The complainant filed a claim with Auto and General following a series of heavy rainfall events in early March of last year, which caused significant damage to her home. Water had entered the kitchen and bedroom ceilings through storm-created openings, resulting in damage to her belongings and the subsequent appearance of mould.
Initially, Auto and General agreed to cover the damages caused by the storm and provided temporary accommodation for the insured and her two children. However, months later, the insurer reversed its decision, claiming that the damage was a result of the gradual deterioration of the property and excessive moisture under the home.
The complainant strongly criticized Auto and General's decision, stating that she had to return to her unsafe home, still affected by mould, as she had nowhere else to go.
A builder appointed by the complainant conducted make-safe repairs, discovering that water leaked into the home through ridge beddings. Another builder's report noted that there was "mould all over" the front eaves of the roof.
The report also identified "excessive moisture damage" in the main bedroom, but it confirmed that the property's sub-floor ventilation had been adequate for 60 years prior to the storm.
Auto and General later engaged with experts to inspect the property six months after the event. One builder, referred to as RC, reported that the building's downpipe was inadequate, causing water to overflow and flood the eaves. RC also noted the lack of sarking and insulation on the roof as a reason for water ingress.
The builder attributed the mould growth to observed moisture on the subfloor walls, limited ventilation, and high humidity levels in the home. However, an inspection by the insurer's internal assessor failed to find any moisture or mould growth in the building's subfloor.
The Australian Financial Complaints Authority (AFCA) stated that the complainant provided enough evidence of the storm's impact for it to be considered a claimable loss. AFCA challenged the insurer's determination that the damage was pre-existing, pointing out that the provided photos showed no evidence of mould damage before the storm event.
The ruling acknowledged multiple possible explanations for the water damage but concluded that it was likely directly related to the severity of the storm. AFCA agreed that the lack of sarking and insulation on the roof made it vulnerable to water seepage.
"While I acknowledge gradual deterioration is present, this is due to the water damage turning to mould. Mould then spread through the home," AFCA stated.
As a result, AFCA required Auto and General to accept the claim and remediate the home from mould damage to its pre-loss state. The insurer was also directed to cover the costs of temporary accommodation for the complainant and her family. Additionally, the complainant was awarded an extra $1500 for non-financial losses on top of the already provided $2000.
