STORM/TEMPEST CLAIM BUILDING NOT ALLOWED

[The Tech Clerk]

23/07/2020 Up-date:- Forwarded documents and forms to FOS as per requested Recorded Delivery - was signed for:-

[The Tech Clerk]

Your complaint about QIC Europe Ltd

Thank you for waiting while I’ve been looking into your complaint about QIC Europe Ltd (QIC). After reviewing everything I won’t be asking QIC to do anything further. I’ll explain why below.

Summary

You’re unhappy your claim for repairs to your roof was declined. There was a storm in December 2019 which resulted in damage to your roof. Your claim was declined because of wear and tear. You’re unhappy with this and want to be reimbursed, at least in part, for the repairs to the roof.

Why I’m making this recommendation

My role as an impartial investigator is to look at all the evidence provided and come to a fair outcome.

When looking at your complaint I’ve answered three questions to determine whether your complaint should be upheld:

1. [*=1]Whether the storm conditions occurred on or around the date of the damage?[*=1]Whether the damage claimed for is consistent with the damage a storm would typically cause?[*=1]Whether the storm was the main cause of the damage?

All three of these questions need to be answered yes for your complaint to be upheld. I’ve looked at the terms and conditions of your policy and the way QIC inspected the damage. I’ve also taken into account your complaint form and the documents you’ve sent to us.

You’ve also mentioned you were unhappy with the response from QIC for an emergency call out for damage to your boiler. I won’t be able to say what I think about the service you
received for this emergency as it’s a separate complaint.

Do we agree that storm conditions occurred on or around the date the damage is said to have happened?

Storms are an insured peril within your policy. Your policy says:

“3 Storm

We will cover loss or damage caused by storm winds of Force 10 or above (as defined under the internationally recognised Beaufort Scale)”

Using the definition of a storm from your policy there would need to be winds of Force 10 or above to show storm conditions. I’ve checked the weather on and around the date of your claim and seen that there were 55mph winds. QIC’s final response letter also confirms the storm conditions and says there were 58mph winds around the date of the damage. This would be Force 10 winds or above on the Beaufort Scale.

So I’m satisfied a storm had occurred on or around the date the claim was made.

Is the damage claimed for consistent with damage a storm typically causes?

Thank you for sending the photos of the damage to your ceiling. The surveyor’s report also mentions the damage to your ceiling from water entering through the roof. I think this is further evidence of strong winds and rainfall. High speed winds and rainfall could damage a roof and allow water to enter the home. So water damage through the roof would be damage a storm typically causes.

Were the storm conditions the main cause of the damage?

I’ve looked at all the evidence and the terms and conditions of your policy to see whether the storm or wear and tear was the main cause of the damage. Your policy says:

“3 Storm

We don’t cover

d. anything that happens gradually.”

This condition is in the policy to make sure the damage was caused by the storm and hasn’t happened over time. Damage because of wear and tear would be excluded because this happens gradually. It’s common to have this kind of exclusion in insurance policies. The exclusion means your claim will be declined if there was already a problem with your roof and the storm highlighted this problem.

I can appreciate why you’d feel the storm was the main cause of the damage. A storm happened and your roof was damaged. But this doesn’t mean the storm was the main cause of the damage. QIC’s surveyor inspected your roof and determined the damage to be because of wear and tear. You may have expected QIC to have their surveyor to climb onto the roof to inspect the damage. But surveyors won’t always climb onto the roof. It’s not unusual for surveyors to inspect from the ground and look at photos. So in this case I think the surveyor assessed the damage in a way I’d expect. I don’t think it’s unreasonable for a surveyor to determine the main cause of the damage without climbing onto the roof.

The surveyor has said erosion/displacement of the mortar and a fractured tile show that wear and tear is the main cause of the damage. And this is the kind of evidence which normally shows wear and tear. I’ve seen that you’ve had to get new tiles for the roof. And you’ve said you were promised part payment towards materials to repair the roof. I can understand why you’d feel the insurer should pay towards this. I’ve looked through the correspondence between you and QIC. QIC said they’d review the cost for the membrane. But later said the cost was too high. If the claim was accepted then I’d expect QIC to put the roof back into the condition it was in before the storm. Because the claim was declined I wouldn’t expect QIC to part pay towards the roof repairs. So I can’t say QIC acted unfairly in not paying towards your roof repairs. The surveyor who visited your house determined the damage to be wear and tear. I haven’t seen any evidence to show the surveyor wasn’t an expert. Or any evidence that shows the inspection of the damage was unusual. So I think it’s reasonable for QIC to follow the advice of the surveyor.

Conclusions
In summary, I can appreciate that you expected to be covered by your insurance policy and feel it’s unfair to have to pay for the repairs yourself. But your policy specifically excludes wear and tear. There was a storm and the damage is something I’d expect form a storm. But I don’t think the main cause of the damage was the storm. The surveyor is an expert and has the most reliable opinion on the damage without any other expert evidence. I think it’s fair for QIC to rely on an expert’s opinion. And their approach to assessing the damage was reasonable. Unfortunately, I won’t be asking QIC to reimburse you for the repairs. I know this isn’t the answer you wanted but I hope you can understand why I’ve come to this conclusion.

Next steps I think this is a fair outcome in the circumstances, for the reasons I’ve explained. But if you decide that you don't accept what I’ve said, then please let me know by 2 November 2020. If I can’t resolve things then an ombudsman here can look at everything again and make a final decision. If I don’t hear from you by that date we might not be able to look at your complaint again. We don’t cover d. anything that happens gradually.” This condition is in the policy to make sure the damage was caused by the storm and hasn’t happened over time. Damage because of wear and tear would be excluded because this happens gradually. It’s common to have this kind of exclusion in insurance policies. The exclusion means your claim will be declined if there was already a problem with your roof and the storm highlighted this problem. I can appreciate why you’d feel the storm was the main cause of the damage. A storm happened and your roof was damaged. But this doesn’t mean the storm was the main cause of the damage. QIC’s surveyor inspected your roof and determined the damage to be because of wear and tear. You may have expected QIC to have their surveyor to climb onto the roof to inspect the damage. But surveyors won’t always climb onto the roof. It’s not unusual for surveyors to inspect from the ground and look at photos. So in this case I think the surveyor assessed the damage in a way I’d expect. I don’t think it’s unreasonable for a surveyor to determine the main cause of the damage without climbing onto the roof. The surveyor has said erosion/displacement of the mortar and a fractured tile show that wear and tear is the main cause of the damage. And this is the kind of evidence which normally shows wear and tear. I’ve seen that you’ve had to get new tiles for the roof. And you’ve said you were promised part payment towards materials to repair the roof. I can understand why you’d feel the insurer should pay towards this. I’ve looked through the correspondence between you and QIC. QIC said they’d review the cost for the membrane. But later said the cost was too high. If the claim was accepted then I’d expect QIC to put the roof back into the condition it was in before the storm. Because the claim was declined I wouldn’t expect QIC to part pay towards the roof repairs. So I can’t say QIC acted unfairly in not paying towards your roof repairs. The surveyor who visited your house determined the damage to be wear and tear. I haven’t seen any evidence to show the surveyor wasn’t an expert. Or any evidence that shows the inspection of the damage was unusual. So I think it’s reasonable for QIC to follow the advice of the surveyor. Conclusions In summary, I can appreciate that you expected to be covered by your insurance policy and feel it’s unfair to have to pay for the repairs yourself. But your policy specifically excludes wear and tear. There was a storm and the damage is something I’d expect form a storm. But I don’t think the main cause of the damage was the storm. The surveyor is an expert and has the most reliable opinion on the damage without any other expert evidence. I think it’s fair for QIC to rely on an expert’s opinion. And their approach to assessing the damage was reasonable. Unfortunately, I won’t be asking QIC to reimburse you for the repairs. I know this isn’t the answer you wanted but I hope you can understand why I’ve come to this conclusion. Next step:- 26/10/29020:- I think this is a fair outcome in the circumstances, for the reasons I’ve explained. But if you decide that you don't accept what I’ve said, then please let me know by 2 November 2020. If I can’t resolve things then an ombudsman here can look at everything again and make a final decision. If I don’t hear from you by that date we might not be able to look at your complaint again. My response:- 26/20/2020:- The surveyor missed broken tile as only a bungalow so low enough to get a small ladder to inspect and not use a camera (technology>>) as that obviously missed a major storm damage, also the roof wear & tear?? we moved in 6 years previous and were told a new roof had been put in place within a year or so of inspection for purchasing property. the company representative on the phone stated he would try and get a partial payment towards material of £500 as obviously the broken tile etc had been missed, and evidenced to surveyor on 2nd visit with claims representative, also the so called bad apex as he suggested was the problem cost £400 to replace/set and turned out not to of been the case. 55 mph was on lower ground xxxxxxxxxx weather station some 23 miles away not up a beacon (mountain which this property is).., The so called (so loss adjuster would be suggested).:- Quote:- surveyor in front of the insurance rep stated not a building surveyor at all, The rep saw the broken tiles and also the broken newish wooden fence on the same side which was the result of a very bad heavy storm, also they saw other bungalows having works on roof taking place with facility:- By the way a PM in the past had a piece of paper stating no war?????? No heavy storm then no damage would have taken place, heavy storm then damage DID take place. conclusion not problems with the roof prior as a new roof fitted short time before we purchased said property also regarding the home emergency call which never was actioned this is still out standing issue and reported same time same complaint.

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[The Tech Clerk]

04/11/2020 = 14.14 hrs:-

Thank you for the information you’ve sent me in response to my view of your complaint.

I’ve looked into what you’ve said about the emergency call out. But as I’ve mentioned in my view this is a separate complaint. And QIC Europe Ltd (QIC) need to have the opportunity to respond to this complaint first.

QIC agreed there were storm conditions. So the claim wasn’t declined because there wasn’t a storm. But the claim was declined because the storm wasn’t the main cause of the damage. I can understand that the roof being six or seven years old and the claim being declined for wear and tear can be frustrating. But this doesn’t mean there wasn’t wear and tear over those six or seven years.

The surveyor was able to conclude wear and tear without climbing up onto the roof. The damage to the roof tiles the surveyor saw is usually a sign of wear and tear. As I said in my view I don't see anything wrong with the surveyor's inspection. And there's nothing unusual about the inspection or conclusion. QIC said they’d review the cost of the membrane for part payment. From what I’ve seen QIC looked at the cost of the membrane. And they’ve said the cost was too high. Because QIC looked at the cost of the membrane I can’t say they’ve done anything wrong by saying it’s too expensive. The claim wasn’t accepted so I don’t think QIC should pay towards these repairs.

If you decide that you still don't accept what I’ve said, then please let me know by 11 November 2020. If I can’t resolve things then an ombudsman here can look at everything again and make a final decision. If I don’t hear from you by that date we might not be able to look at your complaint again.

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[The Tech Clerk]

04/11/2020 = Do not accept your findings dated this 4th Day November 2020 @ 14.24 Hours :- return e-mail sent!

[The Tech Clerk]

06/11/2020 = Your complaint can be sent to an ombudsman for a final decision.

Ombudsman will usually follow the same approach to looking at your complaint as I have. So it's unlikely they'll come to a different outcome.

Please send me any new information you'd like to be considered.

[The Tech Clerk]

07/11/2020 =

Incurred extra charges for refusal to allow ceiling asbestos agent they sent to test lounge ceiling as they were there = they were told no,,, this caused a 2nd bill to me for a second visit to do the mandatory ceiling asbestos check, also the surveyor ( who admitted not a building surveyor - I stated i was a surveyor also by not building surveyor by the way, told him to man up as we all make mistakes, he just looked worried and failed to admit the possibility of missing vital signs as not raise himself from the ground at a height of 10 foot ( 4 foot higher than his height) top check bungalow roof in situ! then i got charged for his 2nd visit , Come on common sense must be availed in these cases, by the way Maintenance of buildings I was a House/maintenance Manager (dealing with contractors etc etc) for a very large company who had multiple stores, so I have experience where by a person in office states Insurance says this/that /the other as and that is word then makes judgement without proper knowledge? yet facts had been afforded to them?????


also pointed out they both stated no Insurance cover to get on roof or get into attic ? the chap stated maybe they have none? i pointed out one of them was from their claims department - do your staff have cover doing on site jobs? er um er um? would of thought so was answer? , also why charge me for ceilings test due to their refusal to have the lounge ceiling tested on 1st visit as the company rang to get permission as on site and they reported 2nd area affected and refusal was given hence 2nd visit to test for asbestos (charged to me)? and so called 2nd visit by surveyor to take photos of lounge ceiling etc for which asbestos people had supplied to them? no response/


I want this to go to Ombudsman as hopefully a person who is not a yes person, but honest and integrity who look and finds out facts not fiction>

Please acknowledge forthwith action taken! also Emergency breakdown boiler complaint have not heard anything??

[The Tech Clerk]

7 November 2020, 08:00


I’ve looked into what you’ve said about the emergency call out. But as I’ve mentioned in my view this is a separate complaint. And QIC Europe Ltd (QIC) need to have the opportunity to respond to this complaint first.



QIC agreed there were storm conditions. So the claim wasn’t declined because there wasn’t a storm. But the claim was declined because the storm wasn’t the main cause of the damage. I can understand that the roof being six or seven years old and the claim being declined for wear and tear can be frustrating. But this doesn’t mean there wasn’t wear and tear over those six or seven years.



The surveyor was able to conclude wear and tear without climbing up onto the roof. The damage to the roof tiles the surveyor saw is usually a sign of wear and tear. As I said in my view I don't see anything wrong with the surveyor's inspection. And there's nothing unusual about the inspection or conclusion. QIC said they’d review the cost of the membrane for part payment. From what I’ve seen QIC looked at the cost of the membrane. And they’ve said the cost was too high. Because QIC looked at the cost of the membrane I can’t say they’ve done anything wrong by saying it’s too expensive. The claim wasn’t accepted so I don’t think QIC should pay towards these repairs.



If you decide that you still don't accept what I’ve said, then please let me know by 11 November 2020. If I can’t resolve things then an ombudsman here can look at everything again and make a final decision. If I don’t hear from you by that date we might not be able to look at your complaint again.



If you have any questions please let me know.

[The Tech Clerk]

7 November 2020, 08:04


Ombudsman will usually follow the same approach to looking at your complaint as I have. So it's unlikely they'll come to a different outcome.

Please send me any new information you'd like to be considered.

[The Tech Clerk]

	Sat, 7 Nov, 15:27

. The damage to the roof tiles the you state above he saw Noooooooooooooo he did not , what he said apex joints looked weathered ( Space in join) so I got it all reset anyway cost £400, and low and behold not the problem , as next storm a week or so later same ingression of water at a different area

[The Tech Clerk]

06/11/2020 = Your complaint can be sent to an ombudsman for a final decision.

Ombudsman will usually follow the same approach to looking at your complaint as I have. So it's unlikely they'll come to a different outcome.

Please send me any new information you'd like to be considered.

Like all these "Quangos" rubber stamp job = no action as money game only! the state of the UK for decades.

[The Tech Clerk]

11/11/2020 =

Thank you for your emails and the information you've sent.

I'm in the process of sending your complaint to an ombudsman for final decision.

I'll let you know once the complaint's been sent to an ombudsman.
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[The Tech Clerk]

14 January 2021, 17:36
14/01/2021 - e-mail just received Financial Ombudsman not upheld complaint - as usual they state inaccuracies of events i gave them. - they even stated the so called surveyor saw a broken tile (He Did Not) from the ground with his up the pole camera , and that i found one at a later date? it was me who showed them the broken tile in question after i had a new roof fitted.

also stated no proof a new roof fitted a year before i purchased property. (maybe if they asked i could of sent Saint Peter a message to ask the deceased last owner to confirm) as nothing in writing to prove such was replaced!

another FOS decline with non factual as they claim excuses,.

[The Tech Clerk]

Well this confirms what liars some so called surveyors (lose adjusters) are they fail to admit their mistakes when faced with fact, admit not building surveyor, the ICO make up events not happened collusion by insurance agents/companies with those who are suppose to enforce truth/reason and facts. - a national disgrace again, money money money the route of all insurance cover ups evils. None Are Fit For Purpose. if somebody was trying to fiddle they seem to win??

[The Tech Clerk]

15/01/2021 == Sent response to their E_Mail not accepting outcome:- Once again non factual statement made that the surveyor noticed broken tile (NO HE DID NOT) also he and claims man state they are doing a job and not covered by Insurance to complete task in an orderly matter, other claims not mentioned so nobody has taken responsibility to look 100% at complaint and act in a professional matter, the complaint outcome is not satisfactory and ounce again regulator (if they seen the claim is wrong again) = action not words required and start being serious or resign as not fit for purpose = do not like comment then tell me so the country can once again find out quangos.

[The Tech Clerk]

08/02
Thank you for your email.

I can understand this isn't the outcome you'd hoped for. But an ombudsman's decision is our final stage - and we can't take your complaint any further.

You've said you wan't this to go to an independent assessor. As this is the final stage of our process if you don't accept the decision you may still be able to take the complaint to court.

Kind regards
/2021 =