Insurer Penalized for Mishandling Storm Damage Claim
Insurer Penalized for Mishandling Storm Damage Claim
The information on this website is general in nature and does not take into account your objectives, financial situation, or needs. Consider seeking personal advice from a licensed adviser before acting on any information.
In a recent development, Auto & General has been instructed to both apologize and compensate a Brisbane property owner with a $2000 payment after an inadequate review of his storm damage claim led to an initial denial of coverage and subsequent policy cancellation.
The homeowner reported his damages following severe storms that hit in February 2022. The insurance company consulted a builder, referred to as PB, to evaluate the property damages.
PB's assessment claimed that the home had pre-existing damage and lacked waterproof integrity. Specific issues highlighted included clogged gutters, cracked and missing roof tiles, and an unconventional roofing method that permitted water intrusion.
According to PB, the storm did not directly damage the roof but worsened existing issues. This led Auto & General to deny the claim and revoke the policy in October 2022, accusing the homeowner of misrepresenting the property's condition as "good" when the policy began and during its renewal.
The homeowner contested the insurer’s stance, arguing that it was unjust. He presented a separate builder’s report, along with written statements and photographs, which demonstrated a lack of prior wall or ceiling damage.
The policyholder attributed the defects cited by PB to partial make-safe work, asserting that the gutters had been regularly maintained prior to the storm. He also mentioned the emergence of storm-induced mold in sections of his home.
While Auto & General did ultimately reverse its initial claim denial and arrange for a cash settlement the preceding October, the Australian Financial Complaints Authority (AFCA) has decreed that the company must retract its claims of disclosure breach and issue a formal apology.
The AFCA identified “multiple erroneous assertions by PB alleging the complainant had neglected to maintain the property appropriately before the storm,” for which the homeowner provided contradicting proof.
The authority’s ombudsman commented, "I am satisfied the complainant reasonably believed that his home was in good condition and waterproof at the time of policy renewal in July 2021. Moreover, I think a reasonable person would agree with the complainant’s evaluation of his home's condition."
They further stated, "I conclude that the complainant did not misrepresent the property's state. Thus, the insurer made a mistake in deciding to cancel the policy."
The insurer has been directed to pay $2000 to cover non-financial losses due to its oversight in investigating the homeowner’s challenges to PB’s report, failure to acknowledge present mould, and incomplete make-safe actions.
The AFCA concluded that Auto & General should have sought a second, independent evaluation of PB’s findings. The resultant protracted claim process subjected the policyholder and his family to undue stress and anxiety.
The original source of this matter was reported by the Insurance News.
Please Note: We do not endorse any specific products or companies. Some content is sourced from third parties, including press releases, and may not be independently verified for accuracy or completeness.
A recent Australian Financial Complaints Authority decision is a timely warning for trade businesses that rely on tools, trailers and mobile equipment every day. The dispute centred on a business that had tools and a trailer stolen from a worksite, then challenged the insurer’s payout after discovering the claim was limited by the portable items section of the policy. - read more
The Financial Advice Association Australia has renewed pressure on the Federal Government to limit Compensation Scheme of Last Resort costs for financial advisers, arguing the profession should not carry more than $20 million in total levy exposure while adviser numbers remain under strain. - read more
Fresh findings from the Insurance Brokers Code Compliance Committee have added another layer to Australia’s continuing strata insurance transparency debate. The committee’s review of strata broker-agent arrangements examined seven brokers collectively connected to one thousand and eighty-eight strata representatives, and resulted in nine formal breach determinations. Two brokers were also referred to ASIC for consideration of conflict management issues. - read more
Australia’s commercial insurance market is entering a more nuanced phase. While headline pricing indicators suggest conditions are easing for many business customers, a recent Insurance Business Australia report highlights a shift away from the old idea of one broad insurance cycle. Instead, pricing is increasingly being assessed by product line, geography, occupation, claims history and the quality of each risk submission. - read more
Australia’s winter school holiday rush has put travel insurance back in the spotlight, with families heading to Bali, Fiji and Thailand, skiers travelling to New Zealand and domestic holidaymakers chasing either snow or sunshine closer to home. But this year’s peak period is unfolding against a more unsettled backdrop: geopolitical tension, airspace closures, airline disruption and a growing expectation that insurers should do more than reimburse costs after the event. - read more
Life is an unpredictable journey filled with twists and turns that can challenge even the most prepared among us. Sudden illnesses and unexpected injuries are just some of the uncertainties that can disrupt the harmony of family life. The emotional turmoil brought on by these circumstances is often compounded by the financial strain they can cause. It's during these trying times that the true value of peace of mind becomes clear. - read more
Single parenting brings with it a mosaic of responsibilities and challenges, not least of which is securing a stable financial future for your child. The rollercoaster of raising a child alone often means that planning for the future can take a back seat to the day-to-day demands of parenting. Unexpected illnesses and injuries can compound these challenges, causing stress to multiply and plans to go awry. - read more
Financial security for families is an essential consideration in any household. Life can be unpredictable, and ensuring that your loved ones are protected from financial hardship in your absence is a critical part of financial planning. - read more
Life insurance is a critical component of a sound financial plan. It provides financial security and peace of mind to you and your loved ones, ensuring that they are taken care of in the event of your untimely death. - read more
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
Knowledgebase
Loss of Use: Insurance coverage that pays for the additional living expenses if your home is uninhabitable due to a covered loss.
No comments yet. Be the first to share your thoughts.