Insurance is not a Maintenance Contract!

The Great British Weather!

Unsurprisingly, Autumn and Winter bring with them the most number of claims for storm damage. From a few tiles coming off in a period of high winds, to a full on disaster like a roof being completely blown off in a near hurricane, your insurance policy sits in the background. It’s your safety net against such misfortune. However…

…Your insurance policy is a two way agreement.

When you took out your policy, there was a question that you almost certainly ticked “yes” to, without giving it a second thought, it was worded something like this: “Is your property in a good state of repair?”  I’ve always thought this to be a rather subjective question, one man’s “good state” is another man’s “right state”, but it becomes a little more serious when it comes to a claim.

The most common claims involving weather damage are roof related and/or water leaks, known in the insurance world as “water ingress”

With regard to the roof, the usual claim involves loss of tiles. This in itself is a fairly straightforward situation, or is it? There’s a period of high winds and rain that batters the roof over several hours, and when it is all over you find half a dozen tiles in the garden and obvious gaps in the roof. The first thing you do is find a roofer and get them around to give you an estimate of the cost of repair. In the meantime you call your insurance company to tell them and, in all likelihood, they arrange to send someone to look at the damage.

In the old days this used to be a qualified Loss Adjuster whose job it was to assess the claim and report back to the insurance company. He was trained and qualified in his field. Nowadays, Loss Adjuster’s are still frequently used, however, in recent years there has been the introduction of firms other than Loss Adjusters being contracted to do this type of work. If your insurance company is sending someone around to assess damage to your property, it is a good idea to find out just who they are and what qualifies them to make such assessments.

Back to the missing tiles…

There are in fact different ways of looking at a claim of this nature and that is where your own responsibility pays an important part. Here are two examples of exactly the same claim, but with very different outcomes. They show the two extremes, and in reality claims may fall at any point between them, but the idea is to illustrate the point.

Scenario 1.
The house is about 20 years old, you bought it 10 years ago and 4 years ago you had a loose tile fixed, had the guttering cleared and had some moss cleaned of some of the tiles. The Loss Adjuster looks at the storm damage and recommends payment of your claim in full. Your efforts in keeping the house in good repair have been rewarded!
Scenario 2.
The house is about 80 years old, you bought it 30 years ago. You have never done any maintenance on the roof. There are numerous loose, missing and slipped tiles, and the moss build up and general weathering prove that some tiles have been dislodged for quite some time. The Loss adjuster looks at the storm damage and recommends payment of the claim, but with an amount deducted because it was not in a good state of repair to start with. it is even possible that the claim be turned down completely, and in the worst case he could recommend that the insurance policy is cancelled completely.

When it comes to a claim, the insurance company will take into account the condition of the property prior to the claim event.

You should also bear in mind the importance of insuring the property for the correct amount. Underinsurance combined with poor state of repair will reduce your claim to a fraction of what it would have been. If you want to find out more about underinsurance and how important it is, just click here.

“Gradually Operating Cause”

The same principles apply to “ingress of water”. If the Loss Adjuster is satisfied that the property is in a poor state of repair, then your claim can be reduced or turned down completely. Another common reason for turning claims down for water damage is the assertion that the damage is a result of a “Gradually Operating Cause”. This is when damage occurs over some period of time, possibly due to a small escape of water that remains undetected until it causes some very noticeable damage.

In common terms, insurance is not there to compensate for problems arising from wear and tear

The Two Way Contract…

An insurance company takes you on as a client on the proviso that you will maintain your property and look after it in such a way that damage to it is minimised. If a potential claim occurs, but it is deemed that you have not kept your side of the bargain, then the insurance company has every right to turn you down.

There are obviously grey areas and should you feel that you have had a claim turned down unfairly, there is a process by which you can appeal a decision and even complain if you feel strongly enough. I have previously written about this in the post, How to Complain Effectively to Your Insurance Company

I hope you never have to deal with the aftermath of damage caused by the weather, but there is no guarantee you won’t. You have taken out insurance to protect you against such things, but to stand the best chance of getting your claim paid in full, you need to fulfil your side of the bargain first.

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