Challenging Exclusions: How CEC Secured a Full Settlement for a Policyholder

At CEC we have always been committed to ensuring that policyholders receive fair treatment when making insurance claims. A recent case involving a burst pipe claim exemplifies the challenges policyholders can face when insurers attempt to impose unjustified exclusions or reductions.

Unwarranted premium average reduction

A policyholder submitted a valid claim for significant water damage following a burst pipe in their property. However, the insurer attempted to apply a ‘premium average’ reduction of 20%, equating to a £50,000 deduction from the claim. Their rationale? They alleged that the policyholder had misrepresented the age of the building and failed to disclose the presence of a flat felt roof. The insurer argued that, had they been aware of these factors, the premium would have been higher.

Understanding the facts and historical evidence

The insured property was a large rural home constructed in 1980, with a total sum insured of £800,000. It had been built on the site of a small cottage dating back to 1850, and to comply with planning regulations, several walls from the original structure had been retained. Over time, the property had expanded from 50 sq. m to approximately 650 sq. m. Additionally, the disputed flat roof was a minor feature—covering less than 20 sq. m—and was made from a specialist material, not felt as claimed by the insurer.

CEC’s ensured a fair outcome to claim

Our experienced loss adjuster carefully reviewed the details of the case and challenged the insurer’s reasoning. Key points in our intervention included:

Demonstrating that the policyholder had not misrepresented the property’s age, as the main structure was indeed built in 1980, and the retained walls were a regulatory requirement.

·       Clarifying that the flat roof was neither a significant structural factor nor made of felt, meaning it did not impact the risk assessment as claimed by the insurer.

·       Highlighting that the sum insured was appropriate for the property’s actual size and characteristics, negating the insurer’s assertion that the premium should have been higher.

·       Following our thorough negotiations, the insurer ultimately withdrew their attempt to apply the premium average reduction, and the claim was settled in full at approximately £300,000.

Helping to protect policyholders’ rights

This case serves as a powerful reminder of the importance of experienced representation when dealing with insurers. CEC is dedicated to ensuring that policyholders are not subjected to unfair deductions or exclusions, and our expertise in policy interpretation and claim negotiation enables us to challenge insurer decisions effectively, ensuring that our clients receive the settlements they are rightfully entitled to.

If you are facing difficulties with an insurance claim, contact CEC today on 0141 781 4695 or email Info@claimsec.co.uk to see how we can assist in securing the best possible outcome.