New India Assurance Company Limited · DRN-6238893

The complaint Mr S has complained that New India Assurance Company Limited declined a claim he made on his buildings insurance policy. Reference to Mr S or New India includes their respective agents and representatives. What I’ve decided – and why I’ve considered all the available evidence and arguments to decide what’s fair and reasonable in the circumstances of this complaint. Our investigator thought New India acted fairly and reasonably, so she didn’t ask it to do anything more. I agree, and for the same reasons, which she set out clearly and comprehensively. So I don’t think there’s a benefit for me to go over everything again in detail. Instead, I’ll summarise the main points: • When considering what’s fair and reasonable in the circumstances I’ve taken into account relevant law and regulations, regulators’ rules, guidance and standards, codes of practice and, where appropriate, what I consider to have been good industry practice at the time. Whilst I’ve read and taken into account everything said by both parties, I’ll only comment on the points I think are relevant when reaching a fair outcome to this dispute. That’s a reflection of the informal nature of this Service. • Mr S got in touch with New India about damage to the wall at the front of his property. A nearby council owned tree was thought to be causing or contributing to the damage. I understand Mr S was primarily hoping for New India to engage with the council to stop the tree from damaging the wall – and avoid the possibility that the tree roots might go on to damage the house. He was also hoping for New India to arrange for the wall to be repaired. • The Insurance Conduct of Business Sourcebook (“ICOBS”) applies to New India when handling a claim. ICOBS 8.1.1 (1) says an insurer must handle claims promptly and fairly. And ICOBS 8.1.1 (3) says an insurer must not unreasonably decline a claim. • The policy covers damage to the buildings, subject to a number of policy terms. New India declined the claim by relying on two such terms: one related to subsidence and the other to gradual damage. I’ll consider each policy term separately. Subsidence policy term • The first term said, in summary, that New India won’t cover subsidence damage to, amongst other things, “boundary and garden walls … unless the main house is damaged at the same time by the same cause”. • New India thought the wall had been damaged by subsidence. That position hasn’t been challenged by Mr S and I haven’t seen any alternative position has been

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suggested. So, on the strength of the available evidence, I consider it likely the wall was damaged by subsidence. • It’s accepted the house itself is undamaged. The dispute has focused on whether the wall amounts to a boundary or garden wall – or is part of the main house. • I think it’s clear the wall acts as a boundary wall. It stands between the public footpath and the main house, with a driveway area between the wall and the main house. Mr S has explained that the wall’s purpose isn’t merely to mark the boundary but also to provide security. So, if the wall were to collapse, it would impact his feeling of safety. I acknowledge that, but I don’t think necessarily means the wall is therefore part of the main house. • Whilst Mr S says the wall is attached to the main house, I don’t think that alone means it must therefore be considered a part of the main house. I understand the front wall is connected to side walls. And the side walls are either connected directly to the main house or via a neighbouring house. In my view, it would be unreasonable to suggest that the neighbouring house being connected to Mr S’ house means the neighbouring house is part of the main house. So I think that shows why connection alone isn’t the defining factor. • If the front wall were to collapse or otherwise be removed, the main house would be structurally unaffected. It could stand alone. The wall doesn’t form an integral part of the main house, as a garage may sometimes do. So I’m satisfied the front wall is a boundary wall, isn’t part of the main house, and is therefore not covered for subsidence as a result of the policy term noted above. • To clarify, garden and boundary walls are defined by the policy as part of the insured buildings. So they’re covered for damage caused in some ways, but not subsidence. As I’ll explain below, that’s typical of the cover provided by buildings insurance policies. So I don’t agree with Mr S that New India is ‘an outlier’ in this respect. • Mr S has argued the policy term is onerous or unusual, so it should have been highlighted to Mr S when the policy was sold – but it wasn’t. • I agree in principle that a term which is onerous or unusual in nature ought to be appropriately highlighted at the point of sale in order to ensure the policyholder is able to make an informed decision about whether the policy is right for them. • For a term to be onerous, I would usually expect it to require Mr S to take steps he may not usually do in order to be covered. For example, if a term required him to have the wall inspected by a relevant professional at regular intervals and maintain a record of those inspections in order to be covered, I may consider it onerous. But this term doesn’t require anything of Mr S. It merely limits the extent of subsidence cover. • Terms along the lines of this one are commonly found in buildings insurance policies. It’s rare for insurers to cover boundary or garden walls and the like for subsidence unless the main house is also damaged by subsidence and at the same time. So I’m not satisfied the term is unusual. On the contrary, it’s typical for buildings insurance. • As I’ve found the term was neither onerous nor unusual, it didn’t need to be highlighted when the policy was sold. I know Mr S feels strongly that it’s unfair to rely on a term found deep within the policy without highlighting it. But the policy contains

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hundreds of terms, so it would be impractical for them all to be highlighted. That’s why only terms which have a certain impact must be highlighted. Gradual damage policy term • New India also relied on a second term which said, in summary, that any damage caused by gradual deterioration or wear and tear isn’t covered. It said the damage had begun as far back as 2019, so it was clearly gradual in nature. It supported this position by reference to historic images of the wall. • I’ve viewed these images myself and I agree the damage was visible in 2019. It had become more prominent by 2022. And Mr S has noted he made the claim because he thought the damage had ‘worsened’ in 2025. The damage has been caused by the tree and its roots growing, which is an inherently gradual process. • Taking all of this together, I’m satisfied the damage was caused gradually over time. And, given the damage was clearly visible in the images over time, I’m satisfied Mr S either was aware of it, or could reasonably have been aware of it happening. Policy terms summary • For the reasons given above, I’m satisfied New India was entitled to rely on the two policy terms to decline the claim for the wall damage. I haven’t seen anything to make me think it would be fair and reasonable for it to depart from the policy terms. • I understand the main reason for Mr S making the claim was to seek New India’s support to engage with the council. He was hoping to secure removal of the tree in order to ensure the stability of the wall and the main house. • If the claim for the wall damage had been covered, New India may have taken steps to engage with the council about the tree to ensure the wall could be repaired in a lasting and effective manner. But the policy doesn’t provide cover for engaging with the council when a claim has been declined. So there was no obligation on New India to engage with the council. • Ultimately the policy is primarily intended to cover loss or damage to buildings and contents in certain ways. It’s not there to provide wider support to policyholders, even if that happens to be in relation to the buildings and contents. In my experience, it would be highly unusual for an insurer to step in to support a policyholder with an uninsured council matter. So I can understand why New India didn’t do so. Policy renewal • After the claim was declined, at the next renewal, New India said it would add a policy term. In short, the term would exclude cover for subsidence to the entire property, including the main house. As a result, Mr S moved to another insurer to maintain subsidence cover for the main house, though I understand with an increased excess. • Each insurer is entitled to take its own view of risk and, based on that, what policy terms to set when providing insurance to a particular policyholder. And because the subsidence claim was declined, there was no obligation on New India to offer continued subsidence cover to Mr S.

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• Nonetheless, I would expect New India to be able to show it acted fairly when it added the exclusion. • New India has shared underwriting information with this Service. It’s commercially sensitive, so it wouldn’t be appropriate for me to discuss it in detail. But I can reassure Mr S the information is comprehensive and persuasive. • I’m satisfied it shows that New India acted in line with its general underwriting criteria and any other policyholder would be subject to the same criteria. So Mr S has been treated consistently with other customers and according to New India’s general view of risk. It’s also clear that if Mr S had completed the ‘subsidence questionnaire’, New India would have considered his response in line with its underwriting criteria. That may not have changed the outcome, but it shows New India was prepared to at least consider the matter further. I think that’s fair and reasonable in the circumstances. • As a result, I’m satisfied New India acted fairly when it excluded subsidence cover at the renewal. Summary • For the reasons given above, I’m satisfied New India acted in line with the policy terms, relevant rules and regulations, and fairly and reasonably overall. So I won’t uphold this complaint or require New India to take any further action. My final decision I don’t uphold this complaint. Under the rules of the Financial Ombudsman Service, I’m required to ask Mr S to accept or reject my decision before 28 April 2026. James Neville Ombudsman

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