Insurance claims for ceiling damage: The most common claims

We are often faced with ceiling damage claims that are not always covered by the community scheme policy, as different insurers use different policy wordings.

In this article, we will attempt to paint a general picture based on the main insurer’s policy wordings for the insurers we (Addsure) mainly work with, so that owners have a better idea of the concepts involved when claiming for ceiling damage.

For damages to a part of the building to be claimable, the following should be true:

1. The damage must have occurred suddenly, must have been unforeseen and must have occurred at an identifiable time. The damage should not have occurred over a period of time. 
2. The proximate cause must not have been wear and tear, neither directly nor indirectly. 
3. There should be no fault or defect with the original design or workmanship. 

When dealing with the material damage policy wordings in the past, events were listed and damage to ceilings deemed ‘water damage’ if occurring suddenly, but with the advent of the more recent all-risk type policy wordings, all damages are covered, subject to the above three basic criteria.

The older policies used to list what is covered, and the newer policies now list what is not covered. This should, theoretically, produce more or less the same outcome. Owners are often confused, as the newer policy wordings can be a little bit more difficult to navigate in terms of what is not covered.

Let us first look at a few ceiling damage scenarios based on some common causes.  Always remember, the success of any claim comes down to what caused the damage.

Damage Scenario #1: Leak causing damage to the ceiling

This is likely the most common problem reported in sectional title. Usually, a leak is detected after an initial period of seasonal rain. An owner will report that there are wet marks on the ceiling after a heavy downpour or even worse, the owner will report water dripping down walls when it rains. The ceiling is often damaged to the extent that it needs replacement.

The three basic criteria mentioned above will apply when claiming:

1. On the claim form, the owner should advise the insurer of the date and approximate time the leak occurred. If this is indeterminable, i.e., the tenant reports that it has been happening for weeks or months, then there is no claim.

2. There should be no wear or tear involved, so strictly speaking, if the leak occurred because a heavy storm shifted or cracked a tile, then there would be grounds for a claim, but if the waterproofing has failed due to wear and tear, or lack of maintenance, there should be no claim.

3. Lastly, the leak should not have been caused by previous poor workmanship or defective design.

The insurer will want proof that the offending roof leak is repaired before settling a ceiling damage claim.

Damage Scenario #2 Cracks in the ceiling

This is probably the second most common damage reported in sectional title.

Unless cracks appear immediately following a severe storm or earthquake, the likelihood is that the cracks are from a cause other than an insured event. Cracks can form with settlement, subsidence over time, poor ceiling installation, moisture or damp, etc.

Damage Scenario #3 Sagging ceiling

Sagging ceilings are often reported as claims and unfortunately, usually declined.

This is because sagging of ceilings is usually caused by an accumulation of moisture over time. Parts of the ceiling will start to hang lower than the rest, eventually reflecting a sagging effect. Insurers will usually only admit a claim for a sagging ceiling if such damage follows a sudden event, such as a storm and the ceiling was flooded or damaged by water.

Damage Scenario #4: Ceiling collapse

There are a few factors which could contribute to a ceiling collapse.

If a ceiling collapse occurs following an insured event, such as fire, storm, flood, etc., the insurer has a cause and can justify admitting such as a claim. Unfortunately, quite often ceilings simply collapse for reasons which would not qualify as a claimable event, for example:

• • Failure to fix ongoing leaks, cracks, etc.

• • Neglected or poor maintenance.

• • Poor materials used – nails or pins used instead of screws

• • Improper construction techniques applied

• • Termites or other infestations

The only way to mitigate this scenario is to look out for signs that the ceiling is under stress, for example:

loud cracking sound in the ceiling;

• • Sagging or dropping of the plasterboard sheeting and/or the cornice; and

• • Visual cracking and/or small circles or blisters (nail pops) on the ceiling, which are a sign the plasterboard sheeting may be pulling away from the nails or screws

• • Stains on the ceiling

It is also not uncommon for owners to report that a ceiling has “just collapsed” with no identifiable cause. Insurers will still apply the same three basic criteria and will look for evidence of a sudden insured event. Even if a specific cause cannot be established, the insurer must still be satisfied that the damage was sudden, unforeseen and not the result of wear and tear, gradual deterioration or defective design or workmanship. Where this cannot be demonstrated, the claim is unlikely to succeed. Insurance responds to events, not to conditions that have developed over time, even if the eventual collapse itself appears sudden.

In summary

The insurer will generally accept damaged ceiling claims that are of a sudden and unforeseen nature, not resulting from wear and tear, and not due to defective design or poor workmanship.

When reporting a ceiling damage claim, be very clear about when the damage occurred and ensure that any repair quote has full details about the price and quantities of material being used. Include photos and ensure that a contractor’s report confirms that the previous materials used and design was adequate and up to standard. Such report should refer to likely cause.