The complainant states that storm damage claim caused a ceiling in his home to collapse, and states that the damage should be covered under the insurance policy. The providers loss adjusters advised the complainant that the damage was due to ongoing ingress of water which cumulated in the ceiling collapse. They advised that an insured peril has not operated in these circumstances, according to the provider, hence leading to the rejection of the claim and repudiation of a storm damage claim.

The provider ensures that at assessment was carried out by loss adjusters regarding the storm damage claim, the assessment by the loss adjusters provides that the storm damage claim was caused by water ingress over a long period of time and not storm damage.

The policy terms provide that storm or flood damage is insured under the policy terms. The policy terms also provide that the building is not insured under gradual deterioration or wear and tear. There was clear evidence that the cladding had come off the vertical stand up, allowing water to get in and leading to an ingress of water over a prolonged period of time, as reported by the providers loss adjuster.

A copy of the loss adjuster’s inspection document and report were provided to the FSPO offices, along with photographs from the complainant’s house on 30 January 2019, at 10.05am. The report stated that sagging was creating a gap through which rainwater was entering, and causing an ingress of water and damage over time. The policy liability provides that examination of the roof reveals the decking to be sagging, allowing a gap to develop between the vertical stand up and the decking, this over a long period of time has led to saturation of the chipboard, and collapse of the same.

The loss adjuster, on the providers behalf has provided enough evidence to demonstrate that the collapse of the ceiling was not caused by storm damage and no storm damage claim could be reaslised but instead through gradual wear and tear over a period of time. Gradual wear and tear over time is not covered under the insurance policy, hence the reasoning for this claim being rejected.

Understanding the terms of your policy can be vitally important on the determination of a successful or unsuccessful claim. If you are unsure about some terms in your policy why not contact us for help.