1 reviews | Active since Jan 2011
Refusal to respond to requests made for pertinent information regarding rejection of claim
Have to wait for around 15min for call centre to answer and when leaving message to return call there is no response. Rejected claim but cannot substantiate reason. Followed process of appeal and requested information but the same original rejection letter is being sent without any answers. Dear Claims Department, I refer to your rejection of the above claim, which relies on Policy Exclusions clause 7 (Wear and Tear). I respectfully submit that this exclusion has been incorrectly app**** and request a formal reconsideration of the decision. In terms of established insurance principles, exclusions must be interpreted restrictively, and the onus rests with the insurer to demonstrate that an exclusion clearly applies to the proximate cause of the loss. In this instance, the evidence does not support a finding of wear and tear as defined in the policy wording. The built-in cupboard unit is approximately six years old and was in excellent condition prior to the incident. There were no visible or reported signs of gradual deterioration, age-related fatigue, rust, damp, loosening, or any defect acting slowly over time. None of the examples cited in the wear-and-tear exclusion are present or applicable to this loss. The damage resulted from a sudden, accidental, and unforeseen event — namely, the unexpected collapse of the cupboard from the wall. A sudden structural failure constitutes a fortuitous event and does not fall within the ambit of wear and tear, which by definition refers to progressive and inevitable deterioration occurring over time. A qualified contractor attended the site and submitted a quotation for replacement, which was provided to yourselves. This assessment supports the conclusion that the loss arose from an accidental failure rather than gradual decay or maintenance-related causes. Importantly, the broken cupboard unit remains available for inspection by the insurer, should you wish to appoint an assessor or loss adjuster to verify the condition and cause of failure. In the absence of clear and objective evidence that wear and tear was the dominant or proximate cause of the loss, the exclusion cannot be re**** upon to repudiate the claim. I therefore request that the claim be reassessed in accordance with the policy terms and prevailing principles of insurance law. Should the repudiation be maintained, I kindly request a detailed written explanation setting out the factual findings and technical basis supporting the application of the exclusion.
