Two burdens, not one
People assume a declined claim means fighting an insurer that holds all the evidence. That is only half true, and the half that is not true is the useful one. The Ombudsman decisions split the question cleanly.
DRN-4550974 states the first half: "When a policyholder makes a claim, the onus is on the policyholder to show they have a valid claim under the policy." DRN-5646463 states the second: "Where an insurer has applied an exclusion to decline a claim, the onus is on the insurer to show that it has done so reasonably."
The Ombudsman’s published guidance on gradual damage says the same thing from the consumer side: at the outset "it’s down to you – as the policyholder – to show the damage was likely caused by an insured event", and when an insurer declines under a policy term "the insurer must tell us why it relied on this policy term to decline the claim".
So the sequence is: you get over the first hurdle, and then the weight moves.
The standard is the balance of probabilities, both ways
Neither burden is a high one in the criminal sense. DRN-5646463 puts the insurer’s side of it beyond doubt: the insurer "only needs to show on balance of probabilities that the damage was likely to have occurred gradually. It does not need to definitively show this was the case." The policyholder in that case argued the adjuster had said the damage could have been ongoing rather than stating it definitively, and that argument failed for exactly this reason.
The same standard applies to you. DRN-3748774 describes it: "In cases like this, where the evidence is incomplete or contradictory, I’ll reach my decision on the balance of probabilities. That is, what I think is more likely than not to have happened."
Which means the game is comparative. You are not proving your case to certainty. You are making your version more likely than theirs.
Failing the first hurdle
Two decisions show what that looks like.
In DRN-4550974 the wording covered "water or oil leaking from any fixed tank, domestic appliance or pipe". A leak detection company instructed by the insurer found shower tray movement and failed sealant to the screen, and confirmed no evidence of an escape of water from pipework anywhere in the property. The decision records that the policyholder "hasn’t provided evidence that any of these were the source of the leak", so there was no insured risk under that part of the policy, and the sealant exclusion covered the rest. Not upheld.
In DRN-2137820 the wording required the buildings to be damaged by the escaping water. The only evidence was a photograph taken after the repair, showing darker patches under the pipe, and a surveyor’s inspection carried out after the damaged material had been removed. The Ombudsman concluded that on balance the damage present was caused by the access works rather than the water. Not upheld.
In both, the insurer did not need to prove anything much. The claim did not get far enough to shift the weight.
Clearing it, and what happens next
DRN-3748774 is the model of getting over the first hurdle on ordinary domestic evidence. The policyholder produced a video of the leak spraying upwards into the floorboards, photographs of soaked floorboards and joist, and a photograph of the soaked hardwood flooring, even though the flooring itself had been disposed of and the insurer never inspected it.
Once that landed, the burden of displacing it sat with AXA, and the decision shows how that is assessed. The insurer’s theory was that the flooring might have got wet in some other way, or come from a different part of the house. The Ombudsman’s answer: "it hasn’t supported this theory with any evidence beyond its concerns with Ms S’ version of events", and there was nothing to suggest any other part of the flooring showed previous or alternative water damage. A known leak spraying at the flooring was a more likely explanation "than some other non-specific potential cause coincidentally happening at the same time".
Scepticism is not evidence. That is the sentence worth taking away from it.
Where an insurer failed to discharge its own burden
DRN-5970477 is the clearest example, and it is notable because the Ombudsman Service’s own investigator had gone the other way, finding that the insurer "had done enough to fulfil the onus on it to show that an exclusion applied". The Ombudsman disagreed.
The insurer had two expert reports supporting sealant failure, flood testing showing water seeping through the shower frame, and high moisture readings. On paper that discharges the burden. What undid it was that the exclusions were specific. One excluded damage caused by failure or lack of sealant "known to you or that you ought to have been aware of", so the insurer needed to show not just a defect but a knowable one, and the photographs did not show an obvious gap. The other was the general wear and tear exclusion, and the Ombudsman held that the service "wouldn’t expect a claim to be excluded where the predominant issue was hidden from view".
The insurer also had to contend with a finding it had generated itself: its own experts had not identified the pipework behind the tiles as the likely cause, which the Ombudsman treated as showing the policyholder could not be expected to have identified it either.
What each side is actually being asked for
| Stage | Who carries it | What satisfies it |
|---|
| An insured event caused the damage | You | Evidence that the source was a covered one, more likely than not. Photographs, video, dated readings, a detection report identifying the defect. |
| An exclusion applies | The insurer | Evidence, on the balance of probabilities, that the excluded cause was the predominant one, and that it relied on the clause reasonably. |
| You could reasonably have known (on gradual damage) | The insurer | Visible signs you could have acted on. Mould in photographs, exposed corrosion, repeated symptoms. |
| The cost claimed is reasonable | You | An invoice that reconciles with the report. Hours mapped to activities, not a lump sum. |
What this changes about the report you commission
The first row is the one a detection visit exists to satisfy, and it is worth being precise about what satisfies it. Not an opinion that there is probably a leak somewhere. A named defect, in a named location, with the test that found it and the reading that supports it, photographed before it is repaired.
That is what stops an argument at the first hurdle rather than at the Ombudsman eighteen months later. We write our reports to carry exactly that, and the contents are listed on what an insurer-ready report contains. The questions an adjuster will ask you are on what the loss adjuster will ask, and the full claim sequence on making a claim step by step.
Read this properly
Everything above describes how the Financial Ombudsman Service has reasoned in specific published decisions on specific policies. It is not a statement of law, it is not advice about your claim, and none of these decisions binds your insurer. Your own wording governs. If your claim is declined, ask for a written final response naming the clause relied on, and the service will review it free of charge within six months of the date on that response.
When not to call us
If the source of the water is obvious and visible, you do not need a detection report to prove an insured event, and paying for one is money you will not get back. If your insurer has already accepted the claim, the burden question is settled and the argument has moved on to scope and cost. Where the source is hidden and somebody has to establish what caused what, we work at £150 per hour agreed before we attend, with no charge for the search if we do not find it. Book an engineer.
