A Victorian woman has won a payout and been awarded compensation for unusual physical inconvenience and stress in a claim dispute with IAG over sagging ceilings throughout her 13-year old home.

The Australian Financial Complaints Authority (AFCA) said evidence in three reports from a structural engineer relied on by IAG was contradictory and inconclusive and “at best offers several possible causes but makes no definitive findings”.

In contrast, it said expert evidence from an engineer engaged by the homeowner “supports a view that the cause of damage cannot be attributed to one of the relevant exclusions referred to by the insurer”.

IAG was found not to have met its onus to prove that an exclusion for gradual deterioration, wear and tear, structural defects and climatic conditions applied. It was instructed to get an independent repair cost quote and either repair, or cash settle the claim with a 15% allowance on top in line with the terms of the woman’s IAG Accidental Home Insurance policy.

The insurer was also required to cover additional benefits such as temporary accommodation and removal of debris, as well as $1550 in professional costs incurred in pursuing the claim and $2000 non-financial loss compensation.

“The cause of damage noted by the insurer’s expert reports is not clear and contradicts itself,” AFCA said.

“The ongoing delays caused interference with the complainant and her partner’s expectation of enjoyment or peace of mind. The house was unsafe to live in … leaving the complainant confused and unsure on how to approach their claim. The process caused considerable stress.”

Early last year, the woman noticed the dining room ceiling was sagging and square set ceilings in the rumpus room, living room, passage, bathroom and laundry had cracked.

A building consultant inspected the home and identified issues with the trusses. A make-safe was conducted with a prop to the dining room ceiling and she lodged a claim in February last year.

IAG denied the claim, saying the damage was not caused by a single event and while accidental, was due to climatic conditions overtime combined with structural defects - long trusses, insufficient nail support, lack of sarking - that led to the gradual deterioration of nail plates.

AFCA dismissed this, saying the damage most likely resulted from nail plate backout - in which nail plates separate from the parent timber - of no obvious cause.

In a 13-year old house with no building defects, and no faulty workmanship or climatic changes, it was “unlikely such damage would be due to gradual deterioration or wear and tear,” the ruling said.

A third report from IAG’s engineer in November concluded he could not apportion blame to any person for the failure of the trusses and that nail plate backout could not be ruled out as the primary cause.

The trusses were designed to the relevant standards and appeared correctly installed. There had been no roof leaks or any actions by the owner that would have contributed towards the failure of the trusses, he said.

A month earlier, structural engineers acting on behalf of the homeowner found wear and tear was not a significant primary contributor and no design defects in or obvious signs of poor workmanship in the trusses.

AFCA said it was “not persuaded that the insurer has established, on the balance of probabilities, that the exclusions apply to allow it to deny the claim”.

“The insurer’s expert reports outline potential causes but cannot say that any of the suggested causes resulted in the damage,” AFCA said.

“The most recent report confirms there were no building defects. There was no evidence of faulty workmanship. It is unlikely climatic conditions caused the damage.”

AFCA said IAG did not dispute that the home sustained accidental damage and the panel was satisfied the roof problem fell within the terms of the accidental damage policy as it was “unintentional and an unforeseen and uncontrollable event”.

See the full ruling here.