J001010 - Lycetts Newsletter Jan 2024 LR - Flipbook - Page 12
W H E N CL A I MS
G O W RONG
The hard truth is that if claims go wrong, the chances are they went wrong long before the claim
was made. This is because in most instances where clients do not receive the payout they were
hoping for, it is down to failures which occurred in scoping the policy, adhering to the terms of
the policy, or when changes have not been reported.
Karin Clark
Divisional Director,
Newcastle
Of course, at Lycetts, our specialist claims team
works hard to negotiate with insurers to get the very
best outcomes for our clients. We do our best to find
a way to help but when claims fail it is invariably due
to this type of oversight.
Here are a few examples of when claims go wrong.
COVER NOT INCLUDED:
STORM ARWEN
When Storm Arwen hit the North East of England and
Southern Scotland in November 2021, many hectares
of woodland were decimated and buildings were
damaged. Where specific storm damage was
included in our clients’ policy wording, these claims
were paid out without difficulty. However, some had
either opted not to include storm damage or had not
asked their broker to ensure this cover was
reinstated when it had been excluded previously for
farm buildings. This led to some clients not being
able to make claims.
MAINTENANCE CONDITIONS NOT
FOLLOW ED: FL AT ROOF
Insurers often insist on maintenance clauses with
their policies. With flat roofs this is almost always a
condition and when the policy holder has not
undertaken regular maintenance and there is, for
example, significant storm damage, a claim will not
be paid without inspection or maintenance reports.
In this situation, the insurer is likely to consider the
storm to have merely highlighted an existing defect
rather than damaging a structurally sound roof. We
do use online tools like Google Street View where
they support the case for the good state of a roof but
it does not always result in a satisfactory claim.
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MAINTENANCE CONDITIONS NOT
FOLLOWED: ELECTRICAL CHECKS
In a similar way, if a client has been informed of the
policy requirement for regular electrical inspections
and reports to be carried out, these need to be
undertaken. Without evidence of the inspection and
maintenance documentation, if a fire occurs as a
result of a related electrical fault, the claim may run
into difficulties.
CH A NGE IN CIRCUM S TA NCE S:
PUBLIC LIABILITY
This is a specific example of a client with a large
house, visited by the general public. During the post
Covid lockdown period, in order to encourage social
distancing, the policyholder placed various large
ornaments on the stairs to discourage people from
standing too close. Unfortunately, no risk assessment
was undertaken, no warnings given and the insurer
was not informed. When a member of the public
tripped and fell, resulting in an injury, they made a
public liability claim against the policy holder. Even
though the intention was good, it was not possible to
defend the position and therefore liability had to be
conceded and the claim for damages against our
client was settled.
CHANGE OF OWNERSHIP:
PROPERTY OWNERS’ INSUR ANCE
For sound tax planning reasons, lifetime gifts of
property are commonplace. We had an instance
recently where an insurer turned down a claim in
such circumstances, as the policyholder title had not
been amended to reflect the new ownership.
Although eventually paid, the insurer initially denied
liability on the grounds that the claimant (the donor)
had no insurable interest in the property.
