Aviva Insurance Limited · DRN-6119505

The complaint O complains Aviva Insurance Limited unfairly declined a claim it made on its property owner’s insurance policy for damage it said was caused by a storm. O has been represented in bringing the claim and complaint but for ease I’ve referred to all comments and actions as being those of O. What happened O made a claim for damage to the roof of its property; it thought the damage had been caused during a named storm. It also claimed for internal damage caused by rainwater getting into the property. Aviva assessed the claim; it wasn’t satisfied there had been storm conditions around the time of the damage, nor that the storm had been the main cause of the damage. It considered the damage had been caused by “gradual deterioration or wear and tear”. However, it said it would pay for the internal damage caused by rainwater getting into the property. O complained about Aviva’s decision, it said the report Aviva had relied on was inaccurate, and it hadn’t been given the opportunity to put its points across to Aviva regarding what it considered were issues with the report. Aviva didn’t agree to change is position and so O referred matters to the Financial Ombudsman Service for an independent review. Our Investigator asked Aviva for a copy of the report it had relied on to decline the claim, but it wasn’t provided. As such he recommended the complaint be upheld. He wasn’t satisfied Aviva had shown it could fairly rely on the exclusion to decline the claim for damage to the roof, bearing in mind O’s policy was an ‘all-risks’ one. As such he said Aviva should reimburse what O paid for the works to be done, plus compensatory interest. He also recommended Aviva pay £200 compensation for the unnecessary inconvenience caused. O accepted that outcome. Aviva didn’t provide a response. As such, the matter hasn’t been resolved and so has been referred for an Ombudsman’s decision. What I’ve decided – and why I’ve considered all the available evidence and arguments to decide what’s fair and reasonable in the circumstances of this complaint. This Service has a well-established approach to considering storm damage cases, but that is generally only relevant when the policy has ‘storm’ listed as one of the perils it will cover. O’s policy doesn’t just cover damage caused by a storm (or other specific events); it is an ‘all- risks’ policy. The policy covers O for “damage to the property insured occurring during the period of insurance” unless it can reasonably show that a valid exclusion applies. I’m satisfied O has shown that the roof of its property suffered damage during the period of insurance. Which means Aviva will need to meet the claim unless it can fairly rely on a valid exclusion to decline it. Aviva’s notes say it was satisfied the damage was caused by “gradual deterioration or wear and tear”, however it hasn’t provided this Service with its expert report it relied on to make this finding. So, I haven’t been able to assess that as part of Aviva’s

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evidence. Instead, I’ve reviewed what I have been provided, to reach a fair and reasonable outcome. I can see from Aviva’s notes about the report that it didn’t accept roof tiles had been dislodged, because it didn’t see any during the roof inspection. However, O explained to Aviva that its own contractor, hired to carry out some emergency mitigation works to stop water ingress into the building, had already replaced those roof tiles before Aviva had inspected the roof. I consider that was a reasonable action for O to take, given it then limited the internal water ingress into the property. But this doesn’t appear to have been considered by Aviva or its expert, with it concluding the roof showed no visible signs of damage. O has also said Aviva’s expert asked it to confirm the exact location of roof damage which had allowed the water ingress. But when its contractor pointed out the area, it still declined the claim. I haven’t been provided with Aviva’s reasons for this, supported by any photographs or expert commentary, that persuades me that was a reasonable decision. Aviva’s notes further say that the roof hadn’t been replaced in the 19 years of O’s ownership of the building, as such the damage was most likely age related. However, O had provided evidence of roof repairs and maintenance carried out in 2021 and 2022. So, whilst the roof itself might have been over 20 years old, that fact alone doesn’t persuade me that the damage reported by O was more likely to be caused by wear and tear, bearing in mind the relatively recent works O had carried out. It also appears from Aviva’s notes on its report that it focussed on the wind speeds, stating it didn’t consider those had reached storm-force conditions. But given this was an ‘all risks’ policy, the claim clearly shouldn’t have been declined simply because Aviva didn’t consider there had been a storm, because all damage is covered unless an exclusion applies. Having considered matters, in the absence of the report itself, I’m not persuaded Aviva has shown it can fairly rely on the gradual deterioration or wear and tear exclusion to decline this claim. As set out above, I’ve seen no photographs of the roof or commentary which persuades me the damage was most likely as a result of wear and tear. I’ve considered the points Aviva has made, set out above which I’m persuaded O has reasonably answered. As such, I find that a fair and reasonable outcome is for Aviva to reimburse O what it paid for the repairs to the roof. It will also need to add 8% simple interest onto the amount it pays, from the date the repairs were paid for, until the date of settlement. And to recognise the inconvenience caused by Aviva unfairly declining the claim, I’m satisfied that an award of £200 is reasonable and in line with similar awards this Service has made where the impact of a business’ mistake has caused considerable inconvenience, requiring considerable effort to resolve. My final decision My final decision is that I uphold this complaint and I direct Aviva Insurance Limited to: • Reimburse what O paid for the work carried out to the roof. To the sum it pays, it will need to add 8% simple interest from the date the invoice was paid, until the date of settlement. • Pay O £200 compensation for unnecessary inconvenience caused. Under the rules of the Financial Ombudsman Service, I’m required to ask O to accept or reject my decision before 28 April 2026. Michelle Henderson Ombudsman

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