Insurance refusing to pay out

Wasp16692

Good morning, all. I really need some advice. 

My mother (who is in her 80's) has had the roof of her house significantly damaged as a result of a fire that started at the occupied property next door, last week. The residents next door are insured, and their property is being taken care of, but their insurance company is refusing to foot the bill for the repairs to my mother's house as a result of the fire that was caused (albeit innocently) by their customer.

The fire started as a result of the lady next door hanging highly reflective decorations in her window. The heat of the sun reflecting off these decorations set fire to the curtains, and the fire spread rapidly. The firefighters who attended caused additional damage to the roof as they accessed the loft space. 

Unfortunately my mother's home insurance lapsed without any of us realising, so she was uninsured. Surely her neighbours insurance should repair my mother's roof?

Please can anybody offer some advice. Is this something I could take to an ombudsman?

The company is called Payment Shield, and she resides in Manchester. 

Thank you in advance. 

user1977

She'll need to prove the neighbours were negligent, there's no legal principle that they're liable merely because the fire started in their property. I'm not sure whether the decorations makes them sufficiently culpable.

And I don't think she can complain about another party's insurer.

I would suggest she seeks legal advice.

cw8825

by the sounds of it the neighbour has not been negligent.

This would normally be a case of claim of own insurance and let them discuss behind the scenes.

Your mother cant complain to the ombudsman about the insurance company as she is not one of their customers

DullGreyGuy

Wasp16692 said:

Good morning, all. I really need some advice. 

My mother (who is in her 80's) has had the roof of her house significantly damaged as a result of a fire that started at the occupied property next door, last week. The residents next door are insured, and their property is being taken care of, but their insurance company is refusing to foot the bill for the repairs to my mother's house as a result of the fire that was caused (albeit innocently) by their customer.

The fire started as a result of the lady next door hanging highly reflective decorations in her window. The heat of the sun reflecting off these decorations set fire to the curtains, and the fire spread rapidly. The firefighters who attended caused additional damage to the roof as they accessed the loft space. 

Unfortunately my mother's home insurance lapsed without any of us realising, so she was uninsured. Surely her neighbours insurance should repair my mother's roof?

Please can anybody offer some advice. Is this something I could take to an ombudsman?

The company is called Payment Shield, and she resides in Manchester. 

Thank you in advance. 

You say the fire was innocently caused therefore they are not liable for your damage and so their insurer isnt liable either. You would claim off of your own insurance for your damage. 

You cannot go to the ombudsman because you are not their customer, you would have to sue your neighbour who technically would choose if they pass it to their insurers to deal with or deal with it themselves but again if you maintain that they are innocent then you've lost your court case already

Aretnap

This is a common misconception unfortunately. The neighbours insurance covers the neighbours property. It doesn't cover your mum's property. It's there to protect the neighbour, not your mum, after all.

The other thing that the neighbour'a insurance covers is their liability to other people - in other words money that they would legally be obliged to pay themselves were they not insured (and not a penny more). To be legally liable the neighbour would have to have been negligent - in other words failed to take the level of care that would be expected of a reasonable person. It's not enough that the fire started in their property - negligence has to be proved, and from your description I'm not sure that it could be. Hanging reflective decorations in a window didn't sound like something which would seem obviously dangerous to the average person in advance, as opposed to with the benefit of hindsight. Unless maybe the decorations were sold with a big "do not place in direct sunlight" warning or similar?

In any event your mum cannot make a claim from someone else's insurance policy, or take someone else's insurer to the Financial Ombudsman - their duties are to their own customer, not to her. Her route of redress would be to take the neighbour to court for negligently causing the fire. The neighbour can then make a claim on their own insurance, and their insurers will deal with the court case on their behalf. As it sounds like this could be a substantial claim your mum should probably take legal advice before going down that route, as there could be significant legal costs if she tried it unsuccessfully.

The other route that *might* be open to you is through your mum's own (former) insurer. You say that her insurance had lapsed - can you say any more about how that happened? Eg had it previously auto-renewed, and how much warning did they give her that it was going to lapse? I recall some financial ombudsman decisions to the effect that an insurer has to make a significant effort to ensure a customer understands that their cover is going to end, and that a single letter or similar may not be sufficient. So depending on the circumstances there *may* be some mileage in pursuing that angle, especially if your mum is vulnerable on account of her age or health.

Wasp16692

I just wanted to thank you all for taking the time to reply. My rationale was, that if I damage someone's car, accidentally or not, my insurance would pay. When the fire at her neighbours started I assumed the same rules would apply. 
Lesson learned - keep an eye on the expiry date for her house insurance. 
Thanks again!

Aretnap

Car accidents follow the same principle actually - it's also necessary to demonstrate negligence on the part of another driver before his insurance will pay for damage to your car. 

The difference is that about 99% of car accidents are caused by negligence on the part of one driver or another, and it's usually fairly easy to point to what that negligence was. A carefully driver would have avoided the accident by paying more attention to the road ahead, or waiting for a bigger gap in traffic before pulling out of the junction, or taking the bend at a more appropriate speed so he didn't end up on the wrong side of the road, and so on and so forth.

Whereas with home insurance there are a lot more cases where damage might have originated from your house, but it's not clear what you could realistically have been expected to do to prevent it. A freak storm blows a tile off your roof and onto your neighbour's car; an electrical fault causes a fire which spreads to your neighbours property, a burst water pipe causes a flood in the flat downstairs etc etc...

To claim you have to be able to complete the sentence "a reasonably careful householder would have prevented the incident by...", and the second part of the sentence has to be something realistic, not "getting the tiles on their roof professionally inspected at least once every six months" or something along those lines.

There are a few cases where you can "cause" a car accident and yet be entirely blameless. The classic one is where a driver has a sudden and unexpected medical episode at the wheel. In that scenario the insurer would have no liability to third parties and everybody involved either has to claim on their own insurance, or pay for their own repairs.

chrisw

Aretnap said:

There are a few cases where you can "cause" a car accident and yet be entirely blameless. The classic one is where a driver has a sudden and unexpected medical episode at the wheel. In that scenario the insurer would have no liability to third parties and everybody involved either has to claim on their own insurance, or pay for their own repairs.

My car was parked in a line of parked cars at the side of the road when someone driving past had a diabetic episode and bounced off my car and into several there's on the other side of the road.

The damage to just mine was around £15k, this and the credit hire car were paid for by her insurance company without quibble.

Aretnap

chrisw said:

Aretnap said:

There are a few cases where you can "cause" a car accident and yet be entirely blameless. The classic one is where a driver has a sudden and unexpected medical episode at the wheel. In that scenario the insurer would have no liability to third parties and everybody involved either has to claim on their own insurance, or pay for their own repairs.

My car was parked in a line of parked cars at the side of the road when someone driving past had a diabetic episode and bounced off my car and into several there's on the other side of the road.

The damage to just mine was around £15k, this and the credit hire car were paid for by her insurance company without quibble.

Well potentialy the insurance company might have had a defence to the claim, depending on the nature of the episode, how foreseeable it was, how much warning of it the driver had etc. That doesn't necessaarily mean that they'll always try to use the defence. 

The courts have apparently taken a harder line on some of the details in recent years, though the principle of the defence remains sound.

cw8825

Aretnap said:

chrisw said:

Aretnap said:

There are a few cases where you can "cause" a car accident and yet be entirely blameless. The classic one is where a driver has a sudden and unexpected medical episode at the wheel. In that scenario the insurer would have no liability to third parties and everybody involved either has to claim on their own insurance, or pay for their own repairs.

My car was parked in a line of parked cars at the side of the road when someone driving past had a diabetic episode and bounced off my car and into several there's on the other side of the road.

The damage to just mine was around £15k, this and the credit hire car were paid for by her insurance company without quibble.

Well potentialy the insurance company might have had a defence to the claim, depending on the nature of the episode, how foreseeable it was, how much warning of it the driver had etc. That doesn't necessaarily mean that they'll always try to use the defence. 

The courts have apparently taken a harder line on some of the details in recent years, though the principle of the defence remains sound.

Also can be a commercial decision. If they use a perfectly legal defence but looks bad on then as ‘weasling’ out of it

DullGreyGuy

chrisw said:

Aretnap said:

There are a few cases where you can "cause" a car accident and yet be entirely blameless. The classic one is where a driver has a sudden and unexpected medical episode at the wheel. In that scenario the insurer would have no liability to third parties and everybody involved either has to claim on their own insurance, or pay for their own repairs.

My car was parked in a line of parked cars at the side of the road when someone driving past had a diabetic episode and bounced off my car and into several there's on the other side of the road.

The damage to just mine was around £15k, this and the credit hire car were paid for by her insurance company without quibble.

They were presumably a diabetic and therefore it's not a sudden and unexpected but poor management of their condition which they have control over.