Your insurance policy is not your maintenance plan

Your homeowner’s insurance policy can protect you from unforeseen expenses when storms, floods, hail or freezing temperatures or snow cause damage to your home.

But if a storm results in a room being flooded when you didn’t maintain your gutters, blows off part of your roof that hasn’t been maintained in years, or causes a dead tree to fall on your car or home, don’t expect your short-term insurer to pay.

All short-term insurance policies have “general duty of care” clauses that oblige you, as the policyholder, to safeguard and maintain insured property, John Wessels, actuary and member of the Short-term Insurance Committee of the Actuarial Society of South Africa (ASSA), says.

Cover is excluded if you don’t do what you can to keep your property in a manner that prevents damage and increases your risk of losses, Wessel says.

Many policyholders overlook or do not understand this clause and when it is used to deny a claim, they feel they have been treated unfairly, he says.

But if insurers did not apply exclusion clauses and settled claims for damage or loss caused by negligence or a lack of care, short-term insurance premiums would soon be unaffordable, and policyholders who take care of their property would be subsidising those who do not, he explains.

Ombud backs insurers on maintenance

The biggest reason for claims being rejected under homeowners' insurance last year was due to exclusions related to wear and tear, gradual deterioration, and a lack of maintenance, according to the 2024 Annual Report of the National Financial Ombud (NFO) Scheme.

The NFO scheme includes the ombud previously known as the Ombud for Short-Term Insurance – a voluntary ombud who hears complaints from short-term insurance policyholders.

The NFO’s latest annual report includes a case in which a homeowner complained to the short-term insurance ombud that his insurer rejected his claim for water damage to his house caused by a storm.

The insurer stated that the damage was due to a lack of maintenance, wear and tear and gradual deterioration of the roof and the man’s policy excluded cover for damage attributable to a poorly maintained property.

The insurer commissioned a report from an export who found that the roof was in a poor condition, had unsealed overlaps, rusted sheets and several holes. The report was supported by photographs of the roof.

The homeowner submitted invoices for work on the roof, but the ombud found these recorded that the roof was painted rather than maintained, more than four years before the storm damage.

Kishendren Pillay, an adjudicator for the Non-life Insurance Division of NFO, said the homeowner was unable to present sufficient and clear proof that the roof had been maintained, while the insurer’s evidence was “compelling”.

 The complaint was therefore dismissed.

Complaints about declined weather claims

Wessels says in 2024, rejected claims for loss or damage due to acts of nature contributed to 40 percent of complaints submitted to the NFO.

He says it is not surprising as short-term insurers receive high volumes of claims following acts of nature, but on assessment insurers often find that weather-related damage could have been prevented had the damaged property been properly maintained or if proper risk avoidance measures had been followed.

He says water damage caused by roofs that were not adequately maintained, collapsed boundary walls that had been in desperate need of repair for years, and swimming pools that cracked due to neglect are common examples.

Trying to be fair

When assessing claims, Naked always aim to be fair. Ernest North, co-founder of Naked Insurance, says.

North says during the rainy season, Naked often sees claims that could have been avoided if routine maintenance had been done. He says this is especially true for structural issues, such as damaged roofs or gutters, which are often the result of wear and tear rather than storm damage.

North says insurers differentiate between damage caused by severe weather and that resulting from neglect, such as roof leaks due to blocked gutters or cracked tiles that have not been maintained, and a claim may be partially or entirely rejected, depending on the circumstances.

He says this can also lead to delays in claim processing as it takes longer to determine whether the damage was weather-related or due to pre-existing wear and tear.

North says the aim of insurance is to help when things go wrong unexpectedly — but it relies on policyholders doing their part to take reasonable care of their property.

Provide for maintenance

Homeowners often delay maintenance because it is costly and the rising cost of living may have resulted in you putting your regular maintenance work on hold.

Johann Rossouw, associate financial planner at Fiscal Private Client Services, says you need to spend about 1.5 to two percent of the value of your home on maintenance each year.

For example, a house valued at R1.5 million would require between R22 500 and R30 000 a year in upkeep - a figure that rises as the property ages.

Homeowners should ideally plan for these costs in their budgets, as failure to do so not only shortens the lifespan of the home but can also jeopardise valid insurance claims in the event of damage, Rossouw says.

As insurers increasingly scrutinise the state of a property when processing claims, preventative maintenance becomes not just a wise financial decision, but an essential one, he adds.

Maintain security

Wessels also cautions homeowners to ensure that home security is maintained and functional. “If your home is burgled and the claims assessor finds that access was gained to your home because the electric fence was not working, the security cameras were no longer monitored, or that you had not replaced a broken security gate lock, your claim will likely be rejected.”

He says the same “general duty of care” applies to vehicle owners. For example, if an auto repair centre advised that the brakes on your car were worn and needed to be replaced, don’t put off doing this costly repair. If you are involved in an accident, and the claims assessor finds that worn brakes prevented you from stopping in time and avoiding the accident, you claim could be declined.