Building insurance cover

20122013

My building insurance company has accepted my claim on the water damage caused by upstairs.

Their third party contractor did the repairs by stained blocked the water stains and then painted (one coat) over the areas.  However, the bubbling up areas can still be seen. 

I am trying to find out to what extend the repair should cover? should it be back to the condition before the damage?  

I had  2 - 3 decorators' views, all had said that using very matt paint may help but most likely needs re plastering. On the other hand, the insurer's explanation was that :

1/ the damage did not cause the swelling, but possible cause was how the property was built and the reason why I had noticed it now is because the diamond egg shell paint used will show more imperfections. However, if a matt paint was used this would have been less obvious.

My thinking is that it should be repaired to how it was before the damage. As I do not think there was swelling before the damage and also I should not be restricted to using only Matt paints.

I have 3 rooms with bubbling areas and the fourth room  does not and it was painted with matt but still shows imperfections. 

Would it make sense to state to the insurer that even though that the fourth room  ceiling was painted in matt and has no bubblng area it still shows imperfections , so the Matt paint is unlikely to lp with the bubbling area which is more prominent. than the imperfections and it needs a different approach to return the bubble area to the pre water damage state?

As it is not easy to get things done via insurance company, hence I want to know what is included before asking them. 

  

DullGreyGuy

Generally insurance is based on the principle of indemnification, you should be in the same financial position after the claim than you were immediately before the claim, less anything you have agreed to be excluded (ie the excess). Obviously a house with massive water stains on the ceiling or a car lodged in the kitchen wall is worth less to a buyer than one without those "features". 

So yes, if it is damaged caused by the leak then the insurer should deal with it however you are saying "you think they weren't there" whereas the insurer appears to be saying the damage isnt consistent with the event. Ultimately you need to register a complaint with any evidence you have to support your case but you'd be better placed if you knew they weren't there before, had photos showing it was fine before and/or an expert's opinion that it is likely caused by water ingress. 

20122013

@DullGreyGuy 

I have photos showing whether the brown water stains were, and the bubbling up areas are at the same spot. 

To clarify my first post: 

 'My thinking is that it should be repaired to how it was before the damage. As I do not think there was swelling before the damage and also I should not be restricted to using only Matt paints.

What I was trying to say is that there was on swelling before the damage ie the swelling appeared after the water damaged.  So the repair should return to its condition before the damage. ie not just stain block and paint over and leaving the bubbling area as is.

DullGreyGuy

20122013 said:

DullGreyGuy  

I have photos showing whether the brown water stains were, and the bubbling up areas are at the same spot. 

To clarify my first post: 

 'My thinking is that it should be repaired to how it was before the damage. As I do not think there was swelling before the damage and also I should not be restricted to using only Matt paints.

What I was trying to say is that there was on swelling before the damage ie the swelling appeared after the water damaged.  So the repair should return to its condition before the damage. ie not just stain block and paint over and leaving the bubbling area as is.

It would be pre-loss photos you'd ideally have.

"I do not think" has uncertainty in it, it's not a definitive statement of fact. The fact you are leaving a gap for uncertainty will be used to state you are probably just misremembering/hadnt spotted it before. 

20122013

DullGreyGuy said:

"I do not think" has uncertainty in it, it's not a definitive statement of fact. The fact you are leaving a gap for uncertainty will be used to state you are probably just misremembering/hadnt spotted it before. 

Appreciate your helpful comment (above), I will be more mindful.  I have noted that the insurer's contractor and the insurer have both used their own Technical managers to inspect their own work which I am having to dispute that by myself , is that how dispute work ? their own people check their own work ? 

DullGreyGuy

20122013 said:
I have noted that the insurer's contractor and the insurer have both used their own Technical managers to inspect their own work which I am having to dispute that by myself , is that how dispute work ? their own people check their own work ? 

Generally yes, in the first instance the firm that did the work comes back, if the customer still isnt happy then the insurer checks themselves. Being on an insurer's approved supplier list can lead to a lot of fairly lucrative work and so most will want to ensure they are doing a good enough job else they may find themselves off the list and much quieter. 

There are exceptions occasionally where an insurer will agree to a different firm inspecting and naturally there are cases where the insured themselves organise an alternative opinion but that isnt always accepted. 

20122013

I thought using their contractors should be ok as it would be easier to get things done etc but did not seem that way.  After a lot of efforts and delays , I had received some good will but not enough for the repair (see my earlier posts) and kept being told they are pre-existed.  I had contacted the ombudsman,  and was told to wait till the deadline and come back to them if not satisfied with the outcome. 

I am surprised that they can be given more than 18 months extensions. Even the deadline has passed and   and no submission from the insurers. The ombudsman has provided their drafted findings and said there is no repair no good will. 

As I have never been asked to submit any information and it seems I have been given much less time to respond. I am wondering whether I can disagree with the ombudsman and submit my information ? and  what to do if  I am still not happy? as the ombudsman decision is binding? 

DullGreyGuy

The ombudsman has two tiers, the first decision will be made by an investigator or adjudicator (they've switched job titles and can't remember which is the latest one). Both you and the insurer can dispute this decision. 

If either of you do the case is then transferred to an ombudsman (an/small o not The Ombudsman) who will review the case along with any additional evidence submitted. Their final decision cannot be disputed by the insurer, if you accept it its legally binding on them. If you still dont accept it then the Ombudsman process is over and your only remaining choice is to go to court. 

The ombudsman however is typically seen as more consumer leaning because they are obliged to find "fair" outcomes whereas the courts should blindly follow the law. I have never seen a case where the ombudsman rejected a complaint that the person then won in court... not to say its never happened but just not come across any. 

Some banks/insurers have gone to court for a judicial review of decisions however its important to note that even if the court agrees the ombudsman was wrong it doesnt reverse the decision that the court case was about but will influence future decisions. 

20122013

Appreciate your explanation as not easy to read the emails from the ombudsman.. 

I have found out that their job title is 'Investigator' and their email  reply to me: 

'I think this is a fair outcome in the circumstances, for the reasons I’ve explained. Please let me know by 3 July 2025 whether you agree to my recommendations so the case can be resolved.

But if you don’t accept what I’ve said – and want an Ombudsman to make a final decision on the complaint – you must provide any further evidence or representations by 3 July 2025.

Requests for more time must also be made by that date. If I don’t hear from you by 3 July 2025 I’ll arrange for an Ombudsman to determine the complaint.'

20122013

Due to the insurer constant delays, my case has been opened for over 18 months and now the FO wants to close it asap.

The investigator's finding states that the insurer should pay me for the storage costs but disagree with  my other claims, and states that no repair is required for the buldge. 

As such, I had asked for an extension to respond  and they had initially declined but I asked again and said I do not agree with their findings. Their reply was:'
I appreciate you need further time, but our Service must set deadlines in order to progress matters. We can't leave cases open indefinitely.
 
Given I'm on annual leave shortly, I won't be able to respond until I return. So, I will grant a further extension till 29 July, however this is a strict deadline, and I won't be able to extend this any further. 
If I don't receive a response by this date, I'll refer the case to decision stage (on the basis you've not accepted my findings).'

I would like to know if I was to reply,  will I have until 23.59 hours on 28  or 29 July 2025? 
As I have not gone through this process before, may I check that if I do not reply, will the investigator pass my case through to the Ombudsman to look at? is this a good option? or shall I try and do my explanation to this Investigator (they seem to have made up their mind already - I know they should not be but that is life)

MyRealNameToo

An investigator will only entertain trying to resolve it for so long before deciding it's going to go up to an Ombudsman. In my experience as a customer (rather than representing an insurer) is that investigators are more amenable and more open to discussion. My limited experience of ombudsman as a customer has been they make their decision and won't entertain further discussions. 

Until 29th July is ambiguous, to be safe it'd be better to respond today than tomorrow but a general rule is that if there is ambiguity then the non-drafter's interpretation should be the correct one as long as its reasonable.