An insurer denied my income protection claim because I could still do some work
- 31.08.2026
Water damage appeared in my ceiling and the insurer sent an assessor who said the leak came from a worn pipe fitting, so the claim was declined under a wear and tear exclusion. I have paid premiums for years without a claim. Can they really refuse?
Insurers can rely on exclusions, but they must interpret them fairly, and the burden is on the insurer to show that an exclusion applies. Wear and tear exclusions generally apply to the gradual deterioration of the item itself, but the resulting damage, such as water damage to ceilings and floors, is often still covered unless the policy clearly says otherwise. Ask the insurer for the decision in writing, quoting the exact policy wording and the assessor's report. Compare the wording with your policy, and consider a second opinion from a plumber. Under the Fair Insurance Code and the fair conduct rules, insurers must handle claims fairly and explain decisions. If you disagree, use the insurer's internal complaints process, and then refer the dispute to its approved dispute resolution scheme, such as the Insurance and Financial Services Ombudsman.
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