I'm insured with APIA.As a result of a problem caused by a burst in a downpipe during a storm, we had water flooding

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Customer: I'm insured with APIA.As a result of a problem caused by a burst in a downpipe during a storm, we had water flooding through one ceiling area. When processing this insurance claim, APIA ordered a roof inspection and are now telling me they won't cover my roof at all under this home insurance. The roof in 27 years old, concrete tiles. All the tiles are sound and not leaking at all (the leak was due to a downpipe). The roof was cleaned and re-pointed in 2012 and, as a result of the cleaning, some of the surface glazing on the tiles is worn. The APIA-commissioned roof report states "it was found the entire tiles (sic) roof was in poor condition. The roof was determined to be in a poor condition due to the tile coating is (sic) damaged". APIA have now told me verbally that this means they won't cover the roof at all now or in the future. I maintain that this is cosmetic only and the roof is structurally very sound. Can they do this?
JA: What state are you in? It matters because laws vary by location.
Customer: Queensland
JA: What steps have you taken so far?
Customer: I have tried to contact the company which did the cleaning in 2012 to ask them to comment. Unfortunately, despite leaving several messages they are not getting back (I didn't say what it was about) and I'm wondering if they are still in business - Brisbane Roof Restorations. APIA have offered a cash settlement for the internal work only, which I am prepared to accept and I am prepared to pay to have the downpipe in question replaced at my expense. But I'm very concerned that the roof is not covered for future storm damage. If I change insurance companies I will have to declare if I've ever had a claim knocked back and so it's really damaging, I feel. APIA say I can get a second report done, which I will try to arrange asap, and I've also spoken with another roofer, who says it's rubbish, the roof is in very good condition. APIA say the only way they will re-instate my insurance is if I have the whole roof replaced or recoated. It's a very large house and no way can this be afforded. I'm just trying to find out where I stand.
JA: Anything else you want the Lawyer to know before I connect you?
Customer: I am 69 and my husband is 79 with Alzheimer's Disease. Not that APIA are interested!
Answered by John Melis in 9 hours 2 years ago
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John Melis, Expert

Hi, I’m John, solicitor, and reviewing your post, and may need to ask a few questions a long the way to assist you.

You can seek resolution in the following way and claim compensation as well.

I recommend that you file a claim as soon as possible.

What you need to do is issue a formal complaint in writing to the other party, seeking an assessment/review on the matter, and that you require a response within 7 to 14 days subject to your requirements.

Make sure you enclose al factual evidence you have with the correspondence that you send to the other party.

When you draft this correspondence make sure it is in chronological order that is by listing with numbers example; one, two, three, etc.

The more detail you provide it will assist in resolving the specific matter in a timely way.

Where no response is received and you have reviewed the conditions carefully on the agreement if there are any, and you are still not in satisfied with the situation that is occurring, you can then raise a claim in the Tribunal

​You can manage this process without a lawyer, in your local tribunal, QCAT.

The QCAT process is very good to meditate disputes of this type as it forces the parties to come together to discuss the issues involved.

In most cases at mediation the matter will settle.

You will be the applicant and the other party the respondent.

The important filing document is the points of claim. This document needs to be carefully drafted.

What you need to do is to write the complaint in a chronological order detailing what is the issue and what action you have taken to try and rectify the matter.

The chronological order need to be numbered with points 1, 2, 3, etc. with each point being a separate item. 

I recommend that you download the application first, complete the same and then upload as required to commence the claim.

The following link will assist you further. 

http://www.qcat.qld.gov.au

Would you like to consider this option.

You have a legal right to protect your interests in this important situation.

This link above will assist you in the requirements to complete the application form and there are various help menus on the website that will also assist you in finalising the application that can be submitted in respect of pursuit of your claim.

Before you submit your application, make sure that you have all your evidence in hand as this will be required at the hearing date and to be served on the other party.

Keep in mind that once you have lodged your application you need to serve the application on the other party once instructed by the tribunal.

​Thank you for reaching out today.

You have a legal right to protect your interests in this important situation.

I am a user like you in this chat forum to assist in your important question today.

Thank you kindly for rating me with 5 stars, which helps me support the community.

You can come back to this post any time to ask questions without additional charge.

I hope I have assisted with answering your important question today, and thank you for supporting the community.

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