Pre-existing damage and lack of maintenance: the insurer’s most common excuse to avoid payment (and how to dismantle it)

When an insurance company wants to close a claim without covering the actual cost of the loss, two phrases come up time and again:

“That damage was already there.”

“That's due to lack of maintenance.”

To many policyholders, these phrases sound definitive. In practice, they are not.

In fact, a significant portion of the claims that reach our team are already denied or blocked for this reason, and in many cases, they are no longer blocked when the claim is technically reviewed.

This article explains what these concepts really mean, when they can be applied, when they cannot, what the law says, and why appointing an independent expert often completely changes the situation.

The problem isn't the damage, but how it's classified

Most policyholders believe the discussion revolves around whether the damage exists or not. In reality, the core of the conflict is usually how that damage is classified.

Insurers use the concepts of:

• Pre-existing damage
• Wear and tear
• Age
• Lack of maintenance

As exclusion tools, although they are not always properly justified.

This is where many claims are lost… not because there is no coverage, but because no one has technically constructed a defense against the damage.

What is pre-existing damage (and what isn't)

Pre-existing damage is damage that:

• Existed before the reported loss
• Has no causal relationship with the sudden event
• Can be objectively proven

It is not:

• An old item
• Used material
• A system with years of service
• An asset with normal wear and tear

Age is not pre-existing damage.

Use is not pre-existing damage.

For an insurer to exclude an item due to pre-existing damage, it must prove it, not simply assert it.

This point is key from a legal perspective.

Lack of Maintenance: When It's Valid and When It's Used as an Excuse

Lack of maintenance is another frequently used exclusion, especially in:

• Water damage
• Leaks
• Installations
• Machinery
• Roofs and downpipes

However, not everything that fails is due to lack of maintenance.

From a technical and legal standpoint, it's necessary to distinguish between:

• Actual and proven lack of maintenance
• Normal wear and tear
• Subsequent failure
• Aggravation of damage after an incident

In many cases we analyze, the insurer doesn't prove the lack of maintenance: they simply mention it.

And that isn't enough.

What the Insurance Contract Law Says

The Insurance Contract Law establishes very clear principles that are often forgotten in these cases:

• Exclusions must be clear, specific, and explicit.

• The burden of proof for an exclusion lies with the insurer.

• The claim must be analyzed according to its efficient cause, not conjecture.

This means that it is not enough to say:

“That was already there”

or

“That's maintenance”

It must be proven technically and legally.

When that proof does not exist, the exclusion is debatable and, in many cases, contestable.

Why these denials stand… until someone enters the file

This is where real-world experience comes in.

We have seen hundreds of cases in which:

• The insured accepts the explanation

• The case is closed

• Or it remains blocked for months

And we have also seen the opposite.

When a member of our team is formally appointed as a party expert, something very specific happens:

• Technical justification of the “pre-existing damage” is required.
• Objective proof of the “lack of maintenance” is requested.
• The actual cause of the loss is analyzed.
• The policy coverage for the damage is reconsidered.
• Reports, photographs, and the timeline are reviewed.

In many of these cases, what was a denial is no longer a denial.

Not because a new coverage appears, but because:

• The exclusion was not correctly applied.
• The damage was misinterpreted.
• Or the case had been closed due to inertia.

Common cases where this argument is misused

Without going into names or addresses, these are very frequent scenarios:

• 🔥 Fires

“The wiring was already old.”

→ Degraded thermal insulation is not maintenance, it is thermal damage.

• 🌊 Floods and DANA

“The dampness was already there”

→ Subsequent structural dampness is not pre-existing if there is a change in condition.

• 🏠 Homes

“The floor was deteriorated”

→ Wear and tear does not imply unusability or loss of function.

• 🏭 Businesses

“The machinery was already used”

→ Use does not equate to prior damage or automatic exclusion.

We have also analyzed many of these cases from an expert perspective: Undervalued claims: why they happen and how to correct them

The direct relationship with blocked claims

When an insurer uses the argument of pre-existing damage or maintenance, one of two things usually happens:

• They deny the claim outright
• Or they leave the claim "under review" indefinitely

This silence is not accidental.

We explain it in detail here: The insurance company doesn't respond and the claim is stalled

Why appointing an independent expert changes the outcome

An independent expert doesn't "argue" with the insurer.

It does something much more effective:

• It technically organizes the file
• It redefines causality
• It demands proof of exclusions
• It documents the evolution of the damage
• And it translates the problem into technical and contractual language

This forces the insurer to:

• Review reports
• Justify positions
• Or rectify

That's why many denials become untenable when the file is handled correctly.

Here we explain when it makes sense to do so: When to hire an expert in a claim

The insured's mistake: accepting the explanation without analyzing it

Most people don't give up because "they're wrong," but because:

• The technical language is intimidating
• The process is exhausting
• No one explains alternatives
• And they believe that "nothing more can be done"

In many cases, something more can be done.

What to do if your insurance company claims pre-existing damage or lack of maintenance

Before accepting a denial:

• Check if the exclusion is actually in the policy
• Check if there is technical proof of the pre-existing damage
• Analyze the cause of the loss
• Document the progression of the damage
• Consider an independent review

We explain the complete process here: Home and business damage: how to file a correct insurance claim

Conclusion

“Pre-existing damage” and “lack of maintenance” are legitimate arguments only when proven.

When used generically, without a technical or legal basis, they should not close a claim.

Our experience shows that many cases that seemed lost turn completely around when analyzed with technical expertise, legal knowledge, and a clear strategy.

Does your insurance claim say the damage was already there or that it's maintenance?

We review claims that were denied, blocked, or closed for these reasons and analyze whether the exclusion is truly valid.

In many cases, what appeared to be a denial isn't.

Review my claim