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What if my policy is confusing or I didn’t get a copy?


Insurance contracts are complex documents. This section aims to explain some of the differences between insurance contracts and what to do if you have not received a copy of your insurance contract.

What is a 'standard cover' contract?

A 'standard cover' contract requires the insurer to pay for flood damage. If the written policy excludes damage caused by floodwater and this was not clearly explained, you can make a claim under the standard cover contract. Special rules apply where the insurer has failed to clearly inform you of the risks covered in your policy.

How do I know if I have a 'standard cover' contract?

If the insurer failed to clearly explain or advise you that flood damage was excluded from your policy, you will have a 'standard cover' contract, which will cover a claim for flood damage. If you were not given a copy of the policy or if the wording is unclear or confusing, then a standard cover contract applies.

If you used a broker then the broker may be responsible for compensating you for the fact that you may not have the cover you expected. If you used a broker to take out or renew your insurance policy, seek legal advice.

If you were unaware your insurance policy did not include flood damage, you may still be able to make a claim through section 35 of the Insurance Contracts Act. Section 35 requires the insurer to clearly inform you of the restrictions and cover provided by the insurance policy before you enter into the contract. If the insurer does not do this, the penalty is that the contract will have effect according to law and this includes cover for flood.

How does section 35 work?

The insurer has to prove standard cover does not apply. The standard cover provided by section 35 will apply unless the consumer was clearly informed and advised in writing of the risks covered and excluded (before the contract was entered into) or otherwise knew, or should reasonably have known, the risks covered by the contract.

The easiest way for the insurer to avoid standard cover is by:

  1. providing all relevant information to you, before the contract is entered into and
  2. ensuring this information clearly advised you that flood damage is not covered by the policy.

The documents that may advise you that flood damage is excluded from your insurance coverage are:

  • the insurance policy, if given to you at the time you took out the policy
  • the proposal form
  • the notice showing payment, if this specifies that flood damage is not included
  • notices/information provided at renewal, as each renewal is a new contract.

It is important you check the documents you have been given by your insurer. A copy of your policy is available from your insurer. Standard cover does not apply if the policy clearly states the insurer will not pay for flood damage, even if you did not read the policy or you assumed flood damage was covered.

When does a 'standard cover' contract apply?

Standard cover applies if you were not given written information that stated flood cover was not included before entering into the contract, and you did not find out about the flood exclusion in any other way.

It is important to consider if any written information was provided before or after the contract was entered into. There are two situations where this might occur:

1. When the policy was taken out for the first time

Usually, the policy will be entered into when the insurer accepts the consumer's offer (which often happens on the telephone). This happens after the insurer has disclosed to the consumer all relevant information about the insured risk. If the information about flood damage exclusion was only provided after this time, then standard cover will apply. If you paid the premium when at the insurer's or insurance broker's office and the policy was sent out in the mail afterwards, then you were not informed in writing at the time of entering the contract and standard cover will apply.

2. When the policy is renewed

A new contract is entered into each year when your policy is renewed. If a policy has been sent to you in the mail and a year later the policy was renewed, standard cover would not apply. Written information about the flood exclusion would have been provided after the first policy, but before the renewal.

However, insurers sometimes change the policy wording at the time of renewal. These changes may further restrict the circumstances in which the insurer will pay. For example, your insurer may change its definition of rainwater damage, by saying it will now only pay for rainwater damage where the rainwater entered the house through a hole in the roof. If these changes were not made clear prior to renewal, then standard cover could apply.

Was there a failure to clearly inform me?

The insurer is obliged under section 35 to clearly inform you of the risks covered in your policy, so even if you received written information, a standard cover claim may still be possible.

Case study: Where the insurer did clearly inform the consumer

In Decision 97-5791, the consumer had made a claim under a home buildings policy. The consumer argued that a standard cover contract applied.

The panel saw the consumer had been provided with copies of the policy documents in 1991 and 1996. It decided the policy wording was clear and the policy had an index that made it easy to follow. The panel found the insurer had clearly informed the consumer of the restrictions under the policy and so standard cover did not apply. The insurer was able to reject the claim.

What does the insurer pay for under a 'standard cover' contract?

If standard cover applies, under the Insurance Contracts Regulations, the insurer must pay for loss from "storm, tempest, flood" for both building and contents insurance.

This can include:

  • the total cost of damage to the house
  • the costs of demolition and debris removal
  • any money paid for emergency accommodation
  • the cost of damaged household items.

Last updated 22 March 2022

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