Case Studies

Breach of Policy Warranty	Business Interruption	Definitions are Vital
Entitlement to Alternative Accommodation	Orchestrating a claim	Sets and Pairs Clauses

Entitlement to Alternative Accommodation

A lady telephoned us in great distress. Her house was suffering from subsidence damage and was being underpinned. Because one of the four bedrooms and the kitchen were not directly affected by the massive building works that were in progress, Loss Adjusters had contended that the house was not "uninhabitable" within the meaning of the policy wording. Every inch of the house was covered in dust and life for the policyholder was impossible – and getting worse. Her work required her to carry out certain functions at home and that was now impossible. She had two cats to whom she was very devoted. They were sensitive to dust, and so reluctantly she had had to put hem into a cattery. Her social life was now nonexistent and she was beside herself with frustration.

The one bright aspect was that on a flight back from Europe she sat next to a man for whom we had acted on a difficult claim. He immediately gave her our details and she called us. We immediately went to see her and we were appalled at what we saw. To all intents and purposes the house was a building site. Floors were up, ceilings were down, windows were out – but still Loss Adjusters refused to accept that this policyholder should be rehoused in alternative accommodation.

We immediately sent an email to Insurers and demanded an urgent meeting with a senior claims officer. The following day we met on site with the claimant, the chief claims inspector from Insurers and the Loss Adjuster in charge of the case. Within half an hour the Insurer's representative agreed that the house was indeed uninhabitable both de facto and within the definition of the policy wording. Accordingly, he said it would now be in order for the policyholder to search out an appropriate house to rent – at Insurer's expense – for the next few months until the refurbishment was complete. We had anticipated that the meeting would go this way and had already asked the client to obtain details of suitable alternative accommodation. Accordingly, during the meeting we were able to present Insurers with details of the house that our client wished to live in for the next few months – and of course they readily agreed.

Over the next few months we went on to win numerous concessions from Insurers for our client’s benefit. This case demonstrates very clearly that Insurers and their appointed Loss Adjusters treat claimants who act for themselves, very differently from those who are represented by an enthusiastic Loss Assessor.

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