A vulnerable policyholder has won a dispute over his collapsed ceiling after the financial services ombudsman accepted a storm caused the damage.  

The man alerted Auto & General to cracking last September, and a contractor found damage to the lounge room and kitchen ceiling.  

The insurer initially attributed the collapse to heavy wind and water ingress, which would have been covered as storm damage under its policy. It noted broken roof tiles had allowed rain to enter.  

But it reversed its decision when an expert identified long-term water staining on the roof’s timber rafters and concluded the ceiling cracked due to failure of its nail or glue fixtures.

A second export report agreed on the cause.  

Auto & General also cited Bureau of Meteorology data showing limited rainfall and wind speeds on day the claimant reported the issue.  

In its dispute ruling, the Australian Financial Complaints Authority says there may be more than one cause for the damage, but it accepts a storm hit the property.

It notes the insurer’s weather data was for a suburb 10km from the home.  

AFCA says a storm probably caused the collapse, given the timing and the evidence of cracked roof tiles and ingress.

It says the insurer’s reports included no photos showing failure of nails or glue holding the ceiling to the roof frame.  

“If the ceiling had collapsed due to the failure of the screws and nails, the whole property would likely be affected,” the authority said.

“The damage being limited to the kitchen, hallway and lounge room is more consistent with water ingress in that area.”  

Auto & General has been told to settle the claim. It has already waived a $2000 excess, and AFCA says this means further compensation for stress is not required.  

The complainant had “disclosed multiple vulnerabilities to AFCA and the insurer”, and alleged he was left “emotionally distressed and scarred after the insurer declined his claim”.

But AFCA says the insurer’s actions “do not appear unreasonable”.

See the ruling here.