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.

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.

Published:Wednesday, 3rd Jul 2024
Author: Paige Estritori

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.

Share this news item:

Insurance News

Clear

Could AI Speed Up Heavy Vehicle Repair Claims?

23 Jul 2026: Paige Estritori

Australian smash repair insurtech DingGo has introduced an AI platform designed to produce rapid crash repair estimates from vehicle photos, adding another signal that claims technology is moving quickly across the motor insurance sector. Its Crash Intelligence AI tool uses a large dataset of completed Australian repairs to estimate likely repair costs, with the company positioning it for dealer groups, independent repairers and panel shops. - read more

What Genetic Testing Reform Could Mean for Life Insurance

22 Jul 2026: Paige Estritori

Australia’s life insurance sector is preparing for a significant shift in how genetic test information may be treated during applications. The Federal Government has been moving towards stronger restrictions on insurers using adverse predictive genetic test results when assessing life insurance, a change designed to reduce fears that medical insight could later become a financial disadvantage. - read more

Why rural heavy vehicle safety matters for insurance

22 Jul 2026: Paige Estritori

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

Why Lithium Battery Fire Risk Matters for Tradies

22 Jul 2026: Paige Estritori

Lithium-ion batteries are now part of everyday trade work. They power cordless tools, site lighting, testing equipment, drones, portable power stations and, for some electricians and solar installers, the systems being installed for customers. A fresh insurance industry analysis has again highlighted why this technology is not just a convenience issue, but a serious risk management issue for businesses. - read more

Why the Simple Advice Push Matters for Your Cover

22 Jul 2026: Paige Estritori

Australia’s life insurance sector has renewed its push for consumers to receive simpler help with the cover they already hold, particularly through superannuation. The Council of Australian Life Insurers has again argued that many people need clearer, more accessible guidance about insurance inside super, including death, disability and, where available, income protection insurance. - read more

Click for more Insurance News