The Australian Financial Complaints Authority (AFCA) has ruled Suncorp does not have to cover a $50,000 fee paid by policyholders to someone they engaged to assist with a home storm damage claim after they were dissatisfied with the insurer’s response.

The property owners argued the fee was covered by the “other repair/rebuilding costs” policy section, which pays for “reasonable and necessary” expenses for the services of professionals, “such as architects or surveyors”.

Engaging the project manager, described as “N” in the AFCA report, was necessary because the insurer and its nominated builder were not adequately handling the hail storm rectification, the complainants said.

Invoices of services provided included meeting with contractors on-site, reviewing and analysing assessments and roofing reports and communicating with the insurer about “failings by their builder and builder’s contractors”.

AFCA says the policy covers services that can only be provided by those with specific professional training and qualifications, and the complainants would need to show the project manager’s services could only have been performed by a professional of his skills and experience.

An insured would be expected to be able to liaise with contractors and insurers and be capable of reviewing quotes and scopes.

“There is no evidence to show these particular complainants were incapable of doing these activities,” the AFCA adjudicator says.

“I appreciate N’s engagement assisted them in managing these tasks, and reduced the stress associated with this type of claim, however I do not accept this shows, or means, it was both reasonable and necessary for them to engage a professional in N’s field to complete these activities.”

AFCA supported adding a 10% contingency to the building cash settlement, which equalled an extra $12,317, rather than a proposed additional 15% in a preliminary assessment.

The insurer offered to contribute $7,390.14 toward the project manager’s fee, which AFCA said was fair, and the determination backed a case manager decision to award $3000 for non-financial loss.

AFCA heard the male homeowner suffered a back injury after having to seal cracks and lay and weigh down tarps to prevent further damage, while the complainants say their physical health and safety were compromised, as well as their mental health.

“I agree with the case manager that the complainants have suffered an unusual degree of inconvenience and stress in the early stages of the claim,” the decision says.

Click here for the ruling.