Exceeding Customer Expectations in a Contested Flood Claim

1. Context and Challenge

Following a severe and widely reported flash-flooding event, elderly and vulnerable homeowners experienced extensive flooding to the ground floor of their property. Fire crews attended the street and pumped water from several homes, including the customers’ property.

Despite this clear context, the insurer initially recorded the loss as storm damage rather than flood damage. This early misclassification had significant consequences: inappropriate inspections were arranged, specialist drying and decontamination support was not deployed, and the property remained damp and contaminated for several months.

As a result, the homeowners were forced to live in unhealthy conditions, causing prolonged distress and anxiety.

The insurer’s Loss Adjuster subsequently declined the claim, asserting that:

• The policy did not cover “water ingress”; and
• The damage was attributable to wear and tear on the flat roof.

This assessment failed to recognise clear low-level indicators of flooding and conflated minor roof defects with the primary cause of damage.

How Concept Claim Solutions Helped

Concept Claim Solutions appointed a dedicated Loss Assessor to represent the customers who completed a joint site visit with a further Loss Adjuster to review the damage. However, the insurer declined the claim again, stating there was “no evidence of flood damage” and asserting that any internal damage arose from the roof, which was excluded under the policy.

Establishing the Facts

To address the insurer’s position, the Loss Assessor undertook a comprehensive technical review:

• Conducted a fresh assessment of the damage.
• Documented clear evidence of flooding through photographs, moisture profiling, and technical explanation of water ingress pathways.
• Clearly distinguished flood-related damage from isolated roof leaks to prevent conflation of causes.
• Collated independent corroborating evidence, including flood reports, meteorological data, confirmation of emergency services attendance, and contemporaneous media coverage.
• Prepared a structured, evidence-based report for submission to the insurer and the regulator, demonstrating that flooding was the proximate and dominant cause of loss.
• Supported the vulnerable customers in compiling their complaint to the Financial Ombudsman Service (FOS) when all other avenues had been exhausted.

Outcome

The FOS upheld the complaint, directing the insurer to reopen the claim and reassess it as a flood loss. As a result, the homeowners received an appropriate settlement to fund the necessary repairs, bringing an end to months of delay and uncertainty.

For the homeowners, this outcome was about more than reinstatement. Prolonged exposure to damp and damage had taken a significant emotional toll. They felt overlooked and overwhelmed, particularly when neighbouring properties were receiving support while they were repeatedly denied.

By providing a single, consistent point of contact, explaining the process clearly, advocating robustly on their behalf, liaising with the insurer, and project-managing the reinstatement works, the Concept Claim Solutions Loss Assessor helped restore a sense of control and security at a time when both their home and wellbeing were under sustained strain.