If You See These Words in Your Insurer’s Expert Report, Watch Out...

“Environmental mould”

This term is often used as a broad label to define mould caused by humidity, condensation, or poor ventilation. 

However, in most reports we see, “environmental mould” is asserted based on assumptions, by unqualified experts, or without consideration of how the insured event (such as water ingress from a storm, burst pipe, or flood) and subsequent make-safe actions (or inactions) may have created the conditions for mould growth. 

The industry has adopted this term broadly, but the rationale and science supporting the conclusion is often lacking. 

“Not to code”

The phrase “not to code” is frequently used in reports to justify limiting the scope of works or to support a cash settlement based on a narrow or incomplete scope. 

In practice, this wording can be used as a shortcut. Rather than preparing a scope of works that would allow proper reinstatement of the damaged areas, the report may point to alleged non-compliance with current building standards (but not with standards at the time the works were done), helping insurers to avoid organising repairs and offer a cash settlement instead. 

This can leave customers with a cash offer, based on a scope the insurer themselves said they can’t do, at rates no builder would ever take on, due to an alleged ‘defect’ which has not been proven. 

“Pre-existing damage”

Pre-existing damage is a legitimate concept, but it is often raised in a way that overreaches. 

For example, in many cases, undamaged or pre-existing components must be disturbed, removed, or reinstated as part of accessing and repairing the insured damage.

The relevance of pre-existing damage depends on how the repair actually needs to be carried out, not just on whether the item was in perfect condition before the event.

“Unrelated to a single event”

Insurance policies often respond to single, one-off events such as storms, impacts, bursts, or accidents. Expert reports sometimes rely heavily on the phrase “unrelated to a single event” to suggest that damage must be excluded. 

The reality is rarely that simple. Buildings are complex systems. Damage may develop over time but still be triggered, accelerated, or materially worsened by a specific insured event. Cracking, water ingress, and mould, for example, can involve both pre-existing vulnerabilities and a sudden event that causes the actual loss.

Where a report asserts that damage is “not related to a single event,” it is worth checking it the report explains how the expert ruled out the insured event as a contributing cause, particularly where the damage appeared or worsened after the event occurred. 

“Poor housekeeping” or “poor maintenance”

These terms are often used to characterise the condition of a property in a way that reflects poorly on the homeowner, rather than focusing on the actual cause of loss. 

While maintenance can be relevant in some claims, it is frequently raised in a generalised way. Reports may refer to clutter, cleanliness, or general upkeep without clearly linking those observations to the specific damage being assessed. This can subtly shift the narrative away from the insured event and toward the conduct of the homeowner, even where there is no clear causal link. 

In some cases, references to housekeeping or maintenance appear to be used more as colour commentary than as evidence-based findings that are directly relevant to the claim decision.