Gradual damage
How we can help if you have a complaint about a claim and your insurer says the problem is gradual damage.
Home and buildings insurance policies usually set out what’s covered by listing a number of ‘insured events’. These are things like:
- flood
- theft
- accidental damage
Your policy will also have ‘exclusions’. These explain when you won’t be covered. Policy exclusions often include damage that’s happened gradually. Gradual damage is also called a ‘gradually operating clause’ exclusion.
Types of complaint we see
You might complain to us if your insurer has declined a claim because:
- they think the damage was caused gradually
- they don’t think the damage was caused by an insured event
- gradual damage is a policy exclusion
You might be unhappy because you:
- don’t think the damage is gradual
- didn’t know the damage was happening gradually
Some insurers will also specifically exclude rot, which usually occurs gradually, from policies.
We often see complaints about storm damage claims. Insurers sometimes reject these claims because they think the damage was caused by bad weather over time – not a single storm.
How to complain
Talk to your insurer first so they have the chance to put things right. They have to respond within eight weeks. If they don’t respond, or you’re not happy with their response, let us know.
Bringing a complaint to us is straightforward and won’t cost you anything. We’ll check if your complaint is something we can deal with, and if it is, we’ll investigate.
What we look at
Your insurer may have declined your claim because it doesn’t think the damage was caused by an insured event, such as a flood. If this is the case, we’ll need to decide whether that’s fair and reasonable. We’ll look at all the evidence, but particularly:
- what events the policy covers
- professional reports and photos about the damage
At this stage, it’s down to you – as the policyholder – to show the damage was likely caused by an insured event. However, insurers may take steps to investigate that for you, perhaps by arranging for a relevant professional to inspect the damage and report on it.
As a policyholder, you’re entitled to get your own professional advice to support your claim. But the cost of that may not be covered, especially if what happened isn’t an insured event. So the usual practice – which is in line with the policy terms – is to contact your insurer about the damage first.
If we believe the damage wasn’t caused by an insured event, we’re likely to agree that it’s fair for the insurer to decline your claim. In the same way, if we think an insured event did cause the damage you’re claiming for, we’d usually tell your insurer to accept the claim.
To begin with your insurer may accept that the damage looks like it was caused by an insured event. But after investigating the cause, it may then decline your claim because of a term of the policy. This might be, for example, a policy term saying the insurer won’t pay for damage which happened gradually.
In these circumstances, the insurer must prove that it’s fair and reasonable for it to rely on this policy term to decline the claim. We’ll look at all the evidence, but particularly:
- what the policy term says – as different policy terms have different meanings
- professional reports and photos about the damage – and whether it happened gradually
If we’re not satisfied the insurer has shown the damage happened gradually, we’re likely to tell it to accept your claim.
Where the damage did happen gradually, we might still tell the insurer to pay if:
- the damage was caused by an insured event covered under the policy – such as, escape of water or flood, and
- we think you couldn’t reasonably have been aware of the damage happening gradually – for example, the damage is concealed behind a kitchen unit or bath panel, and
- you made the claim – or took reasonable action – as soon as you could reasonably have known about the problem
Our decision will be based on the details of each case. In some situations we may see things differently, including if:
- the damage was caused by wear and tear
- the damage was caused accidentally
- you have an ‘all-risks’ policy
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Your insurer might decline a claim because they think the damage was caused by wear and tear. If we agree, we’re unlikely to tell them to pay the claim. This is because everything wears out eventually and insurance can’t protect you from that.
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Accidental damage isn’t normally covered as standard. You usually have to add it to your policy and pay for it separately.
If you have a gradual damage complaint under accidental damage cover, we’re unlikely to tell your insurer to accept your claim. This is because doing so could make insurers pay for a wide range of situations they never intended to cover.
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Some policies don’t restrict cover to a list of insured events. These are called ‘all-risks’ policies. They usually cover damage, subject to a number of exclusions.
All-risks policies give more extensive cover and are usually more expensive than standard policies. So we don’t think it’s fair for customers to be worse off than with a standard policy.
For claims on all-risks policies, we’ll decide whether the damage was caused by an insured event – for example, flooding. If so, we'll take the same things into account that we normally do for a complaint about gradual damage.
If the damage wasn’t caused by an insured event we’d just consider whether the damage was gradual or not.
Putting things right
If we find you’ve been treated unfairly, we’ll ask the insurer to put things right. This usually involves putting you back in the position you’d be in if things hadn’t gone wrong. It will depend on the nature and type of complaint.
For example, if we think the damage was caused by an insured event and didn’t happen gradually, we’ll probably tell your insurer to pay the claim.
Or if the damage did happen gradually, we might still tell the insurer to pay. We’re likely to tell the insurer to pay if:
- we think you couldn’t have been aware of the damage happening gradually
- you made the claim or took reasonable action as soon as you knew about the problem
We may also ask the insurer to compensate them for any distress or inconvenience you’ve experienced as a result of the problem.
Case studies
Slow leak damage not covered under all risks policy
Insurance Buildings insurance
Couple unaware of ‘preventable’ bedroom water damage
Contents insurance
Ceiling collapse caused by insured event, but insurer still declines claim
Contents insurance
Gradual damage irrelevant as the problem wasn't covered in policy
Buildings insurance
Consumer not ‘reasonably aware’ of leak or damage to prevent floor collapse
Buildings insurance
Information for financial businesses
You can read more information about gradual damage in the business section of our website. This includes technical details and information to help you resolve complaints.
