Your insurance might not cover damage resulting from gradual deterioration, wear and tear and a lack of maintenance.

Claim for damage caused by KZN floods

The claim

On 21 April 2022, the insured reported a claim to the insurer for water that had accumulated on the roof of his property after the April floods in KZN.

A contractor appointed by the insurer inspected the insured’s property and reported, amongst other things, that the roof was a flat concrete roof and was poorly designed. The contractor advised that the insured had to break the concrete structure to allow rainwater to escape from the roof and that the roof was not maintained; the waterproofing membrane sealant had perished and the water outlets were blocked.

The contractor advised further that the property was poorly ventilated and there was black mould visible on all the ceilings and walls. The contractor was of the view that the damage to the insured’s property was old and had not occurred as a result of a single incident but had rather formed over a period of time.

The claim was rejected by the insurer on the basis that the policy does not cover damage resulting from gradual deterioration, wear and tear and a lack of maintenance.

The insured disagrees with the insurer’s decision

The insured submitted that approximately 300mm of rain fell over a 24-hour period. This was a natural disaster that could not have been predicted. The insured stated that the waterproofing was maintained and that the interior was painted two years ago.

The insured questioned why he was not informed about the poor design and maintenance issues on the property when the policy was taken out.

OSTI’s findings

OSTI found that the extent of the damage, including the extent of the discolouration of the ceilings and walls, the peeling paint, and the disintegrated waterproofing, visible on the photographs taken by the contractor, supported the findings made by the insurer.

The internal damage was extensive and on a balance of probabilities occurred gradually over a period of time. The date of loss was reported as 11 April 2022 and the contractor inspected the insured’s property on 11 May 2022. It was unlikely that the extent of the internal damage occurred over a one-month period.

The policy terms and conditions contained exclusions for damage caused by a lack of maintenance, wear and tear and gradual deterioration. OSTI upheld the insurer’s rejection of the claim.

OSTI also mentioned that there was no obligation on the insurer to inspect the property prior to the inception of the policy.