Common Insurance Disputes in Sectional Title Schemes
One of the most common questions in Sectional Title Schemes is whether the insurer will pay the claim and who is responsible for paying the insurance excess.
Many owners assume that because the Body Corporate submits the insurance claim, the Body Corporate must also pay the excess. Others believe that if they were not responsible for causing the damage, they cannot be held liable for the excess.
Unfortunately, it is not always that simple.
The responsibility for paying an excess depends on a number of factors, including the cause of the damage, who has the maintenance responsibility for the damaged property, the provisions of the Sectional Titles Schemes Management Act and the specific terms of the insurance policy.
Every claim must therefore be considered on its own facts.
What is an Excess?
An excess is the first amount payable towards an insurance claim. It is effectively the portion of the loss that is not paid by the insurer.
Excesses vary depending on the type of claim and are specified in the insurance policy. Depending on the circumstances, the excess may be payable by the owner who places the claim, the owner whose section caused the damages or the Body Corporate.
What Does the Legislation Say?
PMR 23(2)(b) of the Sectional Titles Schemes Management Act provides that an owner is responsible for any excess amount that relates to damage to any part of the building that the owner is responsible for repairing and maintaining.
Determining who is responsible for an excess is not always straightforward. It depends on the cause of the damage, who has the maintenance responsibility for the damaged property and the terms of the insurance policy. Every claim must therefore be considered on its own facts.
Common Insurance Disputes
The following examples illustrate some of the situations that commonly arise in Sectional Title Schemes.
1. Burst Geyser - Who Pays?
The Body Corporate insures the geyser
Although the hot water installation generally forms part of the common property, it is insured under the Body Corporate's insurance policy.
The owner maintains the geyser
In terms of the legislation, an owner is responsible for maintaining, repairing and, when necessary, replacing the hot water installation that serves his or her section.
Where a hot water installation serves more than one section, the owners concerned must share the maintenance, repair and replacement costs on a pro-rata basis.
Geyser excess and policy limits
Most insurance policies apply limits to geyser replacement claims, and an excess is usually payable.
In addition, insurance is intended to cover sudden and unforeseen events. A burst geyser is generally an insured event; maintenance items such as elements and valves may only be covered where the policy specifically provides for this.
Resultant water damage
Where a geyser bursts, the Body Corporate's insurance policy will generally cover the resultant damage caused to the building and its insured fixtures and fittings, subject to the terms and conditions of the policy.
The owner of the geyser is generally responsible for the applicable excess relating to the replacement of the geyser, as well as the excess payable in respect of the resultant damage caused by that geyser.
This can sometimes lead to disputes where the geysers are situated in the roof space above another owner's section. For example, a ground-floor owner's geyser may burst and cause damage to the ceiling and fixtures of the unit above.
Many owners believe they should not be responsible for the excess because their own unit did not sustain the damage. However, this overlooks the fact that the damage originated from the owner's geyser. Likewise, the owner of the upper section is exposed to the risk of several geysers being situated above their unit, any one of which could burst and cause damage.
For this reason, the excess is generally allocated to the owner of the geyser that caused the damage, rather than the owner whose section happened to be damaged.
Limiting further damage
An owner also has a duty to minimise further damage once a burst geyser is discovered. This includes switching off the water supply to the geyser, isolating the electrical supply where it is safe to do so, and reporting the incident promptly to the managing agent or insurance broker.
2. My Bath/Shower Trap Leaked and Damaged the Unit Below
Water seepage from a leaking bath/shower trap is one of the most common causes of disputes between neighbours in Sectional Title Schemes.
Maintenance responsibility
In terms of the legislation, every owner is responsible for maintaining his or her section in a state of good repair.
A bath/shower trap forms part of the owner's section and is therefore the owner's responsibility to maintain and repair.
In many instances, the owner is unaware that the bath/shower trap is leaking, as there are no visible signs of water damage within their own section. The problem often only comes to light when the owner below notices water staining or water seepage into their unit whenever the bath/shower above is used.
Resultant damage
Although the owner above may not have been aware of the leaking bath/shower trap, this does not change the maintenance responsibility.
Insurance does not cover the repair of the leaking bath trap/shower itself, as this is regarded as a maintenance issue.
Before considering a claim for the resultant damage to the section below, the insurer will generally require proof that the leaking bath/shower trap has been repaired. Once the cause of the leak has been rectified, the insurer may consider the claim for the resultant damage, subject to the terms and conditions of the policy.
Who pays the excess?
Although the insurance claim is usually submitted by the owner whose section has suffered the damage, this does not necessarily mean that the owner is responsible for paying the excess.
The excess is generally allocated to the owner whose failure to maintain the bath/shower trap resulted in the damage to the neighbouring section. This remains the case even where the owner was unaware that the bath/shower trap was leaking.
If the owner of the leaking bath/shower trap has also suffered resultant damage within his or her own section, that owner may submit a claim for those damages and would generally be responsible for the applicable excesses relating to both claims. Whether the damages can be placed as a single claim would depend on the policy conditions.
Limiting further damage
Once an owner becomes aware of a possible leak, there is a duty to minimise further damage.
This includes arranging for the source of the leak to be investigated without delay, refraining from using the bath/shower until the necessary repairs have been completed, and ensuring that the repairs are carried out as soon as reasonably possible.
Owners should also remember that insurance policies contain time limits for the submission of claims. Delays in repairing the source of the leak or reporting the damage may prejudice the claim and, in certain circumstances, could result in the insurer declining the claim altogether. Where this occurs, the owner responsible for the leak may become liable for the full cost of the resultant damage rather than only the insurance excess.
3. My Upstairs Neighbour's Pipe Burst
Water leaks between neighbouring sections are another common source of insurance disputes. One of the first questions that needs to be answered is:
Who is responsible for maintaining the leaking pipe?
Maintenance responsibility
As with a bath or shower trap, an owner is responsible for maintaining and repairing the interior of his or her section.
As a general rule, any pipe serving only your section and situated within the median line boundary of your section is your responsibility to maintain and repair.
Even where access to the pipe is obtained through common property, this does not necessarily make the pipe common property or transfer the maintenance responsibility to the Body Corporate.
Owners are often surprised to learn that the boundary between stacked sections is the median line. Responsibility is therefore determined by the location and purpose of the pipe, rather than by which owner can physically access it.
Insurance generally responds to the sudden and unforeseen failure or bursting of a pipe that was otherwise in a reasonable condition, subject to the terms and conditions of the policy. Pipes that have deteriorated due to wear and tear, corrosion or gradual deterioration are regarded as maintenance issues and are generally not covered by insurance.
Resultant damage
Where a leaking pipe causes damage to the section below, the affected owner should report the damage to the managing agent and submit an insurance claim as soon as reasonably possible.
The insurer will generally require proof that the source of the leak has been repaired before considering the claim for the resultant damage.
It is important not to repair the resultant damage before the source of the leak has been permanently repaired.
If repairs are carried out too soon and the leak continues, further damage may occur and the insurer may decline a second claim for the same unresolved cause.
Who pays the excess?
The insurance claim is usually submitted by the owner whose section has suffered the damage. However, this does not necessarily mean that the owner is responsible for the excess.
Where the leak originated from a pipe that another owner was responsible for maintaining, the excess may generally be recovered from that owner, even where the owner was unaware of the leak.
The managing agent and insurance broker should be informed of the circumstances of the claim so that responsibility for the excess can be determined and, where appropriate, recovered from the responsible owner.
Limiting further damage
Both owners have a duty to minimise further damage once the leak becomes known.
The affected owner should report the damage immediately and, where the section is tenanted, ensure that regular inspections are carried out so that water seepage is identified as early as possible.
The owner responsible for the leaking pipe should arrange for the necessary repairs without delay to prevent further damage to both sections.
Failure to repair the source of the leak promptly may result in further damage.
Where an owner delays carrying out the necessary repairs, the insurer may decline any additional damage arising after the owner became aware of the problem, potentially leaving the responsible owner liable for those additional repair costs.
4. The Roof Leaked During a Storm
The Body Corporate's insurance policy generally covers damage to the structure of the building caused by an insured, sudden and unforeseen event, such as:
- Fire;
- Storm, wind and hail;
- Lightning; and
- Impact damage.
Who pays the excess?
Where damage to an owner's section is caused by the Body Corporate's failure to maintain the common property, the owner of the damaged section has the right to hold the Body Corporate responsible for the applicable insurance excess.
However, this is generally not the case where the damage is caused by an insured event such as a storm. Storm damage is regarded as an insured peril and is ordinarily beyond the control of the Body Corporate.
Where a storm damages the roof, the Body Corporate will submit an insurance claim for the repair of the roof.
If water enters a section through the storm-damaged roof and causes resultant damage to ceilings, walls or other insured fixtures within the section, the owner will generally submit a separate insurance claim for those damages and will usually be responsible for the applicable excess relating to that claim.
It is important to distinguish between damage caused by an insured storm event and damage resulting from poor maintenance. If an investigation establishes that the roof leaked because it had not been properly maintained, rather than because of the storm itself, the responsibility for the excess may differ.
5. Broken Windows
Broken windows are another area that often causes confusion, particularly when determining who is responsible for the insurance excess.
Maintenance responsibility
Windows and doors that separate a section from another section or from the common property form part of the median (middle) line.
As a result, responsibility for the repair, replacement and the applicable insurance excess will depend on how the damage occurred.
Who pays the excess?
Damage caused by an insured peril
Where a window is broken as a result of an insured event, such as a storm or high winds, or where the damage is caused by the owner or the owner's occupant, the owner will generally be responsible for the applicable insurance excess.
Damage caused from activities on the common property
Where a window is damaged as a result of an occurrence on the common property, such as a stone projected by a lawnmower operated by or on behalf of the Body Corporate, the Body Corporate would generally be responsible for the applicable excess.
Cause of the damage cannot be determined
Where it is not possible to determine how the window was broken, the responsibility for the excess is generally shared equally between the owner and the Body Corporate, as the window forms part of the median line between the section and the common property.
This principle does not apply where the window or door is situated wholly within a section or within an exclusive use area where the rules make the owner responsible for its maintenance. In those circumstances, the owner would generally be responsible for the applicable excess.
6. Vehicle Drives Through the Boundary Wall
Boundary walls generally form part of the common property and are therefore repaired and maintained by the Body Corporate.
Who submits the claim?
If a vehicle collides with the boundary wall causing damage, the Body Corporate would generally submit an impact damage claim under its insurance policy.
Gathering the necessary information
To assist the insurer, the Body Corporate should obtain as much information as possible at the scene of the incident, including:
- The driver's name and contact details;
- A copy of the driver's identity document, where possible;
- Vehicle registration details;
- The driver's insurer, if known;
- Photographs of the damage and the accident scene; and
- A South African Police Service (SAPS) case number.
The more information available, the easier it is for the insurer to assess the claim and, where appropriate, recover the costs from the responsible third party.
Recovery from the responsible party
Once the claim has been submitted, the insurer may seek to recover the cost of the damages from the driver or the driver's insurer where the driver was responsible for the accident.
This recovery process is handled between the insurers and does not generally delay the urgent repairs required to secure the scheme.
Securing the property
Depending on the terms and conditions of the insurance policy, the Body Corporate may also be able to claim the reasonable cost of temporary security measures, such as security guards or temporary fencing, until the boundary wall has been repaired.
The Body Corporate should also take reasonable steps to prevent further loss or damage by securing the damaged area as soon as possible.
7. Damage Caused by Lack of Maintenance
One of the most common reasons for an insurance claim being declined is that the damage resulted from a lack of maintenance rather than from a sudden and unforeseen insured event.
Examples of maintenance-related issues include:
- Defective shower waterproofing;
- Perished bath sealant;
- Leaking bath traps;
- Slow leaking pipes;
- Damp;
- Roof leaks caused by deteriorated roofs;
- Leaking valves within service ducts or shafts; and
- Any other damage that has developed gradually over time.
Insurance is not a maintenance contract
Both the Body Corporate and owners should be aware that insurance is intended to cover sudden and unforeseen loss or damage. It is not intended to replace routine maintenance or repairs that should have been carried out before damage occurred.
Where the Body Corporate or an owner has failed to carry out the necessary maintenance within a reasonable period or cannot demonstrate that the affected area has been properly maintained, the insurer may decline the claim on the basis that the damage resulted from wear and tear, deterioration or lack of maintenance rather than an insured event.
Who is responsible?
If the damage is the result of a failure by the Body Corporate to maintain the common property, the Body Corporate may ultimately be responsible for the cost of the repairs.
Similarly, where the damage results from an owner's failure to maintain his or her section, the owner may be responsible for the repair costs, the applicable insurance excess, or, where the insurer declines the claim, the full cost of the resultant damage.
Regular maintenance is therefore one of the most important steps that both owners and the Body Corporate can take to protect not only their property, but also their financial interests.
"Insurance Myth vs Reality"
Final Thoughts
Determining who is responsible for an insurance excess is not always straightforward. Every claim must be assessed on its own facts, taking into account the cause of the damage, who has the legal responsibility to maintain the area that caused the damage, and the terms and conditions of the insurance policy.
Owners should also remember that the Body Corporate's insurance policy is intended to insure the buildings and insured fixtures and fittings. It does not provide cover for household contents such as furniture, clothing, televisions, appliances and other personal belongings. Owners should therefore ensure that they have appropriate insurance for their household contents and any additional risks that fall outside the Body Corporate's insurance policy.
When in doubt, seek guidance from your managing agent or insurance broker before assuming who is responsible for an insurance excess.
Please note: The examples in this article illustrate common scenarios encountered in Sectional Title Schemes. Every insurance claim is assessed on its own facts and in accordance with the terms, conditions and exclusions of the applicable insurance policy.
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Determining who is responsible for an insurance excess is not always straightforward. Every claim must be assessed on its own facts, taking into account the cause of the damage, who has the legal responsibility to maintain the area that caused the damage, and the terms and conditions of the insurance policy.
Owners should also remember that the Body Corporate's insurance policy is intended to insure the buildings and insured fixtures and fittings. It does not provide cover for household contents such as furniture, clothing, televisions, appliances and other personal belongings. Owners should therefore ensure that they have appropriate insurance for their household contents and any additional risks that fall outside the Body Corporate's insurance policy.
When in doubt, seek guidance from your managing agent or insurance broker before assuming who is responsible for an insurance excess.
Please note: The examples in this article illustrate common scenarios encountered in Sectional Title Schemes. Every insurance claim is assessed on its own facts and in accordance with the terms, conditions and exclusions of the applicable insurance policy.
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- Body Corporate Insurance – What Every Owner Should Know – Understand what is covered by the Body Corporate's insurance policy, what owners should insure themselves and when additional insurance may be required.
- Leaks Between Units – Who Is Responsible and What Is the Process? – Learn how water seepage between neighbouring sections should be managed and who is responsible for repairs.
- Who Is Responsible for Windows and Doors in Sectional Title Schemes – Learn who is responsible for repairing and maintaining windows and doors, and how this affects insurance claims and excesses.