Jake went on holiday to visit his friend Adam in London, and he took out travel insurance before his trip. When Jake was at Adam’s apartment, he accidentally knocked over a tin of paint which damaged the carpet.
Adam told his landlord about the damaged carpet. The landlord said that under the tenancy agreement, Adam was responsible to have the carpet replaced.
Jake considered himself responsible for the damage, so he told Adam he would pay for the replacement carpet.
Jake’s travel insurance policy had a section that covered his ‘legal liability’, so he made a claim for the replacement carpet.
Jake’s insurer declined his claim, so he contacted FSCL.
Jake thought that because he was responsible for spilling the paint, he was ‘legally liable’ to replace the carpet.
Jake’s insurer outlined that the policy section Jake was claiming under covered ‘legal liability to pay damages’. They said that if Jake were legally liable, there would be court documentation saying this. Jake’s insurer also said that spilling the paint was accidental, but not negligent.
We considered that ‘legally liability’ doesn’t necessarily require that a matter has gone before a court, and that Jake’s actions were both accidental as well as negligent.
We considered that if Adam were to make a claim in court against Jake for the damage, it was most likely the court would say that Jake was liable to pay for replacement carpet.
We didn’t think it was fair for Jake’s insurer to require Adam to have a successful claim in court against Jake in order for the claim to be covered.
Whilst Jake’s insurer didn’t agree that Jake’s claim was covered under the policy, they agreed to pay it as a gesture of goodwill.
Insights for participants
Whether or not a claim is covered under an insurance policy is sometimes straightforward, but sometimes it is a lot more complicated. There can be a number of different interpretations of a single clause, or even a single word.
In the interests of fairness, sometimes insurers and their policyholders can agree to disagree on a specific point, but still find a way to resolve a dispute.