AXA Insurance UK Plc · DRN-6223069

The complaint Mr S complains AXA Insurance UK Plc isn’t handling a claim against his home insurance policy fairly. What happened Mr S had a home insurance policy with AXA. In September 2024 he made a claim against the policy for an escape of water. AXA accepted the claim, but progress has stalled. Over the course of the claim Mr S made complaints culminating in a complaint to our Service. I dismissed that complaint (for reasons I won’t detail here) and arranged for a new separate complaint with a purposefully narrow scope, setting aside the past and with the sole focus of moving the claim forward. The central question was: “Is AXA’s proposal to progress the claim fair, and if not, what would be fair?” An Investigator considered the new separate complaint (this complaint) and set out her findings and recommendations. I will include the core content below. It was addressed to Mr S. I have anonymised third-party names and referred to AXA as it’s responsible for the claim. “I’ve reviewed AXA’s proposal, as well as your own. I find AXA’s proposal to be fair and reasonable in principle, for reasons which will soon become apparent. But to provide a clear structure to what I find would be practical and pragmatic, I will set out the proposal in my own words, to form a more specific and tailored recommendation on how I think the claim should be progressed. 1. AXA should appoint Q [loss adjuster] to act as a single point of contact. I think this is fair, as it meets your request for a single point of contact, and they’ll be able to review things afresh. 2. Q, G [surveyor] and R [drying expert] should attend to carry out a joint inspection along with you and/or your representative(s). I find this to be fair, as AXA first needs to know what works are required to calculate strip out and repair costs. I accept you don’t think this should be necessary. But AXA thinks it is, and I find it’s reasonable. AXA is being asked to pay a lot of money to settle the claim, and there is a material dispute over what claim related works/repairs are necessary. It follows a practical and pragmatic way to move the claim forward is for all parties to attend jointly to review/discuss what’s needed. 3. AXA, following input/recommendations from Q, should present settlement options to you. These should be: a) an offer to undertake works/repairs with details of the scope, using AXA’s contractor network; and

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b) a cash settlement offer based on the same scope of work, at the cost those works/repairs would have cost AXA. I accept you don’t think it’s fair for AXA to base a cash settlement on what the cost would have been to AXA, but the policy terms (the contract) allow for that, as do insurance principles in general, if the insurer offered to undertake works/repairs, and the insured insist on undertaking them themselves. 4. You would then decide which offer you’d like to accept. If you accept AXA undertaking the works/repairs, AXA should start making the necessary arrangements. If you choose a cash settlement, AXA should pay you the amount it has agreed to pay without undue delay. 5. If you dispute the scope of work, this will impact both AXA undertaking the works/repairs and cash settlement options. Both parties should endeavour to avoid this delaying the claim. You should provide the basis of your dispute concisely and with relevant evidence to Q. Q should review your submissions with appropriate urgency and provide a response. 6. If there is a dispute over the scope of works/repairs which can’t be resolved between the parties, AXA should set out its final position in a final response letter. I would ask it to do so quickly once a deadlock has been reached. A complaint can then be referred to me to consider. If I’m asked to consider a complaint about a dispute over the scope of works/repairs, my considerations will be limited to that dispute. Other matters I’m not recommending AXA pay compensatory interest. This is because, for the reasons set out above, there is no cash settlement or costs for you to be compensated for. If there are specific costs you’ve incurred which you consider AXA should pay and haven’t yet reimbursed you for, you should put these to AXA with a concise explanation and relevant evidence for its consideration. In terms of project management costs, AXA has already agreed to cover your surveyor’s costs at 10% of the total claim value or at the surveyor's quote of £5,000, whichever is the lower amount. This is more than they’d pay their own surveyors, so I consider the offer fair. The policy doesn't offer cover specifically for project management costs, and as such I won’t be asking AXA to include an additional contingency for these costs in any offer. I make no award for compensation for distress and inconvenience caused. This is because this is a new complaint, about very recent events, and nothing material has happened. It follows AXA can’t have caused you any material distress and inconvenience for which compensation would be appropriate.” AXA accepted the Investigator’s findings and recommendations. Mr S didn’t. He’s explained why he disagreed in many calls and emails. In summary, Mr S doesn’t want a visit to his property because he considers it unnecessary and inappropriate, for a variety of reasons, and he doesn’t consider the proposal will move the claim forward in any meaningful way. He put forward his own proposal which is broadly that AXA should settle the claim based on his schedule of works, at the cost to him, and any disputes should form part of this complaint.

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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. Mr S may have further submissions to make. But he’s already provided many submissions (including a 15-page letter) and I’m not aware of any new arguments, or new evidence, which is likely to be forthcoming. I’m mindful of the need to advance this complaint to help progress the claim, and I’m satisfied I have enough information to reach a fair and reasonable outcome. I will now set out the reasons for my decision. The policy (Mr S’ contract of insurance with AXA) says AXA will: choose the most suitable option for repairing damage, that it uses approved suppliers to settle claims, if it agrees for Mr S to use his own supplier or to a cash settlement, it will pay the costs it would have incurred. It also says if asked, Mr S must allow it to inspect the damage. These are common terms in this type of policy and in line with general insurance principles. In September 2024 Mr S reported an escape of water. A drying agent attended and installed drying equipment. Then a loss adjuster (whom I’ll call ‘G2’) attended the property in October 2024 to produce a preliminary report (rather than a full scope of works). G2 identified water damage, but it didn’t appear to be particularly extensive. I’ve seen photos which also show there wasn’t extensive damage. G2 set a buildings reserve (the amount the claim would likely cost AXA) at £40,000. The claim was accepted in November 2024. Mr S provided repair quotes for about £60,000 (plus VAT). AXA wanted to validate the costs. Rather than AXA surveying the property to draft a scope of works, Mr S chose to appoint his own surveyor. He provided this and three quotes in the summer of 2025. The three quotes were all for about £200,000 (plus VAT). AXA wasn’t expecting costs to be this high, so it asked to inspect the damage. Mr S has declined to allow this to happen for various reasons. The Investigator thinks AXA’s request is reasonable. I find it is too. Mr S is asking AXA to pay a lot of money based on only his quotes and I find AXA’s concerns that the quotes contain costs which are excessive and works which are likely unnecessary to be justified. I’ll explain why. And while AXA hasn’t provided specifics because it wants to inspect the damage first, I’ll include some examples to demonstrate the point. 1. G2 said the tiles would need to be taken up to allow drying. Mr S says this triggers mandatory improvements under government guidance. His quotes include the cost to break up the floor slab and excavate, replace it, install underfloor heating and then new tiles. This comes to about £100,000 (plus VAT). This is unusual and expensive work. It’s fair for AXA to want to inspect the damage to establish it’s necessary. Mr S says tying mitigation to reinstatement work is wrong. Drying has been completed in part, but there’s water under the tiles. Ordinarily tiles would be taken up to allow drying. But Mr S is asking for the foundations to be excavated and replaced at considerable expense and likely with considerable collateral damage. It’s fair for AXA to want to inspect the damage before agreeing to fund this. 2. There is a reference to making good to renders and finishes to existing walls. On one quote this is £25,000 (plus VAT). On another it’s £30,000 (plus VAT) and includes costs of re-tiling the bathrooms. The photographs I’ve seen don’t show any obvious damage to walls or a need for re-tiling bathrooms, and G2 didn’t refer to such damage. It’s fair for AXA to want to inspect the damage to establish it’s necessary.

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3. Two quotes refer to removing and disposing of the kitchen, at significant expense. G2 noted no material damage to the kitchen units and thought they could be refitted without causing further damage. The photographs I’ve seen don’t show any obvious damage to the kitchen units. It’s fair for AXA to want to inspect the damage to establish the kitchen needs replacing. AXA is entitled to review and validate costs before settling a claim. As matters stand, there is a material dispute over what works are reasonable and necessary, and AXA hasn’t had the opportunity to inspect the damage to draft a scope of works. Mr S says AXA should use his scope/quotes, but they represent the works Mr S wants done, rather than a scope of works based on loss-related damage, which is what’s necessary. It follows a fair, reasonable and pragmatic step towards a resolution is for AXA to inspect the damage with Mr S (and/or his representatives) to review and discuss. Mr S doesn’t want AXA to attend the property. He says it’s not necessary. For the reasons set out above, I find it’s necessary to move the claim forward. He says it’s not appropriate. This is primarily because of reasonable adjustments based on his vulnerabilities. I recognise Mr S’ vulnerabilities make a visit from several people at the same time a concern. But AXA has agreed to a new loss adjuster (which Mr S wanted and now doesn’t) and they need to inspect the damage. That a surveyor and a drying expert will be present, at the same time, will mean there can most likely be one productive visit, rather than several. And Mr S doesn’t necessarily have to be there as he has his own surveyor (paid for by AXA) and the support of his family. In all the circumstances, I find AXA’s proposed joint visit to be fair. The Investigator set out two options under Point 3, and the consequences which follow under Point 4. Mr S says allowing AXA to undertake the repairs using its contractor network isn’t an option because the relationship has broken down, so the claim must be settled at the cost to him. I don’t share Mr S’ opinion. AXA is entitled under the contract to use approved suppliers to settle claims, or if requested, cash settle based on its costs. The contract guarantees the repairs it undertakes, and any concerns over the quality of the repairs can be considered by our Service if necessary. In any case, once a scope of work has been agreed AXA will instruct a contractor to undertake them, and they’ll have had no prior involvement with the claim. Mr S has concerns with what the Investigator set out in Points 5 and 6. I’m not going to address these concerns again as they stem from the question of whether AXA inspecting the damage to draft a scope of works is fair. I’ve already set out why I find it is. There may well follow a dispute over the scope of works as Mr S suggests. But that doesn’t mean AXA inspecting the damage to draft a scope of works is unnecessary, and at the very least it will help crystallise areas of dispute and allow for a more focussed and considered review of those areas. Point 6 was the Investigator setting out a mechanism for a fast-paced response to any disputes which might arise, which I find is appropriate in the circumstances. Regarding the ‘other matters’ the Investigator referred to, Mr S hasn’t disputed them in a material way, and I agree with her conclusions and her reasons for them. So I see no compelling reason to comment on them further. Final thoughts I’m very sorry to hear about the impact of the claim on Mr S and his family. If he wants to continue to be actively involved in it, he’s entitled to. But generally, in claims such as these, the insurer takes the lead, so the policyholder doesn’t have to. From my objective review I’m satisfied AXA is keen to progress the claim and to do so fairly. While I don’t want to offend Mr S, from my objective review, it’s his actions preventing the claim progressing.

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I accept Mr S doesn’t trust AXA. But as I’ve said, looking at the matter objectively, it’s keen to progress the claim and to do so fairly, which it’s required to do by the regulator, under the Insurance Conduct of Business Sourcebook (ICOBS). The contract guarantees the repairs and disputes can be referred to our Service. So I would ask Mr S to reflect on whether it might be best for him to take a step back and allow AXA to take the lead on the claim. My final decision I don’t uphold this complaint because I’m satisfied AXA’s proposal to progress the claim is fair and reasonable. While not binding, I would ask both parties to progress the claim in line with the steps set out by the Investigator and endeavour to be concise and pragmatic as matters proceed. Under the rules of the Financial Ombudsman Service, I’m required to ask Mr S to accept or reject my decision before 22 April 2026. James Langford Ombudsman

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