Some damage to a home or its contents happens gradually over time. For example, mould isn’t usually something that suddenly appears. Damage caused by flash flooding, on the other hand, happens at a single point in time.
Policy exclusions will explain under which circumstances you won’t provide cover – these often include damage that’s been caused gradually.
Gradual damage is also called a ‘gradually operating cause’ exclusion in policies.
Types of complaints we see
We see complaints where the insurer has declined a claim because:
- it believes the damage was caused gradually
- it doesn’t think the damage was caused by an insured event
- gradual damage is a policy exclusion
Customers will often complain because they don’t think the damage was gradual.
Others accept the damage was gradual, but don’t think it’s fair for their claim to be declined because they didn’t know the damage was happening gradually.
Other examples of complaints we see include where the insurer has declined a storm damage claim because they don’t think the damage was caused by a single, sudden storm, but by bad weather, gradually over time.
What we look at
We won’t automatically say you’ve treated the customer fairly simply by relying on the exclusion to decline the claim. We’ll think carefully about what’s fair and reasonable under the circumstances and look at whether the customer could have known about the damage.
If you’ve relied on a policy exclusion to decline a claim, firstly, we’ll look at the policy to see:
- what’s covered
- what’s excluded
- what parts of the policy the exclusion relates to
We’ll need to decide whether the damage being claimed for was caused by an insured event. If it wasn’t, then there’s no claim. If it was, then we’ll need to look at whether the damage occurred gradually. And if you’re relying on an exclusion, then it’s your responsibility to prove it applies to the claim.
So we’ll weigh up all the evidence and consider whether we think the damage was most likely to have been caused gradually or by a particular event. It’s important for us to see any expert reports and photos of the damage to back this up.
If we think the damage was caused by an insured event and wasn’t caused gradually, we’re likely to uphold the complaint and ask you to cover the claim.
We’re likely to say that you should pay the claim if:
- we think the customer couldn’t reasonably have been aware of the damage happening gradually (they were prevented from noticing the damage and therefore fixing the problem)
- they made the insurance claim, or took reasonable action, as soon as they could reasonably have known about the problem
Read a case study about a claim we upheld because the customer wasn’t aware of the damage to their home.
If we think the damage was caused by an insured event but was actually caused gradually, then you have a contractual right to decline the claim, as long as gradual damage is excluded in the policy.
Also, if the customer could have known they had the opportunity to prevent the damage but didn’t, it doesn’t seem fair for you to pay out.
Read a case study about a claim we declined because the customer was aware of the damage to their home.
As well as an exclusion for gradual damage in general, some insurers will also specifically exclude rot. As rot usually occurs gradually, we think it’s fair – and consistent – to look at a specific rot exclusion in the same way we look at a gradual damage exclusion.
Read a case study about rot.
Exceptions to how we decide gradual damage complaints
There are some situations where we’ll look at complaints differently:
Wear and tear
We see complaints where the insurer has declined a claim because it thinks the damage was caused by wear and tear, and therefore caused gradually.
If we think the damage was caused in this way, we’re unlikely to take the usual considerations into account when we’re deciding on a gradual damage complaint. This is because everything will wear out eventually. An insurance policy can’t protect a customer from that.
Cover for accidental damage isn’t usually a standard part of a policy. It tends to be available for customers to add to their standard policy for an additional premium.
The extra cover provided by the accidental damage section of the policy can be much wider than the insured events. That’s why we’re unlikely to take the usual considerations into account when we’re deciding on a gradual damage complaint. Doing so could make insurers pay for a wide variety of situations they never intended to cover.
There are policies available which don’t restrict cover to a list of insured events, and offer much broader cover. These policies usually cover ‘damage’, subject to a number of exclusions. So we don’t think it would be fair on insurers to look at claims made on all-risks policies in the usual way when deciding on a gradual damage complaint.
All-risks policies provide more extensive cover so they’re usually more expensive. We don’t think it would be fair for customers who pay more for a policy that offers wider cover to be worse off than those who pay less for a standard policy.
So for claims made on all-risks policies, we’ll consider whether the damage claimed for was caused by an insured event, for example, flooding. If so, then we would take the same things into account as we’d usually do for a complaint about gradual damage.
However, if the damage wasn’t caused by an insured event, we’d just consider whether the damage was gradual or not.
Read a case study about an all-risks policy.
Handling a complaint like this
We regularly hear from people who’ve made claims about damage to their home or contents but insurers think the problem is a longstanding one. In these cases, the policy is only intended to cover sudden, one-off problems.
Often, people tell us that they didn’t know there was a problem until they discovered the damage and when they found it, they contacted their insurer straight away.
When you’re dealing with a complaint like this, it’s important that you consider:
- what the policy says
- what caused the damage
- what your customer knew about the problem
Read our case studies for further guidance and examples of how we’ve dealt with complaints.
We only look at complaints that you've had a chance to look at first. If a customer complains and you don't respond within the time limits or they disagree with your response, then they can come to us.
Slow leak damage not covered under all risks policy
Insurance Buildings Insurance
Couple unaware of ‘preventable’ bedroom water damage
Ceiling collapse caused by insured event, but insurer still declines claim
Gradual damage irrelevant as problem not covered in policy
Customer not ‘reasonably aware’ of leak or damage to prevent floor collapse