Tvistsag om udbedringsomfang og erstatningsberegning ved ejerskifteforsikring

Sagen omhandler en tvist under en ejerskifteforsikring med udvidet dækning, tegnet hos ETU Forsikring A/S, vedrørende omfanget af dækningsberettigede skader og den tilhørende erstatningsopgørelse.

Sagens baggrund og forløb

Klageren erhvervede ejendommen den 2. maj 2019 og tegnede en ejerskifteforsikring med udvidet dækning hos ETU. I januar 2020 anmeldte klageren 12 skadesforhold. ETU anerkendte dækning for forhold 1-8 den 27. marts 2020, men afviste forhold 9, 10 og 12, da de var beskrevet i tilstandsrapporten, samt forhold 11, der var under selvrisikoen. ETU meddelte, at erstatningen ville baseres på det billigste tilbud, der indeholdt det rimelige og nødvendige udbedringsomfang.

ETU iværksatte en isoleret bevisoptagelse (skønsforretning) mod entreprenøren og den byggesagkyndige, hvilket satte udbedringsarbejdet i bero. Klageren var ikke part i denne sag.

En skønsforretning blev afholdt den 18. december 2020, og skønsrapporten af 5. februar 2021 vurderede udbedringsomkostningerne for forhold 1-8 til 91.900 kr. ekskl. moms (114.875 kr. inkl. moms).

Klageren indhentede efterfølgende to tilbud, som var væsentligt højere end skønsmandens vurdering. ETU's egen konsulent udbød entreprisen, hvilket resulterede i et revideret tilbud, der var markant højere end de tidligere indhentede tilbud.

Klageren fik i marts 2023 udarbejdet en byggeteknisk rapport, der opgjorde udbedringsomkostningerne til 756.562,50 kr. inkl. moms.

Anmeldte skadesforhold og dækning

| Nr. | Forhold | ETU's oprindelige dækning (27.03.2020) | Begrundelse for afslag | Senere status (sålbænke) | 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------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ The following is a table of the top 10 most common causes of death in the world, according to the World Health Organization (WHO) in 2019: | Rank | Cause of Death | Estimated Deaths (millions) | |---|---|---| | 1 | Ischemic heart disease | 8.9 | | 2 | Stroke | 6.2 | | 3 | Chronic obstructive pulmonary disease | 3.2 | | 4 | Lung cancer (and tracheal and bronchus cancers) | 1.8 | | 5 | Alzheimer's disease and other dementias | 1.6 | | 6 | Diabetes mellitus | 1.5 | | 7 | Diarrhoeal diseases | 1.5 | | 8 | Tuberculosis | 1.4 | | 9 | Cirrhosis of the liver | 1.3 | | 10 | Road injury | 1.3 |

Ankenævnet for Forsikring har besluttet at afvise at afgøre sagen, og klagegebyret tilbagebetales til klageren. Denne afgørelse er truffet, da sagen skønnes uegnet til afgørelse på skriftligt grundlag i nævnet, og tvisten derfor bedst afgøres ved domstolene, hvor der er mulighed for parts- og vidneforklaringer samt syn og skøn. Dette følger af Ankenævnets vedtægter § 4, stk. 3, nr. 3.

Nævnet har lagt vægt på flere faktorer i sin begrundelse:

• Komplekse byggetekniske forhold: Sagen omhandler mange og komplekse byggetekniske forhold, og det fremlagte bilagsmateriale er særdeles omfattende.
• Inkonsekvent dækningstilsagn: Selskabet anerkendte oprindeligt dækning for forhold 1-8 i marts 2020 baseret på en skaderapport. Dog foreslog skønserklæringen fra januar 2021, som selskabet bad klageren om at indhente tilbud i henhold til, en udbedring af forhold 1-5, der ikke stemmer overens med selskabets oprindelige dækningstilsagn. Skønserklæringen tog desuden ikke stilling til forhold 6-7.
• Frafald af dækning: Selskabet frafaldt dækningstilsagnet for sålbænke (forhold 8) baseret på skønserklæringen, der angav ingen skader.
• Skiftende erstatningsvurderinger: Selskabet reducerede erstatningen yderligere den 4. januar 2023, men anerkendte herefter igen fuld dækning i henhold til skønserklæringen.
• Klagerens manglende partstatus: Klageren var ikke part i syns- og skønsforretningen og den efterfølgende retssag, hvilket har betydning for klagerens accept af skønserklæringen.
• Prisstigninger: Der er sket prisstigninger siden skønsforretningen, hvilket yderligere komplicerer fastsættelsen af erstatningsbeløbet.
• Usikkerhed om udgifter: På det foreliggende grundlag er det usikkert at fastsætte den præcise udgift, der er påkrævet for at udbedre de dækningsberettigede forhold.