/ Home & Energy, Money

Fighting my mother’s rejected home insurance claim

Roof damage

In this guest post, Which? supporter Naomi Milward shares her battle with her mother’s insurer, which refused to pay out for storm damage when her garage roof was blown off.

While most home insurance claims are accepted and paid out in full, a minority are not. Our research earlier this year found that one in 10 home insurance customers who made an insurance claim in the past two years had it fully or partially rejected. Naomi’s mother, Carol Milward, is one such person…

Naomi Milward: During March 2012 a storm caused significant damage to my mother’s garage roof. If the storm had not occurred, the garage roof would have remained intact.

When I learned of the storm damage (I live in Devon and my mother lives in Suffolk) I hoped that my mother’s buildings insurance policy would cover the incident as many policies state they include cover for storm damage. Subsequently my mother pursued a claim through her insurer RIAS.

An appointment with a loss adjuster was made, so he/she could attend and assess the damage. Two days previous to the agreed appointment the loss adjuster telephoned my mother unexpectedly, saying he was in the area and could he call.

Obviously my mother had to proceed to employ contractors to urgently repair the garage roof and this cost her approximately £650.

My mother and I heard of other insurers paying out on the same storm damage that had affected nearby properties flat roofs. We understood that these flat roofs were in the same condition and similar age. However, my mother’s claim was rejected as the wind was apparently too slow to be classified as a ‘storm’.

Challenging my mother’s insurer

I was disgusted at yet another insurer avoiding its obligations to a customer when it should have honoured the claim. I challenged RIAS on behalf of my mother stating various points, including that the loss adjuster should have given my mother the opportunity to have another person/witness with her when he attended.

RIAS told us that it only paid out on certain wind speeds. We contacted the Met Office. On questioning RIAS claims department we were told that it only paid out on storm damage for wind speeds of 47mph and above. We were told the wind speed at the time of the incident was 45.47mph!

I requested that RIAS confirm where in its policy documentation it mentions wind speeds. Nowhere in the customer policy documentation does it mention any such thing.

We escalated the matter to Lloyd’s of London stating our dissatisfaction. Eventually – after pursuing the matter, writing time-consuming letters and making various phone calls – my mother was reimbursed. But we should not have had to ‘fight’ for this!

RIAS responds to Naomi and Carol Milward

Which? went to RIAS for its comment on Carol Milward’s case:

‘RIAS has 20 years of experience providing insurance to the over 50s and only works with reputable and fully accredited insurer partners who handle claims as quickly and easily as possible, which is why we are concerned to hear of Mrs Milward’s dissatisfaction about the handling of her claim. Following a Policyholder and Market Assistance at Lloyd’s review, Mrs Milward’s claim has been settled in full.

‘Our insurer partners aim to make contact with policyholders within two hours once appointed, and visit within five days to undertake an inspection, and these timescales were met. The surveyor arranged to meet Mrs Milward within their agreed service levels, however on this occasion as he was already in the area, the surveyor offered to visit Mrs Milward before the arranged date, in an effort to provide a quicker service for her.’

Have you ever had an insurance claim refused? Did you successfully fight back? Do you have any tips to help others in a similar situation?

Which? Conversation provides guest spots to external contributors. This is from Naomi Milward – all opinions expressed here are her own.

Comments
Member

It may well be that RIAS consider a building to be defective if it damaged by wind speeds below a certain value – at a speed not defined as a storm. The responsibility would then be the owner’s, whether due to poor design, poor construction or poor maintenance. So RIAS were perhaps within the terms of the policy that was purchased correct in refusing the claim. It seems a goodwill gesture to settle. I don’t know how a witness would have helped when the assessor visited. I don’t think you should be disgusted with RIAS – sorry.

Member

Just a comment to put another point of view as to claims not being met in part or full.

It is a shame that no photos were taken of the damaged roof to bolster the case for compensation. Also from the technical point of view there is no mention of age of the flat roof. They have a finite life span.

The existence of wind speed limits is not that surprising and I am not sure what one would do even if you knew what the speeds were. They are used by all insurance companies as far as I know. It makes sense as people tend not to look after their roofs until forced to by an event of some description. The state of roof is a consideration so aspect and surrounding properties may mean not all roofs are equal even if installed at the same date. Not all companies send out assessors and as the cost/benefit may mean they take a commercial decision and just pay-up.

I am not saying that RIAS were right just that its not always an open and shut case. Also paying out to avoid lengthy and expensive correspondence can also be a commercial decision.

My experience of this side of things comes from having at one time been an employee in a small general insurance agency, and as an administrator for a hundred plus blocks of flats . I also have an interest in property maintenance and house design.

Member

We moved from them a couple or years ago when our guttering fell down due to the heavy snow according to them there is no such thing as a snow storm !!! Strange next doors paid out so we moved to them.

Member

Forgot to say we also moved our car insurance from them also would never use them again.

Member

Hi & thanks for commenting on this post – a topic I feel strongly about!

I was told recently that when it comes to insurance companies – often some of their profits come from rejecting valid claims.

Not everyone wants to (or can for time consuming reasons) challenge insurers. But my advice is – if you are confident that you have a valid claim and the insurer wriggles their way out of paying that claim – challenge them!

Member

If you believe you have a strong case, gather some expert evidence and take your claim to the small claims hearing in the County Court.. You can represent your mother especially if she goes with you. Prepare everything in folders. I’m afraid a number of insurers seek to escape their obligations. Also consumers must realise that with insurance, cheapest is rarely the best although the converse is not true either.

I threatened to sue my insurer when they tried to escape paying out on a claim for water damaged flooring.. I also made an official complaint. They immediately changed tact and confirmed that they would pay out. A complete try on by the insurer I’m afraid.

Member
Robert says:
14 September 2013

I am ‘phoned every year by RIAS offering a quote, but they have never been competitive and when they ‘phoned again few days ago I told them again I did not want a quote and was satisfied with my present insurer, LV=.

I made a claim a few weeks ago as when having some work done for a new shower room and toilet, a friend, doing the electrical work, drilled through a lead gas pipe. Unfortunately, under legislation, you can’t repair a lead gas pipe. Consequently, new copper pipes had to be installed. When I rang LV= I was told this would not be covered under my policy, but I was called later to say that she had made a mistake and they would consider a claim. I was asked to photograph the damage if possible, and get a quote. Sent all of this off and it was accepted without a problem. I received a cheque a few days later. First time I have claimed from LV= and they were excellent.

The last insurance claim that I made was over thirty years ago, and nowhere near as quick and problem free as LV=.

Member

I agree with you – from my experience (with more than one UK insurer) many insurers do all they can to avoid their obligations to customers who have valid claims – Car, home, travel or otherwise.

A Small claims hearing is an option for people, but insurers know this could be a time consuming & daunting aspect which many won’t want to put themselves through. The Financial Ombudsman Service (as far as I’m aware) are inundated with complaints by consumers.

As you say, insurers ‘try it on’. I had another insurer (who I also challenged successfully) say to me “…we turn down all claims in the first instance…” – A disgrace in my opinion!

I have learnt the hard way & these days always read the small print when renewing cover. Then in the event of a valid claim that needs challenging, I’m armed with the info.

I’m glad you succeeded with yours!

Member

It’s worthwhile researching reputable insurance & LV to my knowledge are pretty good in honouring valid claims.

Through my experience it’s the underwriter that’s vital – they hold the key when it comes to a claim. Some policies eg. M & S – I find misleading as customers may think they are buying insurance with M & S – but it’s the underwriter who the policy is actually with.

Stay with LV it seems!

Member

Naomi, my impression is that if you buy the cheaper insurances – car, house or travel – they are likely to put up more of a fight if a claim may not be clearcut. I believe you get what you pay for when it comes to the crunch.
Regarding underwriters, this is not uncommon. My car insurance is purchased from nationwide, but provided by LV. My house insurance is purchased through John Lewis but provided by AXA. this is disclosed when applying. Whilst I hope it won’t be necessary, in the event of a claim I will be dealing with NW and JLP and hope to benefit from their customer service.

Member

My mother’s chimney was damaged in a storm which affected a number of houses around, and our claim on her behalf was rejected on grounds of lack of evidence of maintenance of the chimney. What do you do to maintain a chimney in a brick-built terrace house? We didn’t have evidence of regular roof inspections, though they had been done every couple of years in the past few years, and didn’t bother to challenge the insurers. But I’m not sure that roof inspections would necessarily have looked at the chimney too, or recorded any acceptable evidence of good condition. Roofers tend to be men of few words.

Member

As – Your comment that the roof has been looked at ” they had been done every couple of years in the past few years” strongly suggest the roof was nearing the end of its life. Roofs other than flat roofs have life spans of 50-100 years so looking every couple of years is revealing. Chimneys can normally be seen from ground level and a pair of binoculars, or a builder can help.

Essentially though a brick chimney will need re-pointing like all brickwork. Probably moreso as it is exposed to the elements [and the flashings checked]. Using the chimney also creates more wear and tear on the fabric of the chimney and this is worse if gas and oil boilers are used. There should be a flue pipe but this can wear out and the fumes attack the brickwork. Capped or with a cowl are options if it is disused.

BTW a lot of chimney problems occur where homeowners have chimney breasts removed which weakens the structure and a lean can be apparent – and eventually a collapse.