Tom’s driveway developed a large crack, Tom wanted to claim $8,990 from his insurance company to replace his driveway. He provided the insurance company with photographs of the crack in support of his claim.
The insurance company declined Tom’s claim noting that his policy had an excess of $10,000 for damage caused to the driveway due to subsidence or movement of land. Because his claim was under $10,000, the insurance policy did not respond.
Tom argued that his claim should instead be considered as “gradual damage”, which carried a smaller excess, and asked the insurer to review his claim.
Tom felt that it was unfair the insurance company had relied on the photographs supplied instead of having an independent expert review his property. It appeared to Tom that the damage could either be as a result of subsidence, or due to gradual damage. In the least, the insurance company should have got an expert to ascertain the cause of damage before declining his claim. Tom complained to FSCL.
Review
We asked the parties whether they would be willing to contribute towards an independent review of the damage.
It transpired the insurance company had the damage assessed in person, but this report had not been passed on to Tom.
This report found that the damage to the driveway was as a result of land subsidence caused by a retaining wall, and not due to gradual damage as defined by the policy.
Outcome
We provided Tom with the expert report, and Tom then accepted the insurance company’s decision. Tom asked if the insurer would consider making an ex-gratia payment which the insurance company declined. Tom agreed to withdraw his complaint.
Key insights for the participant and the consumer
Sometimes consumers find it helpful to have an external opinion of their case to ensure they have been treated fairly. In this instance, with FSCL’s assistance, the consumer was satisfied that the insurance company had conducted a fair and independent review of the damage before declining his claim.
