Financial Ombudsman Service – Case Study – Insurance Claim for cracking in a garage rejected due to questions about the definition of sudden.

Background

The Complainant discovered cracking to his garage and subsequently submitted an insurance claim for cracking when he became concerned that it might be subsidence, he contacted his insurer. The surveyor inspected the damage and agreed the building had moved. But rather than it be subsidence, they tough this cause was a lack of support to the rear wall.

The Complainant also got his own engineer who agreed with the insurer.

The Complainant thought he could claim under accidental damage after checking his policy. To him, an accident is something which happens by chance and without deliberate cause therefore he assumed cover to be in place for his insurance claim for cracking.

The insurer stated the policy defined an accident to mean ‘unforeseen physical damage caused suddenly’. Therefore the Insurer didn’t agree the damage happened suddenly, so declined the insurance claim for cracking.

Complainant said that when he was in the garage a week earlier, there was no sign of cracking therefore the Complainant felt the cracking was sudden.

 

Decision

The FOS checked the policy documents and agreed with the insurer that it could rely on its own definition.

Insurers engineer and Complainants engineer reports both indicated that the lack of support caused the garage to move gradually over many month or years.

The FOS acknowledged that the cracking may have appeared suddenly. But the policy definition referred to damage caused suddenly – not which happened suddenly.

The FOS believed the cause of the cracking was the gradual building movement. The FOS were satisfied it wasn’t accidental damage, as defined in the policy therefore decided that the insurer could fairly decline the claim.

The FOS didn’t uphold the complaint.

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