Household Buildings Decision Reference 2019-0260

• Case Outcome: Rejected
• Subject Matter: Household Buildings
• Reference: 2019-0260
• Date: 28 August 2019
• Conducts Complained Of: Rejection of claim - freezing or escape of or overflow of water or oil,
• Finantial Sector: Insurance

Decision Ref:

2019-0260

Sector:

Insurance

Product / Service:

Household Buildings

Conduct(s) complained of:

Rejection of claim - freezing or escape of or

overflow of water or oil

Outcome:

Rejected

LEGALLY BINDING DECISION

OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN

Background

The complaint relates to the repudiation of a claim for water damage on the Complainant’s

property in January 2015.

The Complainant’s Case

The Complainant is unhappy that a claim he submitted for water damage to a rented

property he owns, was rejected by the Provider on the grounds that the Complainant did

not accede to the Provider’s request for proof of occupancy of the rented house.

Following the water damage on 20/21 January 2015 to the Complainant’s property, the

Complainant appointed a loss assessor to manage his claim. The Complainant contends that,

when the Provider requested proof of occupancy, the loss assessor supplied the Provider

with a statement from the electricity provider showing recent usage in addition to a credit

top-up on the electricity account. The Complainant also asserts that the letting agent of the

property and the neighbours are willing to confirm to the Provider that there was someone

living there at the time the damage occurred. In addition, it is the Complainant’s contention

that the tenants living in his rented property at the time, were using the property address

with the Department of Social Protection, to claim their social welfare entitlements.

- 2 -

/Cont’d…

The Complainant would like the Provider to honour his claim in full for the water damage to

his property. The Complainant has submitted a loss assessor’s report which estimates the

cost of repairs at €35,097.50, loss of content at €5,454 and loss of rent at €13,000.

The Provider’s Case

The Provider maintains that the Complainant failed to provide documentation to prove

occupancy despite repeated requests and reminders. The Provider asserts that it was

entitled to decline to process the claim, by reference to these failures.

The Complaint for Adjudication

The complaint is that the Provider wrongfully refused to admit the Complainant’s claim for

payment based on, what the Provider alleges, was the non-provision of proof of occupancy.

Decision

During the investigation of this complaint by this Office, the Provider was requested to

supply its written response to the complaint and to supply all relevant documents and

information. The Provider responded in writing to the complaint and supplied a number of

items in evidence. The Complainant was given the opportunity to see the Provider’s

response and the evidence supplied by the Provider. A full exchange of documentation and

evidence took place between the parties.

In arriving at my Legally Binding Decision I have carefully considered the evidence and

submissions put forward by the parties to the complaint.

Having reviewed and considered the submissions made by the parties to this complaint, I

am satisfied that the submissions and evidence furnished did not disclose a conflict of fact

such as would require the holding of an Oral Hearing to resolve any such conflict. I am also

satisfied that the submissions and evidence furnished were sufficient to enable a Legally

Binding Decision to be made in this complaint without the necessity for holding an Oral

Hearing.

A Preliminary Decision was issued to the parties on 16 April 2019, outlining the preliminary

determination of this office in relation to the complaint. The parties were advised on that

date, that certain limited submissions could then be made within a period of 15 working

days, and in the absence of such submissions from either or both of the parties, within that

period, a Legally Binding Decision would be issued to the parties, on the same terms as the

Preliminary Decision, in order to conclude the matter.

On 3 May 2019, less than a week before that period expired, this office was advised that the

Complainant was now represented by a newly appointed representative. The new