Home emergency insurance

We would expect to see:

• terms and conditions of the policy that was in force when the damage occurred
• policy schedule
• expert evidence
• details of the guidance the business was relying at the time of the complaint

We would expect to see:

• terms and conditions of the policy that was in force when the damage occurred
• policy schedule
• renewal invitation/schedule
• details of the sales process
• call recordings for telephone sales
• screenshots of the questions for online sales
• completed application form for face to face sales
• demands and needs statement
• fact find

We would expect to see:

• terms and conditions of the policy that was in force when the damage occurred
• policy schedule
• expert evidence such as engineers/plumbers/loss adjuster’s report to show a breakdown of the repairs carried out or why it’s not covered
• photos of any damage inspected
• internal notes when arranging for engineer to attend the emergency (to see when you arranged an appointment)
• evidence to show what repairs were carried out
• evidence to show how many inspections and visits were carried out, and what tests/investigations/repairs were done on each visit
• what recommendations were made after each visit
• checklists and annual service checklist or certificates
• contact notes about when the customer made the claim
• claim file/notes

We would expect to see:

• terms and conditions of the policy that was in force when the damage occurred
• policy schedule
• expert evidence such as engineers/plumbers/loss adjuster’s report to show a breakdown of the repairs carried out or why it’s not covered
• photos of any damage inspected
• internal notes when arranging for engineer to attend the emergency (to see when you arranged an appointment) 
• contact notes about when the customer made the claim
•  claim file/notes

Sometimes an insurer declines a claim because they don’t think an emergency has happened. In cases like this, we’ll start by looking at the policy terms and conditions. Most home emergency policies will define what an emergency is.  

When we examine the complaint, we’ll check whether you’ve applied the definition of an 'emergency' reasonably. If we think the policy definition is unusual or very specific, we may consider a separate complaint about the way the policy was sold.  

We also take the customer’s individual circumstances into account. We’ll consider things like: 

• the time of year the emergency happened 
• if the emergency affected any other family members  
• if the customer is vulnerable 
• any other personal circumstances 

Some situations may be an emergency for one consumer but not another. 

Most home emergency policies say the customer has to pay an excess on their claim. If the customer thinks you’ve applied this incorrectly, we’ll check the policy terms carefully to see whether you’ve acted unfairly.  

We see complaints from people who aren’t happy with the repairs carried out under home emergency insurance. This is often because the repair is temporary and they expected a permanent repair. People complain because they: 

• don’t think the temporary repair sorted out the emergency 
• thought their policy covered permanent repairs, not temporary ones 
• think their insurer should have covered a permanent repair because it would have cost the same as a temporary one 

In cases like this, we’ll look carefully at the policy wording to decide what’s fair.  

This is one of the most common complaints we see with home emergency insurance. If a customer complains about a delayed or cancelled appointment, we’ll look at the circumstances of the case to decide what’s fair. We’ll check:  

• when they made the claim 
• when you arranged the appointment 
• how long the customer had to wait 
• the customer’s personal circumstances, for example, whether they're vulnerable or live with a vulnerable person 

If the appointment was cancelled, we’ll investigate why. If the appointment was delayed, we’ll check: 

• how the delay affected the customer 
• whether you knew there would be a delay and explained this to the customer 
• whether you tried to manage the delay, for example, by giving the customer the option to call a local tradesperson and claim the cost afterwards 
• whether the delay led to any more damage 
• whether the delay meant the customer couldn’t have essential services like heating or water 
• how long the delay lasted 

Most home emergency policies don’t cover consequential damage. So if a customer complains about consequential damage we’ll check the policy terms carefully.  

We don’t normally hold a home emergency insurer responsible for consequential damage if it results from a home emergency. But if your actions have caused further damage we might ask you to: 

• contribute to repair costs 
• pay compensation 

A customer might complain that you failed to stop the emergency because you: 

• rejected their claim unreasonably 
• delayed coming out to assess the problem 

The customer may then have had to claim on their home insurance policy instead, which may mean: 

• they had to pay an excess 
• their home insurance policy went up

In cases like this we’ll check whether you should have dealt with their claim or responded more quickly. If we think you should have, we’ll ask you to put things right. For example, we might ask you to reimburse the excess or extra premium the customer has had to pay. However, we do recognise that in some situations, consequential damage is inevitable, regardless of how quickly you respond. 

We see complaints where insurers have told customers their boiler is beyond economic repair. Customers are sometimes unhappy about the cash settlement they are offered.  

In cases like this, we’ll check: 

• how clear the policy terms are and whether they explain what will happen if the customer’s boiler can’t be repaired 
• how you have valued the customer’s boiler 
• the breakdown of the repair estimate and whether it’s reasonable 

Some people try to sort out home emergencies by getting a local tradesperson to do the repairs without speaking to their insurer first. Then they try to claim the cost back from the insurer.  

Most insurers reject the claim in situations like this. But if we think you would have paid out, had the claimant not gone ahead before speaking to you, we don’t think it’s fair to reject the claim. In cases like this, we’ll ask you to prove that you would have rejected the claim anyway. You'll also need to show that the customer’s actions have prejudiced your position. 

If we don’t think it’s fair for you to reject the claim, we’d normally ask you to pay the customer the cost of the repair. This might not be what they originally paid. Instead, it will be what it would have cost you to fix the problem if the customer had gone to you first.

If the complaint is about a mis-sale, we’ll look at who sold the policy. We’ll also look at whether or not the customer was given advice when they bought it. 

If you provide advice, you have a responsibility to make sure the policy is right for your customer.  

If the customer bought the policy without advice, they should have been given enough information to decide whether the policy was right for them. At the point of sale, you must provide information that’s: 

• clear 
• fair 
• not misleading  

It’s important that the customer understands the information they’re given. This is because most policies will explain what’s required of the customer at the start of the policy or if they claim.  

In cases like this, one of the first things we check is that the customer is eligible to use the policy. If they’ve got the wrong cover, they won’t be able to benefit from it. For example: 

• if they’re a private tenant and bought home emergency cover, they don’t need it because it’s usually the landlord’s responsibility to sort out emergencies 
• if they’re a landlord and bought a policy designed for private homeowners 
• if they have an unusual type of heating system not covered by their policy 

If the customer is completely ineligible for their policy and bought it anyway, we’ll normally ask you to refund their premiums, plus interest. We’ll do this even if it was clear at the point of sale that the customer was not eligible. This is because they’ve been paying for a product they can’t use. You've been getting premiums when you’ll never have to pay a claim. 

Some people say their policy was mis-sold after a rejected claim. But this doesn’t mean they wouldn't have been able to benefit from the policy. If we decide that they'd have been able to benefit from the policy, we're unlikely to think it was mis-sold. 

Exclusions and limitations 

If a customer complains about a policy exclusion or limitation, we’ll check whether: 

• the exclusion or limitation was adequately flagged during the sale 
• they would still have bought the policy if they’d known about the exclusion or limitation 

We’ll also check if the exclusion or limitation is clearly explained in the policy documents. If it is, we’ll probably say this is enough to prove the policy was not mis-sold. However, we might uphold the customer’s complaint if there’s evidence that both of the following are true: 

• you sold them an unsuitable policy 
• you should have known the policy was unsuitable 

Sometimes landlords experience distress and inconvenience when a home emergency claim has problems. If a landlord complains to us, we'll consider their complaint but look at it in a different way to a private homeowner's. 

For example, an electrical fault may stop all the appliances in a kitchen working. If you take too long to sort this out, a private homeowner won't be able to use the kitchen. A landlord, on the other hand, may experience distress and inconvenience because their tenant is complaining or they have to chase you.

If we agree that you’ve taken too long, we’ll probably ask you to compensate the landlord. However, the amount of compensation is likely to be lower than it would for a private homeowner, because the landlord doesn’t suffer the distress and inconvenience of not being able to use the kitchen.

If the landlord compensated their tenant or discounted their rent, they may have suffered financial loss. If this is included in their complaint, we’ll look at evidence of what they paid and consider whether it was a reasonable and proportionate response to the problem the tenant had. 

If you unfairly reject a claim, the customer might have to claim on home insurance instead. If we agree that you should have dealt with the claim, we might ask you to: 

• contact the home insurer and reimburse the cost of the claim 
• pay your customer back any excess they paid 
• contact the home insurer and ask them to remove the record of the claim from their database  
• pay compensation for any distress or inconvenience

If we think a policy has been mis-sold, we’ll usually tell you to refund the premiums the customer has paid, with interest. We might also ask you to pay them: 

• an amount equivalent to a claim they made, or could have made 
• compensation for distress or inconvenience