We have a buildings (£1.4m) and contents (£80k) policy with Brit Insurance

The property is listed Grade 2 and the buildings cover figure is agreed with Brit as 'full cover' (ie. they surveyed the property).

During a storm in 2006, a tree fell down and destroyed a large flint wall around the garden and the total claim came to apx £100k. Brit's loss adjusters handled it badly and things got messy, with Brit disputing the final figure after it had been agreed by their adjusters with the builder. But in the end, it was all settled.

Then, in 2008 a drain in the road outside of our property became blocked (seems a landowner on the other side of the highway filled in a drainage ditch). This caused major road flooding every time it rained, resulting in water being splashed up against the flint wall over a period of several months. During this time, we contacted Norfolk CC Highways team and the landowner, but neither did anything substantial until a section of the wall finally collapsed due to the water damage.

I registered a claim with Brit and they appointed a loss adjuster. This loss adjuster came and did his investigations etc. he then recommended settlement of the claim to Brit. However, someone in Brit's senior surveying team (who worked on the original tree damage claim) became involved and declined the claim on the basis that it was due to 'gradually operating cause' and not 'flood damage'. Whilst the damage did occur over a period of several months, I don't see what else I as a householder could have done to prevent the damage.

Since the wall is listed, I am legally obliged to reinstate (quotes have been £42k) but I don't have the money to do this. Do I have a case for taking this to the ombudsman?

pford75

This would be an absolutely perfect case for the FOS to take a look at.

Were you provided with a copy of the loss adjusters report recommending settlement of the claim? Did the Brit Insurance senior surveyor actually come out to inspect the wall or was decision to decline purely based on past knowledge?

What was the time frame between when you first noted the drainage problem and the wall collapsing? The FOS will require full information of events in date order, so they can see whether the actions of Brit are reasonable or not.

I can understand the Brit decision, the cause would appear not to be flood during a brief period but of damage due to a gradually operating cause. If you have legal expenses cover with your Home Insurance, it is worth looking at whether a claim could be made against Norfolk CC and/or landowner. Whoever is responsible for the land would owe you a duty of care. The landowner should have liability Insurance to cover themselves if you took legal action against them.

If you have the Insurers final decison, then you can complete the FOS form which is in word format on the FOS online site. You may wish to notify your legal expenses Insurers (if relevant) of a possible claim, if the FOS fails to uphold your complaint.

huckster

Huckster - Thanks for the advice. Have already pursued much of this. Here are my responses to your questions:-

>> Were you provided with a copy of the loss adjusters report recommending settlement of the claim? Did the Brit >>Insurance senior surveyor actually come out to inspect the wall or was decision to decline purely based on past >>knowledge?

I didn't get a copy of the loss adjusters report, but I did speak with him directly and he seemed embarassed that Brit had ignored his advice. Nobody from Brit visited the site.

>>What was the time frame between when you first noted the drainage problem and the wall collapsing? The FOS will >>require full information of events in date order, so they can see whether the actions of Brit are reasonable or not

From first notification to the wall collapsing took apx. 6 months (although it was only during the final 2 winter months that the flooding became really severe and was damaging the wall). The opinion of the loss adjuster was that this was not a gradually operating cause, because 1 - it would only occur for a matter of hours and then perhaps not recur for several days/weeks and 2- whilst there was gradual splashing over the period, it was a single day of major flooding which caused the collapse of the wall.

Following the refusal of the claim, I instigated a private legal action against NCC and the landowner. Having obtained counsel's opinion, it would seem that there is little to be done against NCC ( since they argue that they took steps to survey the drain and then request the landowner to unblock the drain and therefore did all that was reasonable). The action against the landowner is ongoing, but not wanting to disclose my case here...we have also decided to pursue the insurer again in parallel.

I have been advised by the FOS that I need to exhaust Brit's own complaints procedure first and have initiated that today.

Can anyone advise if it is normal for an insurer (who has not visited the site) to ignore the recommendation of a loss adjuster?

pford75

My experience is that usually Insurers accept the Loss Adjusters findings as they are independent. Normally if Insurers have any issue with the findings, they would arrange for a second opinion to be provided by either one of their own surveyors or another loss assessor.

I have my suspicion here that Brit have attended to look at the wall, without advising you. I cannot believe they would rely on prior knowledge of a Brit surveyor that was almost 2 years previous. If this does go to the FOS, they are bound to comment on this and I expect them to advise that the loss adjusters findings should be be applied, as the only relevant appraisal of the loss.

I agree with Dacouch that in the future you should look at alternatives, such as Hiscox or Chubb. However, due to the claims, I think you may be stuck with Brit for a few years, as other may not be willing to quote, until a few claim free years have passed.

Huckster

Thankyou for the reply.

I can be fairly certain that noone from Brit has attended the site to examine the wall (we are in a very rural part of Norfolk and it would require someone to access our land without our knowledge to inspect the wall)

You are right about examining other insurers. I was so annoyed with the refusal that I did shop around with a range of others (NFU, Hiscox plus a few others), but none of them would offer cover on the basis of the 2 claims.

Prompted by your note above, I have just made a subject access request to the loss adjusters for a copy of the file etc. and hopefully this will demonstrate that they made a recommendation which Brit ignored. It will be interesting to see if Brit made any further enquiries with the loss adjuster before making their decision.

Have just been speaking with a loss consultant (acts for the policyholder not the insurer) about them representing my claim to Brit. They would charge either £110/hr in preparing the claim, or 10% on no-win no-fee basis.

Any thoughts on this?

Pford75

I am not sure of the value of employing a loss consultant at this point, when more than 6 months has passed since the loss event. The claim has already been submitted, a loss adjuster has made an assessment, it is just a disagreement with Brit as to the cause of the loss. If the loss consultant had particular expertise in regard to claims for disputes involving flood/gradually operating cause, then maybe. But what would be the minimum number of hours you would be billed for? I would think it would cost you atleast £1000.

My advice is to write to the Director of Claims or Chief Executive to advise them that you are looking to refer the claim to the FOS, so require them to review the claim and issue their final decision.

In regard to the Loss Adjuster report, a subject access request is a good idea. I have found in the past that some LA's are not always totally honest with policyholders and leave it to Insurers to provide any bad news.

huckster

Huckster - I am dealing with someone in the Brit complaints team who has advised that they will look into things and come back to me with an initial response within 4 weeks. Would you advise me to stay with that process first, before contacting the Director of Claims or should I cut across the current 'complaints process' and raise this to the attention of someone more senior? I don't want to get anyone's back up, so my feeling is that I should wait and see what sort of response I get from the complaints team first and then escalate if required.

Agree with you on the loss consultant - I think if I were to have engaged one, it should have been at the time of the initial claim. Seems like a waste of money this late in the process.

Pford75

I would go straight to the top Dane Douetil, Chief Executive Officer of Brit Insurance, Brit Insurance's Head Office, 55 Bishopsgate, London EC2N 3AS.If you go through the normal complaints process they will spin it out and then refer it to Head of Claims, if you were still unhappy. The complaints team will deal with dozens of complaints on a daily basis, but very few of which have been referred down to them from the CEO. When a complaint goes to the CEO, it is referred to Director/head of claims, who will ask for someone senior to investigate as a matter of urgency/priority. You will not get anyones back up, any complaint to the CEO is handled with extreme care, as it would be very embarrasing if the customer then had the complaint upheld by the FOS.

huckster

Huckster - Thanks for the advice. Letter to Mr Douetil send registered post today. Have outlined the key facts of the claim and that with a sum insured of apx £2m, I expected rather better communication from Brit.

Also pointed out that this is clearly not something I am seeking to profit personally from, this is not a dodgy accidental damage claim for a pot of paint on the carpet or similar. There have been many minor instances in the lifetime of my cover where I could have made a claim, but my attitude has always been that insurance is there to provide cover for the major things which I can't afford to redress myself.

Let's hope they can see some sense.

As mentioned above, I wrote to Brit's CEO and lodged an official complaint. I have today received a letter back from Brit which essentially summarises the essence of the complaint, setting out my view and the view of Brit's claims team. They are disputing that a flood could have caused the collapse of the section of walling and are therefore suggesting that it must have been in a poor state of repair/maintenance.

They have agreed to appoint an 'independant' structural surveyor at their cost to come and inspect the wall. He called today and is due to come on Thursday this week. He believes that Brit claims will accept his view as the final arbiter (ie. if he says it is wear and tear, then they won't pay...if he agrees with the original loss adjuster that it was flood damage, then they will agree to pay).

Any tips/advice for dealing with the visit? I have been doing a lot of research on the FOS website and have found a couple of (what I believe to be) relevant articles:

1. A case study of a claim for wall collapse after flood being refused on the basis that it was due to the poor construction and age of the wall (http://www.financial-ombudsman.org.uk/publications/ombudsman-news/73/73-household-insurance-disputes.html). The complaint was upheld

2. The second article was to do with identifying whether damage results from poor maintenance or from an event (ie. if a storm blows tiles from a roof, is this storm damage or due to the roof being poorly maintained?) I believe in this case that the remaining section of wall (which was not adjacent to the flood) can be shown to be in a good state of repair and this is what the collapsed section would have been like without the flood.

Finally, because of my previous claim when a tree fell...Brit requested a full survey and revaluation of the entire property. Their surveyors also saw the wall on several occasions when dealing with the tree damage claim....is it reasonable to expect that if they felt the wall was in a poor state of repair that they would have raised this as an uninsurable risk? Having surveyed the property, they increased the total cover and premiums considerably and never mentioned anything about levels of maintenance.

Really appreciate any advice as I have a lot riding on this - I can't afford to reinstate the wall myself....but the local council are threatening to force me to do so via court order (it's listed)

pford75:

Here is my limited take on this. The loss-adjuster saw the wall and considered it flood damage. The insurer didn't see the wall but nevertheless considered it must have been in poor repair. In between times and seperately the insurer requested a full survey and revaluation of the entire property. Either they gained relevent information about the wall or they didn't. I suspect not but maybe at some stage you will need to seek legal disclosure on that. They can't have it both ways.

I don't think the tree surveyors (maybe) seeing the wall is relevent though.

pford75

Sounds like you have been doing your homework!

The only preparation I would do for the visit of the independant surveyor , is some research on flint stone wall construction and issues regarding weathering. The argument is essentially that the Insurers believe that the wall was subject to weathering ( gradually operating cause) and not to flooding over a short period of time. Your policy as you know does not cover maintenance, only Insured perils. The Independant surveyor may or may not have specific knowledge of flint stone walls. If you have any report from a flint stone wall specialist on the damaged wall this may also help guide the surveyor. You could provide the surveyor with a copy of such a report for information purposes.

It will certainly help you that Brit had surveyed the property only 2 years earlier, when dealing with previous claim. Did you receive a copy of the recent surveyors report after submitting the SAR?

I can see this saga being dragged on until Autumn/Winter, unless the Independant Surveyor reports quickly in your favour. If the surveyors report is not in your favour you could still submit to the FOS, but I think you would need to get an alternative opinion from a local surveyor with experience of flint stone walls before you did this. My only slight issue with Independant suveyors appointed by Insurers in these circumstances is, how Independant are they, when the Insurers have paid the fee?

Another thought. It may be worth typing up a chronological note of events, with a copy of all information you have. The surveyor should find out details from the met office about rainfall at the time of the event, but any information regarding the drainage problems may help the surveyor. The surveyor will hopefully look at other sections of the wall and can see what condition it is in.

I think it is just a case of making sure the surveyor is thorough, without telling them what they should be doing or weighing them down with evidence. Advise them of any information you have and that you can provide a copy if it helps. Make a note of any questions you were asked and answers you gave, just in case the surveyors report does not accurately convey this.

Huckster

Jalexa and Huckster - thankyou for your responses.

Jalexa : Perhaps I didn't make it clear in my posts, the chronology of events was like this....

1. Tree fell on section of wall in 2007

2. During this claim, Brit arranged for a full re-survey of my property and requested that I increase my cover as a result (which I did). This survey made several recommendations about things I needed to do inside the house, but made no reference to the condition of the remaining wall. The surveyors were chartered surveyors (I simply called them tree surveyors as their visits related to the tree)

3. Brit settled the tree damage claim at around £100k

4. Then in 2008, flooding caused the collapse of the wall....which Brit are now suggesting might have been due to poor maintenance. (in fact, I struggle to be certain on exactly what basis Brit are refusing the claim...is it poor maintenance, gradually operating cause or something else?)

I am almost certain that there was no reference to the wall by their surveyor in 2007 (primarily because it was in a good state of repair). My view therefore is that, if after a full survey and various clauses etc imposed, they made no reference to the wall...how can they then claim only 12 months later (bearing in mind that the wall has stood for apx 250 years) that the collapse is due to poor maintenance/construction?