Insurer Must Pay After Unfounded Fraud Allegations
Insurer Must Pay After Unfounded Fraud Allegations
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.
A leading insurance company has been ordered to cover a fire damage claim submitted by a policyholder who passed away from cancer two years ago, highlighting the consequences of unjust fraud accusations.
The claim was initially submitted in January 2022 for damage incurred to the man’s remote metal home in New South Wales. The insurer denied the claim on the grounds that the property was fraudulently misrepresented in terms of its status and functionality.
The policyholder, under heavy medication due to his illness, was questioned by the insurance company’s investigators. Unfortunately, he passed away roughly five months following the submission of the insurance claim. His estate's executor took over the complaint afterwards.
Recently, the Australian Financial Complaints Authority (AFCA) determined that the insurer, IAG, did not provide adequate evidence showing that the policyholder had breached his disclosure commitments. Thus, they must honour the claim.
According to AFCA, “Even if there had been a breach, the insurer has not convincingly shown that it resulted in the renewal of the policy when it would not have been otherwise. Thus, it is fair that the insurer accepts the claim.”
AFCA pointed out that IAG did not submit a declaration from its underwriters to either prove it would not have undertaken or renewed the policy. Despite cautions regarding potential adverse inferences, the insurer failed to provide necessary documentation on its underwriting practices pertaining to this case.
Originally, IAG contended that the policyholder had wrongly described the condition of his property upon policy initiation in October 2019, claiming it was watertight, structurally sound, secure, well-maintained, and inclusive of functional kitchen and bathroom facilities, and specifying its construction date as approximately 2019.
The policy contained a clause explicitly stating, “We don’t insure buildings under initial construction.”
AFCA’s investigation found that, as of the relevant policy renewal date in October 2021, the property's construction was completed, and it had been continuously occupied for over a year, meeting structural and maintenance codes.
“Each renewal constituted a new insurance contract,” the ombudsman declared.
Moreover, AFCA emphasized that the allegation of fraud, which carries grave implications, wasn’t sufficiently supported given that for a misrepresentation to amount to fraud, it must be made either knowingly or recklessly.
EVEN if I had determined that the policyholder breached the disclosure duty-which I have not-the insurer did not provide necessary proof to show it would not have entered the 2021-22 policy period without the alleged breach,” AFCA noted.
In their ruling, AFCA also highlighted the insurance contract and product disclosure statements omitted critical information regarding the duty to avoid misrepresentation, relevant disclosure duties, or consequences of any such breaches.
For more information on the ruling, it can be reviewed here.
This article has been adapted from one originally published by Insurance News Magazine.
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.
The National Heavy Vehicle Regulator’s latest focus on agricultural heavy vehicle safety is a timely reminder for farm, livestock, grain and regional freight operators: safety standards are not just a compliance issue. They can also shape claims outcomes, business interruption, liability exposure and future access to affordable truck insurance. - read more
Allianz Australia has refreshed its farm pack insurance, with the updated product announced on 20 July 2026. For farmers and rural property owners, the significance is less about one insurer changing a product and more about what it signals across the broader farm insurance market: insurers are trying to make cover easier to understand while adjusting policy features to better match modern farming operations. - read more
Fresh analysis of APRA’s latest National Claims and Policies Database has added useful detail to the current professional indemnity insurance conversation. The database, released in early July 2026, covers professional indemnity, public liability and product liability policy and claims information, giving insurers, brokers and business owners a clearer view of how different parts of the liability market are moving. - read more
The debate over Australia’s draft Insurance Brokers Code of Practice has intensified, with industry and consumer voices questioning whether the proposed changes go far enough on remuneration disclosure and conflict management. For real estate agencies, the issue is not abstract. Many agencies rely on intermediated advice when arranging professional indemnity, public liability, management liability, cyber cover, office insurance and commercial motor policies. - read more
A recent Australian travel insurance case has offered a sharp reminder that the most expensive travel risk is often the one no traveller expects. According to Finder, an Australian woman who became seriously ill while 19 weeks pregnant in Mallorca faced medical costs of more than $40,000 after being taken to hospital by ambulance. The ambulance component alone reportedly reached $12,000, with the remaining costs linked to hospital admission, testing and treatment. - read more
There's often confusion surrounding the amount of life insurance one truly needs. Common misconceptions cloud our judgment, leading some to undervalue their coverage, while others may overinsure, unnecessarily straining their financial resources. It is a delicate balance to strike, and understanding the nuances of life insurance is pivotal to making informed decisions. - read more
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
Navigating the complex world of insurance can often feel daunting, but understanding the importance of life stage consideration when choosing life insurance is essential. As we journey through the various chapters of our lives, our financial responsibilities, dependents, and personal circumstances evolve. These changes invariably have significant implications for our insurance needs. - read more
Life insurance is a financial product designed to provide a safety net for your loved ones and business in the event of your passing. At its core, life insurance aims to deliver financial protection by paying out a lump sum or ongoing payments to a designated beneficiary upon the insured's death. - read more
Defining life insurance and its importance: Life insurance is a pivotal financial product designed to protect your loved ones from economic hardship in case of your untimely death. It acts as a safety net, ensuring that your family can maintain their standard of living, cover outstanding debts, and afford future expenses like education and retirement. - read more
Knowledgebase
Proximate Cause: The primary cause of loss in an insurance claim, which sets in motion a chain of events leading to the damage or injury.
No comments yet. Be the first to share your thoughts.