Pei-Ling owned an apartment in a big apartment block in Christchurch. She travelled a lot for work so wasn’t regularly at home.
In March 2022, a pipe burst in the apartment block when Pei-Ling wasn’t home. Someone in the building notified the building manager, who contacted the Body Corporate. The Body Corporate contacted the insurance company that insured the block to let them know that there had been a water leak. The insurer sent some contractors out to assess the damage and to dry out the carpet in the affected units.
The water pipe that burst was in one of the building’s internal walls, and water had leaked into the walls and floors of some of the units, including Pei-Ling’s. However, because Pei-Ling wasn’t home, her unit was not identified as one of the units that had been damaged.
Pei-Ling returned from a business trip a couple of weeks later to find that the water leak had flooded her bathroom, causing damage to the wall and floor. Pei-Ling notified the building manager, who explained what had happened. The Body Corporate arranged with the insurer for an insurance assessor to come out and assess the damage to Pei-Ling’s unit a couple of weeks later.
The assessor prepared a report after inspecting Pei-Ling’s unit, and he advised that there was water damage to the wall and some of the floor tiles from the burst pipe. The assessor also reported that he had taken the panel off the bath during his inspection, and that there was a small leak underneath the bath that had likely been occurring for some time. The assessor advised that the leak underneath the bath had caused gradual damage to the floor beneath, and to the surrounding panels.
The insurer received the assessor’s report and advised the Body Corporate and Pei-Ling that the damage caused by the burst pipe would be covered under the claim for ‘sudden damage’, but the gradual damage to the floor and panels beneath the bath would need to be assessed separately.
Pei-Ling disputed the findings in the assessor’s report. She believed the damage underneath the bath was related to the burst pipe and the time it took to get someone out to attend to it. The relationship between Pei-Ling and the insurer broke down because she refused to let the insurer arrange for the assessor to come out to inspect the damage again.
The claim for the ‘sudden damage’ was not settled due to the pending issue of the gradual damage, so Pei-Ling complained to FSCL.
Dispute
Pei-Ling didn’t think it was necessary to have another assessor/contractor come out and inspect her apartment. She thought it was obvious that all the damage was related to the burst pipe.
The insurer advised Pei-Ling that the claim for the sudden damage was covered ($3,000), but that a second claim for the gradual damage would need to be submitted and assessed.
Review
Pei-Ling and the insurer hadn’t agreed about the gradual damage. Pei-Ling continued disputing the findings in the assessor’s report, and she didn’t want to communicate with the insurer anymore.
The insurer sent us the claim file, and we could see that they had decided to accept a claim for gradual damage, based on the assessor’s report. In the interests of resolving the complaint, the insurer offered to pay the maximum amount specified in the policy for hidden gradual damage ($10,000).
The insurer passed the claim settlement details on to the Body Corporate, but they had been unable to reach Pei-Ling, so the settlement had not yet been accepted.
We contacted the insurer to confirm the details in their claim settlement offer, and then we contacted Pei-Ling to let her know.
Resolution
Pei-Ling was happy with the claim settlement amount. Because the Body Corporate was the official policyholder, we told Pei-Ling that she needed to speak with them to let them know that she was happy for them to accept the settlement.
Pei-Ling spoke with the Body Corporate, and the claim was paid.
Insights for participants
Sometimes a relationship with a client can become challenging or break down completely, especially when they have a complaint or are under significant stress, financial or otherwise.
If you are unable to continue dealing with your client directly about a complaint, you will have likely reached a ‘deadlock’. At this point, you should refer them to FSCL, and we will review the complaint. Because we are independent, we assist you both in the complaints process, and help you reach a fair outcome.
