across the different sections. It's simply a negotiation tactic (noting I dealt with third parties not our policyholders) and moves it out of the weeds up to a higher level of negotiation. 

In this case it seems to be a full and final settlement for this particular head of claim rather than a global offer, to be able to consider it it needs clarification of if that is in addition to the amounts already received or inclusive of them 

Kelsbelsrose23

Super appreciate your responses.

We did indeed solicit a report from a damp specialist
I quote
” 1) Inspection

Evidence of wet rot to the floor and deteriorated to wall plaster. Efflorescent salts also

present to the rear right wall. Moisture meter readings were found to be high to the

floor of the utility and dining room where the laminate has also swollen adjacent to the

utility wall.

We consider from the evidence found and the presents of efflorescent salts the cause of

damp to the wall/s and floor is from/due to a water leak.

At this time, we would suggest you contact your insurance company and check

plumbing mains and waste pipes.”

We also found evidence that nitrates could be present from construction.
we live on the coast and I understand construction materials could throw up nitrates due to this. 

Insurance company response:

Please see the below comments from our surveyors following their review -

"I have read the independent damp report and provide the following comments;

The report states there is ‘evidence of wet rot to the floor (although does not state which section of flooring), and moisture readings were found to be high’. If present, wet rot would require the affected timbers to be cut out, and retained timbers in close proximity to be treated with an anti-fungal solution. The causes of wet rot are prolonged exposure to increased moisture and humidity, and restricted/reduced natural ventilation.

As noted on the attached consultant reviews the property has been extended on a number of occasions, with concrete floor slabs laid in the recent extensions. The restoration contractor did not see any evidence that the original air bricks that would have been present have been extended out to provide the necessary ventilation to regulate the moisture vapour levels to the sub floor void. As a result, we would expect the humidity levels within the floor void to be elevated, particularly during periods of rain. The increased levels of moisture vapour within the sub floor void would be absorbed by the floor timbers (joists, floorboards), potentially elevating the moisture levels above the threshold where fungal attack occurs. This would be further exacerbated should there be an escape of water, as has happened at this property.

The report then states ‘we consider from the evidence found and presence of efflorescent salts the cause of damp to the walls and floor is from a water leak’. The restoration contractor completed salts analysis testing to the wall plaster in both the lounge and utility, where salts efflorescence was noted. The results showed significant levels of Nitrates, which indicates the materials have, and may still have been affected by capillary ground moisture. If the deterioration was due to an escape of water from a treated water source we would expect to see the presence of Chlorides, however this doesn’t appear to be the case at this property.

The presence of Nitrates to the wall plaster also confirms that the damp proofing to the walls is not effective, if it were effective then moisture from under the floor void would not breach to the internal finishes.

The photographs provided on the report also have inaccuracies.

The photograph above has been used to demonstrate elevated levels of moisture to floor tiles. Capacitance type moisture readings potentially through several different materials (floor tiles, tile adhesive, etc) do not provide an accurate quantitative moisture reading for any of these materials. Such readings can however be useful in identifying relative differences in similar materials that could be indicative of water damage. Interestingly, the surveyor has not used the pins on the moisture meter to check the moisture readings to the softwood floorboards directly to the left. The reading provided is not a reliable reading when used in isolation as it could be affected by natural interstitial condensation to the unglazed underside of the floor tile, and equally could be further evidence that the humidity levels in the floor void are elevated due to the lack of ventilation.

The above photograph shows maximum readings to the laminate floor, I am assuming this is within the lounge near the sofa. The reading again is not a reliable reading as it could be a result of a conductive underlay being present under the laminate floor. The vee grooves to the laminate floor do not appear to be swollen/delaminating, which I would expect to see if the reading obtained was due to moisture."

Due to the above, the insurers stance remains the same on what is covered under the policy. 

Annemos

Gosh. This is outside my knowledge. I hope maybe after the weekend some damp experts might come and provide any help. 

But just some thoughts. 

As an outsider/layman, I don't understand some of the basics going on here. I am confused. 

Just how are they treating the claim? Why exactly are they not fixing all the damage that you have described? 

Let's consider that there is something like this: 

1  Damage under the Floors (if there is some) 
2  Damage to the Floors (different rooms)
3  Damage to plaster walls (different rooms) 
3  Damage to everything else above the floor, such as worktops, kickboards, kitchen units, cooker, wine fridge, etc


Both sides are agreeing that there was indeed a hot water pipe leak at "the join on the bend" (escape of water).

If that reply from the Insurance Company was to me, I would want a lot more detail for the 4 types of damage above. Because that reply does not tell me just why they are declining to cover all the damage I can see. 


For EACH of the 4 types separately, I would be wanting their clear explanations on these questions: 

a) What damage can be seen? (Complete List of each item of damage that you can see)  

b) What exactly was the cause of damage to each item in the list? 

c) What elements of that damage is the Insurance Company going to pay for? 

d) For any elements of the damage in the list, that the Insurance Company is NOT agreeing to pay for, what is the exact section in the Insurance Policy, that provides them with their reason for denial. (For each item.)


I stress again, I am a total novice on this. But I hope you can get this from them. I think this would make it clear exactly where you stand. And also make it clearer if you have to go to the Ombudsman. 

If they will not deal with you any more.    (That happened to me. Once they did a Final Response, they refused to deal with me any more and said they would wait for the Ombudsman Service review! I was really quite upset at the time, as I had not expected that they would not even allow me to discuss their Final Response. It was a ..... "Here it is... and that's it!").     Then you can include this lack of clear explanations in the Complaint, too? 

Annemos

Quick look to see if I can spot kitchen damage cases with respect to units etc. Lots and lots of cases when I search on "escape of water kitchen units"  Such as.... 

https://www.financial-ombudsman.org.uk/decision/DRN2584974.pdf


==================

This one discussed rot and says this   "I am satisfied that Ms L has done enough to show that she had an escape of water from a pipe that caused damage to her property. UKI knows that where rot is caused by an escape of water that otherwise could not have been known about we will not allow it to rely on an exclusion for rot to defeat the claim. Therefore, I find that UKI should deal with Ms L’s claim for damage caused by an escape of water at her property."

https://www.financial-ombudsman.org.uk/decision/DRN1588102.pdf


This one also has a rot discussion

https://www.financial-ombudsman.org.uk/decision/DRN-3333797.pdf



This one.... kitchen was damaged when they removed it to fix the floor....

https://www.financial-ombudsman.org.uk/decision/DRN-2194343.pdf


Discussions on kitchen and matching items

https://www.financial-ombudsman.org.uk/decision/DRN4032967.pdf

https://www.financial-ombudsman.org.uk/decision/DRN-4053516.pdf


This one kitchen. Also a discussion on whether Alternative Accommodation should have been provided. 

https://www.financial-ombudsman.org.uk/decision/DRN-2825594.pdf


Kitchen damages. 

https://www.financial-ombudsman.org.uk/decision/DRN-2783040.pdf

Havanese

Kelsbelsrose23 said:

I will try to keep this as short as possible. It’s not pretty, we’re having absolutely awful time with coop insurance and Sedgwick loss adjusters.
In June 2024 we discovered a HOT water leak in our utility room. 

When the house was empty my husband heard water running in the utility room when everything was turned off. 

He turned off the cold water feed and could still hear it. Turned off hot and it stopped.

Notified insurance co.

Utility room is surrounded by an open plan kitchen and dining room. There is a dividing wall between utility room and dining room end.
 
Traced and floor in utility room dug up and leak repaired, it was a pipe under the utility room floor which had burst. It had a join on the bend which had failed. 
The floor is still open to this day! 

We covered with a bit of wood as we noticed that my husband and sons asthma was bad and attributed this to spores coming out from the hole.

Not only was there damage in the utility room floor where the water was directly spraying onto the joists, but the damage had radiated out from the utility room under the kitchen floor, the dining room floor, raised the wooden flooring probably made worse by the fact that hot water caused steam which had penetrated the sub floor wooden joists and floorboards in the utility room. The kitchen tiles had cracked and the utility room wall was wet as were the units.

Other damage that we know of includes:
Utility room: Cupboards, worktop, floor tiles, skirting board, wall, doors stopped fitting.
Kitchen: floor tiles, kitchen kickboards, skirting boards, tiles, double cookers (steam damage came up through rear) both stopped working within same week) wine fridge (steam damage) also stopped working in same week. Floor tiles, drawers stopped fitting.
Dining room: wooden floor, skirting boards
plus adjoining wall between utility room and dining room was wet.

Loss adjuster visited and took readings of damp, discussed damage. 

Had a teams call with insurer to discuss what happened.
Claim approved.
Kitchen out of action. 

We’ve been told by the contractor who did the repair that we’re lucky we haven’t fallen though the floor. More floor tiles have cracked and you can feel the floor move under your feet. It’s dangerous.

No offer to resite us, instead they’re paying us a disturbance allowance of £50 per day (5 of us in home). 

They don’t pay the DA unless chased.
We haven’t had a payment since 15/11/24.
The loss adjuster communication is appalling. We haven’t made two complains and both were upheld and they’ve send us compensation of £100 for 1st complaint and £200 for 2nd.

Loss adjusters took nitrate readings from the wall between the utility room and dining room and they’re saying that the readings show nitrates which indicate pre existing damp and attributed this to a rise in the water table. Bearing in mind this was in the summer.
We have never had any problem with damp, in fact 6 yrs ago we had a new kitchen and flooring refit and the flooring was up. No evidence of damp at all. we have photo evidence of this.
The contractor sent out to take the nitrates test was at a loss to why on earth they would cover the cost of the flooring when clearly the damage to the flooring results from the water  from the leak damaging the sub floor which caused the warping and cracking of the tiles and oak? It makes absolutely no sense whatsoever.

We had the Walls reskimmed when the kitchen was fitted and the plaster would not have cured if there was damp present! 

As I say all was perfect until this leak. 

We spared no expense when we purchased the Kitchen including an island all with granite worktops. Floor tiles from Porclenosa, dining room was laid with engineered oak.
We would have never spent out a fortune and laid the kitchen onto damp! 

The insurance company are saying they will only cover the cost of the flooring (tiles and engineered oak) and skirting. 

We are fuming. 

Despite the complaints and us arguing our case, they will not budge on their decision.

They won’t commit to paying for possible repairs if any worktops or kitchen units are damaged when removing and replacing the floor. Nor the hearth which runs under the wooden flooring.

They won’t sort the wall, the kitchen units, the utility room, the cookers or wine fridge.
They sent out a contractor to bring up flooring to check the damage but luckily we were savvy enough to question who would put right the damage resulting from the investigation and they then refused to open it up. Instead they brought fans in to dry the wall. This contractor was also at a loss as to why they won’t cover all of the damage. 

So other than what we can see from the tracing videos which were conducted when the repair to the leak was done we don’t actually know the full extent of the damage under the flooring? They refuse to do any more investigation.

We have disputed existing damp.
there was no evidence of damp prior to the leak. I researched the salt readings and they could have been there since constructions. 

I looked on the gov website and we are not in an area at risk of flooding. There is no previous evidence of damp.
Surface water flood risk-Yearly chance of flooding is LOW.
Rivers and the sea-Yearly chance of flooding is VERY LOW.
Other flood risks- Groundwater- Flooding from groundwater is unlikely in this area.
Reservoirs- Flooding from reservoirs is unlikely in this area.

The loss adjuster has now said there are not enough air bricks which attributed to the damage. 

There is an air brick directly adjacent to the leak site. 

There is another on the opposite wall.
there is no damage to the wider dining room or the walls.
There is no damp on the ground floor whatsoever. 

They said that when our extension which has a concrete floor was built, that we covered an air brick which is untrue. 

However there was an extension fitted prior to us moving in. If the previous occupants had removed an air brick when they did their extension how would we know? 

Surely we were insured and have been paying premiums based on the house as it was since we moved in. How can we be liable for works prior to when we moved in? 

All work we have had done was signed off by a surveyor. 

They advised us to obtain a report from an independant damp specialist which we did and they still argued this report.

I’ve told them I am going to financial ombudsman and asked for a final response.

Anyway this gets worse.
So as you can imagine this has been super stressful.
After waiting several weeks for the final response my husband had a heart attack at Xmas. 

I notified the insurance company and LA. They send the final response and flowers to apologise and wish my husband well.

Then knowing my husband is in hospital, the loss adjuster phones him while he’s still in hospital and puts on pressure the settle for a payment of £6000 to cover flooring only and a “global Disturbance allowance payment” of £4200. I do t even know what this means.

Well that was it. I lost it. I’ve told the insurance company that I won’t deal with the LA anymore. 

Still no kitchen facilities, no end in sight, one very poorly husband…….

Ombudsman it is. 

Should I go to the press? I’m absolutely appalled. I’ve never been through so much stress.
We still haven’t had a Disturbance payment since 25th November. They’ve raised a third complaint. 

At a loss! 

Does anyone have any recommendations what to do because I don’t think o can take much more and the prospect of fighting this through the ombudsman fills me with dread.

I'm so sorry that you're going through such an awful time.
I've been locked in a dispute for almost three years.
Also dealt with Sedgwick and now RICS.
I have a journalist I'm speaking with.
I'd love to speak to you.
Just joined a cohort group for people going through these kind of issues.
Good luck but do reach out, strength in numbers...