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ombudsman news

issue 144

April 2018

Q&As

I’m dealing with a customer’s buildings insurance claim. They’ve reported some water damage to their ceiling, but I think it’s likely the problem’s been there for some time – and that would mean the claim isn’t covered. How can I ensure I make the right call?

We regularly hear from people who’ve made claims like these – and have found their insurer won’t pay out, saying the damage happened gradually.

Often, people tell us that they didn’t know there was a problem until they discovered the damage – and that they contacted their insurer straightaway. Equally, like you, insurers often tell us that the issue is long-standing, whereas their policies are only intended to cover sudden, “one-off” problems.

To sort things out, you’ll need to consider what the policy says, what caused the damage, and what your customer knew about the problem. This month we’ve added new resources to our website to help people resolve complaints about damage to buildings that’s happened over time – explaining, with examples, how we approach investigating and resolving these cases.

So what can I do if I need a bit of guidance?

Some cases can be finely balanced – and the fair answer isn’t always clear. So if you’d like to talk things through, our technical advice desk are there to give a helpful steer to businesses about how to sort out problems with their customers, before they reach us.

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ombudsman news gives general information on the position at the date of publication. It is not a definitive statement of the law, our approach or our procedure.

The illustrative case studies are based broadly on real-life cases, but are not precedents. Individual cases are decided on their own facts.