Insurance Claim Handling

A broker has a duty to notify the policyholder's insurer of incidents without delay, even if non-fault, to ensure accurate records and prevent adverse impacts on renewal terms.

An insurer must pay the reasonable cost to repair damage caused by an insured peril, but is not liable for betterment or repair of undamaged parts.

Insurers must handle claims promptly and fairly in accordance with FCA rules, and should only be held responsible for delays within their control.

An insurer must pay a claim for an insured loss unless it can reasonably rely on a policy exclusion to decline it.

A loss assessor is responsible for the regulated activities it carries out (such as assisting in insurance claim administration) but not for the actions of independently engaged contractors where the consumer has directly contracted with th

An insurer is responsible for correcting documentation errors that led a consumer to believe they had cover they did not actually possess, and must treat the cover as if it were in force for the period during which the error existed.

A loss assessor carrying out regulated insurance activities must provide the service promised and charge fees in accordance with the terms of engagement agreed with the consumer.

An insurer must properly reinstate a property to its pre-loss condition following investigative works, and is liable for damage caused by failure to do so.

An insurer may rely on policy exclusions to decline a claim only if those exclusions reasonably apply to the circumstances, and 'unattended vehicle' means a situation where the policyholder is not in a position to intervene or deter a thief

An insurer must settle business interruption claims fairly and reasonably, applying policy terms correctly and not making deductions (such as underinsurance) that are not supported by the evidence or policy wording.

A single continuous business closure enforced by reiteration or renewal of materially similar regulations constitutes one claim occurrence unless the business reopened and was subsequently closed again.

Business interruption insurance covers losses caused by inability to use insured premises due to restrictions imposed by a public authority following a notifiable disease outbreak.

Business interruption insurance for holiday accommodation covers loss of profit due to infectious disease only where the insured premises provide accommodation for paying guests as defined in the policy.

Insurers must provide appropriate instructions to expert loss assessors that correctly reflect policy coverage, and must act fairly and reasonably in settling business interruption claims based on those expert assessments.

Under the Insurance Act 2015, an insurer cannot apply an average clause to reduce a claim settlement unless it can demonstrate the insured breached their duty of fair presentation and that the insurer would have acted differently absent tha

An insurer must make a fair and reasonable settlement offer based on the value of the property at the time of loss, determined by reference to comparable market values.

Multiple occurrences of a notifiable disease can each potentially trigger separate business interruption claims, with causation assessed based on whether losses are attributable to the specific occurrence.

A policyholder must make a fair presentation of risk by disclosing all material circumstances they knew or ought to have known through reasonable enquiry.

Business interruption insurance cover for notifiable diseases requires a direct causal link between an occurrence of the disease at the premises and the loss suffered, which can be established where the occurrence falls within the relevant

An insurer must settle business interruption claims within a reasonable timeframe and is liable for consequential losses (such as interest on emergency borrowing) that directly result from unreasonable delays in settlement.

An insurer must handle claims fairly and reasonably, including considering loss of income claims based on available evidence and appointed expert calculations.

An insurer is not liable for consequential losses from a claim decline if the consumer has not demonstrated they would have made different business decisions had the claim been promptly settled, particularly where alternative mitigation opt

An insurance intermediary must provide clear information about policy cover, and must be transparent about the details of available extensions, particularly when a policyholder specifically enquires about cover for a particular risk.

A business interruption claim under a notifiable disease clause covers losses caused by the interruption or interference to business resulting from the disease, assessed against standard turnover adjusted for trends, but only for the period

An insurer cannot rely on different policy wording than that quoted to a consumer without explicit notice and agreement prior to acceptance.

An insurance broker has a duty to obtain formal quotes and take reasonable steps to arrange appropriate cover when requested by a client, particularly when the client has expressly requested adequate cover.

Business interruption insurance should indemnify the policyholder for losses caused solely by the inability to use premises due to the insured event, not losses from wider circumstances, and the indemnity period is limited to when income is

An insurer may reasonably request specific evidence to assess a claim, and may settle based on available evidence if further evidence is not provided, but must reconsider if additional evidence becomes available and causes no prejudice.

In an insurance claim, the claimant bears the burden of evidencing both that an insured event occurred and the quantum of losses suffered.

Business interruption insurance covers loss of rental income only when the loss is caused by insured damage from a covered peril, not by unrelated fire safety breaches.

Business interruption claims must be calculated by comparing actual income during the indemnity period with income that would have been earned had the insured event not occurred, without applying a positive trend unless expressly required b

An insurer conducting a non-advised online sales process must provide clear, fair and not misleading information to enable consumers to select appropriate cover levels.

In a non-advised sales process, the seller must provide clear, fair and not misleading information to enable the consumer to make an informed decision about insurance cover.

An insurer must apply a consistent methodology when calculating losses across multiple claim periods arising from the same proximate cause, and must openly communicate any calculation methodology used.

An insurer cannot apply an average clause to proportionately reduce a business interruption claim where the policyholder has fairly presented its actual income figures and the underinsurance was not a breach of the duty of fair presentation

Physical damage caused by a sudden, unexpected impact to a vehicle is accidental damage under an insurance policy, even if it results in mechanical component failure, provided the damage was not caused by pre-existing mechanical wear or del

A loss assessor retained to handle all communications and claim management cannot disclaim responsibility for contractor delays when it introduced those contractors and paid for their services.

An insurer must handle claims promptly and fairly, and should not unreasonably reject claims or misapply policy terms to deny reasonable claims.

Loss adjusters must conduct adequate investigations and assessments of subsidence claims, arrange timely inspections, and fairly evaluate the scope of necessary repairs rather than making inadequate cash settlement offers.

A loss assessor must be transparent with consumers about its role and responsibilities, particularly when introducing specialists and contractors from its network.

A complaint arises when dissatisfaction is expressed, whether oral or written, and must be properly acknowledged and handled even if initially raised over the phone.

Under Regulation 6 of the Insurance Companies (Legal Expenses Insurance) Regulations 1990, policyholders have a right to choose their own solicitor only where judicial proceedings have been issued, not at the pre-litigation investigation st

An insurer must put a consumer back in the position they were in before the loss, and replacement items must be reasonably equivalent to those lost, not merely available at cost price from appointed retailers.

Multiple claim events arise from materially different restrictions imposed on a business, not from a continuous period of interruption.

A structural warranty should cover water damage to structural elements caused by defective construction, even if the immediate visible damage is to finishing elements like tiling.

An insurer must handle claims promptly and proactively, and compensation for distress and inconvenience should reflect delays and poor service over and above what is reasonably expected when dealing with a claim.

An insurer cannot rely on a policy exclusion for damage caused by cleaning when the flooring had not reached the end of its serviceable life, even if damage occurred during a cleaning activity.

An insurer must handle insurance claims fairly and promptly, and must not unreasonably decline a claim by failing to consider relevant evidence about the nature of treatment provided.

Insurance claims must be handled promptly and fairly under FCA ICOBS rules, with compensation awarded for avoidable delays and poor communication.

A financial services provider's standard claims investigation practices, including questioning about undisclosed medical history, do not constitute unfair treatment merely because they cause stress to a customer, particularly where errors a

An insurer must handle claims promptly, communicate clearly with policyholders, and take reasonable steps to mitigate further damage rather than shifting such responsibilities to the insured.

Insurers must handle claims promptly and fairly, and must not turn down claims unreasonably.

Under CIDRA 2012, a consumer must take reasonable care not to misrepresent information when taking out insurance, and an insurer can avoid a policy if it can show the misrepresentation was qualifying and would not have offered the policy at

An insurer must handle claims promptly, communicate proactively, and arrange suitable alternative accommodation without unreasonable delay when a property becomes uninhabitable due to an insured peril.

An insurer must make effective and lasting repairs to flood damage as covered by the policy, but is not obligated to pay for pre-existing maintenance issues or improvements beyond the policy's scope.

An insurer must provide reasonable support such as a replacement vehicle when repair delays beyond the consumer's control prevent them from using their car, even if courtesy car cover is not included in the policy.

An insurer is accountable for delays and poor service in claims handling that cause financial loss to the consumer, including costs directly resulting from the insurer's failure to progress repairs in a timely manner.

Insurers must accommodate reasonable adjustment requests from neurodivergent consumers and handle claims with fair, regular communication.

Under the Insurance Act 2015, when a consumer makes a qualifying misrepresentation, the insurer must apply the proportionate remedy based on premium paid rather than sum insured, unless the policy explicitly contracts out of the Act.

Insurers must apply the Insurance Act 2015 framework for misrepresentation in calculating underinsurance adjustments, comparing premiums paid to premiums that should have been paid, rather than comparing rebuild costs.

An insurer must ensure that repairs under a home appliance policy are completed properly and lasting, and cannot rely on policy cancellation to avoid fulfilling their obligations.

A farm insurance policy's motor vehicle exclusion does not apply to tractors that are listed on the policy schedule as agricultural machinery and are not registered for road use.

An insurer is responsible for the actions of its contractors and agents, and cannot avoid liability by refusing to properly investigate damage caused during the course of a claim.

An ambiguous insurance exclusion must be interpreted narrowly in favour of the policyholder, and the insurer bears the burden of proving all elements of an exclusion apply.

An insurer must ensure complete delivery of replacement parts under a policy and provide fair compensation for service failures and delays in fulfilling claims.

Firms must handle claims promptly and fairly, and keep consumers informed of claim progress.

An insurer has contractual discretion to decide whether to repair or write off a damaged vehicle, provided the decision is exercised fairly and reasonably based on expert assessment.

An insurer may decline a claim under a non-consumer insurance contract if the insured failed to make a fair presentation of the risk regarding material circumstances, provided the insurer can show it would not have entered into the contract

Accidental damage under an insurance policy covers damage caused suddenly by external means which is not expected and not deliberate, and a single act of drawing on a wall constitutes a sudden event rather than gradual damage.

An intermediary arranging an advised sale must ensure the policy is suitable for the customer's needs and provide clear, fair information; when aware of building works, the adviser must ensure the sum insured reflects the actual rebuild val

An insurer must handle claims fairly and promptly, and compensation should reflect additional distress and inconvenience caused by the insurer's failures beyond that inherent in the claim itself.

An insurer must provide replacement goods that meet the same functional standards as the original item, and cannot unreasonably limit replacements based on technical issues it could have prevented.

An insurer must fairly assess whether an insured event covered by the policy has occurred before declining a claim, rather than relying solely on policy exclusions without proper investigation.

The matching items clause in a buildings insurance policy only applies where damaged items are part of a matching group and replacements cannot be sourced, with coverage extending only to undamaged companion pieces in the same room or open

Business interruption insurance indemnity period requires inability to use premises, not mere hindrance or limitation of service capacity.

A policyholder must provide sufficient evidence to demonstrate a valid claim exists under the terms and conditions of their insurance policy.

An insurer cannot rely on breach of unoccupancy policy conditions to reject a claim where the breach did not contribute to the loss, and misrepresentation requires actual change in risk, not merely an application for planning permission.

Under CIDRA 2012, a consumer must take reasonable care not to make a misrepresentation when providing information for insurance reinstatement, and failure to disclose material changes in circumstances can justify policy voidance if the insu

Interest on delayed insurance settlements should reflect the actual loss suffered by the policyholder, which may be the cost of borrowing taken out as a direct result of the claim rejection, rather than a default statutory rate.

Business interruption insurance claims require the circumstances to fall within the specific policy terms and conditions; a business must have been directly subject to the government restrictions to claim under a public authority clause.

An insurer is entitled to decline a claim where the policyholder fails to notify the insurer within the policy's required timeframe, causing prejudice to the insurer.

An insurance policy requires an explicit order from a competent public authority to close the premises; removal of demand or referrals does not constitute such an order.

Under the Insurance Act 2015, the insured has a duty to make a fair presentation of risk at policy renewal, and underinsurance does not entitle the insured to claim beyond the sum insured unless they ask for application of specific policy t

Business interruption insurance cover for COVID-19 claims is limited to periods where there is a total inability to use the premises due to public authority restrictions, not mere impairment or hindrance of operations.

An insurer may reasonably require specific evidence to assess a claim and settle based on available evidence if requested information is not provided within a reasonable timeframe.

A business interruption insurance policy covers losses arising from inability to use business premises due to notifiable illness restrictions, but the insured must substantiate their claim with evidence of actual losses.

Business interruption insurance cover applies only when there is an inability to use premises due to direct government restrictions, not when operational constraints reduce capacity.

Business interruption cover requires an inability to use premises or discrete parts thereof for business activities; partial interruption and reduced capacity may qualify if caused by inability to use discrete parts of premises.

Business interruption insurance cover requires an inability to use premises, not merely a reduction in capacity or operational hindrance.

Business interruption cover requires an inability to use premises; a reduction in capacity or partial restriction while premises remain open does not trigger coverage under the policy wording.

A business interruption claim requires the insured's premises to fall within a category mandated to close by Government restrictions, not merely to comply with general guidance about non-essential businesses.

An insured suffering partial inability to use premises or discrete parts of business activities due to government restrictions may be covered for business interruption losses beyond complete closure, subject to policy terms and underinsuran

Business interruption insurance cover requires an inability to use premises, not merely a reduction in capacity or hindrance to business operations.

Business interruption cover under denial of access extension only applies to insured events occurring within the policy period, and cover ends once restrictions are lifted.

Business interruption insurance requires that business closure be a direct result of an occurrence of infectious disease at the premises, not merely from government-mandated closure measures.

Non-advised sales of insurance must provide clear, fair and non-misleading information to enable informed decision-making, with the consumer responsible for selecting appropriate cover levels.

An insurer may require a joint inspection to establish the scope of works before settlement, and may base a cash settlement offer on what the repairs would have cost the insurer rather than the consumer's costs.

An insurer is entitled to decline a claim that falls outside the territorial limits specified in the policy terms, and is not obliged to extend cover beyond those limits.

An insurer may fairly apply a policy exclusion for items not with the policyholder or their family at the time of loss when the circumstances support that application.

Business interruption insurance cover is triggered only by an inability to use premises, not by mere hindrance or reduction in capacity due to Government restrictions.

A pre-existing medical condition clause in insurance policies can fairly exclude claims for conditions where the policyholder had symptoms or sought medical advice within the five years prior to cover start, unless two continuous years pass

Insurers must handle claims promptly and fairly in accordance with FCA ICOBS 8.1 rules, and compensation for distress must be assessed in relation to the severity of issues experienced during the specific complaint period.

Buildings insurance exclusions for gradual damage and structural defects apply even when sudden events (like brick collapse) are the immediate trigger if the underlying cause is excluded.

An insurance-backed guarantee is limited to the timeframe specified in the underlying supplier's guarantee, and the insurer only has an obligation to cover defects claimed within that period.

An insurer is entitled to keep a claim open and factor it into premium calculations while the third party retains the legal right to pursue proceedings within the limitation period.

An insurer may fairly decline a claim where the policyholder fails to meet the eligibility requirements stated in the policy terms and conditions.

An eligible complainant under DISP 2.7.6(5) as a beneficiary of an insurance policy can only raise complaints affecting their own insured interest, not matters concerning other beneficiaries' claims.

A management company as the named policyholder is the eligible complainant for claim handling issues, and complaints involving multiple eligible complainants cannot be considered without all parties' consent.

An insurance intermediary selling on an advised basis must recommend a suitable policy and provide clear information about coverage limits, but the consumer bears responsibility for disclosing the full value of items to be insured.

Business interruption insurance cover is triggered by an insured peril (occurrence of notifiable disease at premises) and the indemnity period ends when the triggering circumstances change materially (new government restrictions imposed).

An insurer is not required to charge a lower premium based on claim costs, and pricing decisions are commercial judgments for the insurer to make provided they treat customers fairly and consistently.

Business interruption insurance claims must be assessed based on the actual loss of income and the policy's specific coverage terms, including application of proportionate underinsurance adjustments and deduction of collateral benefits rece

An ombudsman cannot act as a replacement claim handler or re-underwrite insurance claims, but must assess whether the insurer acted fairly and reasonably in handling the claim and any compensation offered.

Insurers must handle claims promptly and fairly, providing reasonable guidance and appropriate progress information to policyholders.

An insurer's compensation for distress and inconvenience caused by service failures during a claim must be fair and reasonable, reflecting impact beyond the normal disruption inherent in home repair claims.