The Australian Financial Complaints Authority (AFCA) intervened, reducing the payout by $56,546. This amount corresponds to the difference the landlord would have owed AIG in premiums to insure a building unoccupied for more than 90 consecutive days — an arrangement the landlord neglected, despite receiving clear directives from a broker.
The landlord, with guidance from their broker, had filed a claim last July after criminals gained access through a leased security gate, prompting AIG to refuse the claim due to the structure’s vacant status, which wasn't covered under the policy.
Prior to the unfortunate event, the broker had made the building owner and managing agent aware of the need to refresh AIG of the vacant situation, potentially affecting claims, and the possibility of acquiring extra coverage by adjusting the premium.
Despite the advice, the owner failed to take action, leading to AIG being notified about the vacancy only post-theft. AFCA indicated that AIG would likely have underwritten the unoccupancy risk had they been told, and determined it fair to authorize the claim — factoring in the supplemental premium and other conditions like an excess charge.
Section 54 of the Insurance Contracts Act became pivotal, with AFCA stating that the breach pertained to not informing the insurer of the decision to leave the property vacant beyond 90 days without seeking written permission — not merely the fact that the premises were left empty.
An AFCA official explained, “I am not of the view that the complainant’s failure to request the insurer’s written consent ... can reasonably be regarded as being capable of causing or contributing to the malicious damage and theft event.”
They emphasized, “The insurer cannot refuse to pay the claim by reason only of the post-contractual act, that is, by reason only of the complainant’s failure to seek its written consent. The insurer is, however, entitled to reduce its liability to the extent that it has been prejudiced.”
AFCA specified that AIG had not proved the extent of its disadvantage equaled its ability to completely dismiss its liability under the policy. Instead, AFCA accepted that the liability compared to the additional premium deemed appropriate if the vacancy had been disclosed.
Arguments suggesting partial occupancy, due to daily visits from a property manager and maintenance by contractors, were rejected, as was the claim that it was unjust to deny coverage because the theft transpired over a weekend when the premises would be unoccupied even if tenanted.
This information originally featured in an article in Insurance News Magazine.
Published:Friday, 1st Nov 2024
Source: Paige Estritori
Mental Health Drives Growing Claims in Insurance Benefits: TAL Insights 10 Dec 2024: Paige Estritori The latest release of data from renowned Australian insurer, TAL, demonstrates the pervasive impact of mental health on insurance claims. Notably, mental health conditions have sustained their status as the leading cause for claims under Income Protection (IP) or Total and Permanent Disability (TPD) covers. - read more |
Missed Insurance Coverage Turns Costly for Long-Time Client 09 Dec 2024: Paige Estritori In a challenging outcome for a long-standing customer, a car owner has faced rejection in his bid for damage compensation after it was established that his insurance coverage had been terminated over five years before the incident. - read more |
Driving App in Focus: Safer Roads Through Tech-Savvy Incentives 09 Dec 2024: Paige Estritori Technology is reshaping how we approach road safety, and AAMI, a subsidiary of Suncorp, has taken a significant leap with its driver-focused rewards program. The initiative has reportedly succeeded in fostering better driving habits among participants. - read more |
Mental Health Claims: A Growing Concern for Young Adults 06 Dec 2024: Paige Estritori Recent findings highlight a significant trend: an increase in Total and Permanent Disability (TPD) claims among 30- to 40-year-olds, with mental health as a key factor. Over the past decade, these claims have soared, the Council of Australian Life Insurers (CALI) reports. - read more |
Bakery Blaze Sparks Allegations of Insurance Fraud 05 Dec 2024: Paige Estritori A bakery owner in Western Australia has been engulfed in controversy following accusations of deliberately setting her business premises on fire. Officials allege this was an attempt to secure a hefty insurance payout. - read more |
Life Insurance Audit: Regular Check-Ups for Your Policy's Health Life insurance serves as a crucial safety net, guarding your loved ones against the unforeseen. Just as you would take care of your health through regular check-ups, it is equally important to ensure that your life insurance policy remains in sound condition to provide the necessary protection. - read more
|
Life Insurance for Young Adults: Why It’s Never Too Early to Get Covered Life insurance might not be at the forefront of your mind, especially when you're young and healthy. However, understanding the essence of life insurance early on can significantly impact your financial future and provide much-needed peace of mind. - read more
|
Understanding the Role of Life Insurance in Your Estate Plan Estate planning is a critical process that often goes overlooked, but it's essential for securing the financial future of your loved ones and ensuring your assets are distributed according to your wishes. It involves the careful organization and protection of an individual’s estate to minimize uncertainties and facilitate the smooth transfer of assets after their passing. While it may seem complex, understanding the basics of estate planning is necessary for every Australian adult, regardless of wealth. - read more
|
Strategies to Use Life Insurance in Funding Shareholder Agreements Shareholder agreements lay the cornerstone for stable business relationships and continuity in Australia. Acting as a contract among business owners, these agreements set forth the expectations, rights, and obligations of all parties involved. They are particularly vital in delineating clear paths for dispute resolution, succession planning, and the transfer of ownership shares under varied circumstances, including the untimely death or departure of a shareholder. - read more
|
Understanding Life Insurance: Coverage Types to Protect Your Loved Ones The importance of life insurance in financial planning: Life insurance isn’t just a policy; it’s a cornerstone of comprehensive financial planning. By protecting your family’s financial future, life insurance offers peace of mind, knowing that your loved ones will be taken care of in the event of your untimely passing. It’s not solely about leaving behind a legacy, but also ensuring that your family can maintain their standard of living, pay off debts, and cover end-of-life expenses without financial burden. - read more
|
Strategies to Use Life Insurance in Funding Shareholder Agreements Shareholder agreements lay the cornerstone for stable business relationships and continuity in Australia. Acting as a contract among business owners, these agreements set forth the expectations, rights, and obligations of all parties involved. They are particularly vital in delineating clear paths for dispute resolution, succession planning, and the transfer of ownership shares under varied circumstances, including the untimely death or departure of a shareholder. - read more
|
Understanding the Role of Life Insurance in Your Estate Plan Estate planning is a critical process that often goes overlooked, but it's essential for securing the financial future of your loved ones and ensuring your assets are distributed according to your wishes. It involves the careful organization and protection of an individual’s estate to minimize uncertainties and facilitate the smooth transfer of assets after their passing. While it may seem complex, understanding the basics of estate planning is necessary for every Australian adult, regardless of wealth. - read more
|
How Much Life Insurance Do You Really Need? A Family's Guide to Assessment Life insurance is one of those cornerstones of financial planning that often gets overlooked. Yet, the importance of life insurance in safeguarding your family's future cannot be overstated. It's a robust financial instrument that provides peace of mind, knowing that your loved ones will be financially secure in the event of your untimely passing. This introductory section lays the groundwork for understanding why life insurance is pivotal in your family's financial health. - read more
|
Understanding Life Insurance: Coverage Types to Protect Your Loved Ones The importance of life insurance in financial planning: Life insurance isn’t just a policy; it’s a cornerstone of comprehensive financial planning. By protecting your family’s financial future, life insurance offers peace of mind, knowing that your loved ones will be taken care of in the event of your untimely passing. It’s not solely about leaving behind a legacy, but also ensuring that your family can maintain their standard of living, pay off debts, and cover end-of-life expenses without financial burden. - read more
|
Life Insurance Audit: Regular Check-Ups for Your Policy's Health Life insurance serves as a crucial safety net, guarding your loved ones against the unforeseen. Just as you would take care of your health through regular check-ups, it is equally important to ensure that your life insurance policy remains in sound condition to provide the necessary protection. - read more
|