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Liberty Specialty Markets

'Loyal customer' not covered for rotting pergola, AFCA rules

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A decision by Suncorp to reject a claim for a collapsed pergola from a home and contents policyholder, who had been with the insurer for 44 years and never previously claimed, has been upheld by the Australian Financial Complaints Authority (AFCA).

AFCA says the insurer provided evidence to back up its decision, which it made by relying on an exclusion in the policy that states any damage caused by gradual deterioration including rot will not be covered.

The complainant had lodged her claim in March 2019 after the outdoor structure gave way during a storm. She says her claim is valid since her policy covered for a series of insured events including damage caused by a storm.

She also asked Suncorp to review the decision and to take into consideration her years of loyalty. She urged the insurer to re-think its position on a “commercial basis”.

Suncorp does not dispute that the pergola collapsed during the storm but says the building assessment it has carried out shows the damage was due to dry rot, and not from the severe weather event as claimed by the complainant.

A builder appointed by the insurer to inspect the damage says the pergola was fixed into the rafter through the fascia of the sunroom and rafter timbers had rotted and moved away over time.

The insurer also hired an engineer to look at the damage and it was concluded the original construction of the pergola consisted of a fixing plate planted on the fascia and screw fixed roof rafters. The engineer identified extensive dry rot to the fascia board and to the pergola fixing plate. This has caused the fixing plate to fail and pull away from the property.

Photographs from the engineer showed significant dry rot and deterioration. The engineer says the cause of the pergola collapse was due to the existence of dry rot to the timber nailing plate that supported the pergola rafters.

According to the engineer, the dry rot had been building up for three to five years, and is not due to a single event.

The complainant does not dispute the existence of dry rot. However, she says the dry rot was not evident until the pergola had collapsed, and the damage was caused by the claimed storm event.

“Whilst I accept a storm event occurred, I am persuaded by the insurer’s reports that the damage has been occurring over time,” AFCA says in its ruling of the dispute. “The photographs support the extensive dry rot which has ultimately caused the pergola to collapse.”

AFCA notes the claim dispute took a toll on the health of the complainant and her daughter, but says the available information supports the proximate cause of the damage was dry rot and deterioration.

It also acknowledges the complainant had not made a claim during the 44 years she was with Suncorp.

“However, AFCA is unable to direct an insurer to accept a claim on this basis,” AFCA says, adding it “cannot bind an insurer to make a commercial offer outside the terms of the policy”.

Click here for the ruling.