The following is a case study published in OFS Annual report:
Sheila’s property was damaged in a windstorm which affected the roof. Her fire insurance policy was purchased along with her loan facility; hence she was not required to fill in a proposal form.
However, the Storm, Tempest Extension was not included in the policy coverage, resulting in her claim repudiation. Sheila was unhappy since she was not advised of the available coverage extensions.
OUR FINDINGS
The adjuster confirmed that a windstorm caused damage to the roof. In the insurer’s cover letter to the policy document sent to Sheila, the
coverage extensions to Storm and Tempest were among the extensions listed. Sheila was required to choose the coverage and pay an additional premium. However, Sheila did not respond to the insurer’s letter or request for any coverage extension.
OUTCOME
The Ombudsman upheld the insurer’s decision as it was apparent that there was no coverage for the peril which caused the damage to the roof.