Insurer repairs, maintenance and pre-existing damage

What are maintenance issues?

Maintenance issues are problems with your property that, if not rectified, could cause or contribute to further damage. Maintenance problems commonly include:

• Deteriorated or loose roof flashing
• Cracked roof tiles
• Blocked gutters and downpipes
• Deteriorated sealant
• Rusted or damaged fittings 

Some insurers may decline claims for damage caused by maintenance issues, while others will only decline claims if you were reasonably aware of those maintenance issues. This article relates to claims that are accepted, despite maintenance issues being involved. 

Example: If flashing on your roof has deteriorated over time and water enters during a storm, the insurer may see the flashing deterioration as a maintenance issue. 

What is pre-existing damage?

Pre-existing damage is damage that existed before the insured event. It is not caused by the incident you claimed for.

Examples include:

• Old water staining unrelated to the storm
• Mould that existed before the event
• Long-term subsidence cracks
• Aged wear and tear to internal fixtures

Example: If mould had developed in one room months before a storm event, and was unrelated to the storm, the insurer may classify this as pre-existing damage.

Why insurers care about these issues

When an insurer accepts your claim and repairs a property, their trades must warrant the work. For the insurer to offer its lifetime guarantee, the trades need to be confident the repair will not be compromised by an unresolved issue that was already there. 

This means insurers may ask you to fix maintenance issues or pre-existing problems that would otherwise interfere with their ability to warrant their own repairs.

Example one: Storm damage with roof flashing failure

Water enters your roof during a storm. The insurer accepts the claim. The builder identifies that part of the flashing has deteriorated over time, allowing water to enter.

Before the insurer begins internal repairs, it may be reasonable for the insurer to expect you to replace the flashing. Fixing it means:

• No further water should enter from that failure point, 
• The insurer’s trades can confidently warranty internal works, and
• The insurer can uphold its guarantee obligations. 

Example two: Pre-existing mould and insurer ability to repair

If a property has an unrelated pre-existing mould problem, the insurer may not be able to obtain a post-remediation verification (PRV) certificate for their repairs if they do not remediate the whole property.

In that case, the insurer may argue that cash settlement is more practical for their portion of the repairs only.

When requests may become unreasonable

Sometimes, insurers rely on maintenance or pre-existing issues to avoid warranting repairs or to push a cash settlement. Common problems include: 

• Treating building upgrades as “maintenance”
• Requiring code upgrades where the building met the code at the time of construction
• Refusing repairs because of unrelated minor damage elsewhere (for example, pointing to a cracked driveway to avoid warrantying internal repair work)

These tactics can result in unfair outcomes. If the maintenance or pre-existing issue does not genuinely affect the insurer’s repair obligations, it should not stop insurer repairs. 

What may be reasonable?

It may be reasonable for an insurer to require you to fix issues that: 

• Are a true maintenance matter or pre-existing defect, and
• Would prevent the insurer from warrantying its repair work.