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.
Specialty insurer Newline Group has announced the opening of a new office in Sydney, marking a significant expansion of its Australian operations. This strategic move aims to bring the company closer to its distribution partners and clients in the region, enhancing service delivery and fostering stronger relationships. - read more
Markel Insurance has unveiled a suite of financial institution products specifically designed for the Australian market, featuring localized policy wordings to better address the unique needs of local businesses. This initiative reflects Markel's commitment to providing tailored insurance solutions that resonate with the specific requirements of Australian financial institutions. - read more
A recent survey conducted by KPMG has unveiled a significant shift in the expectations of Australian CEOs regarding office work. The findings indicate that only 22% of those surveyed anticipate a full-time return to the office for corporate employees within the next three years. This marks a substantial decrease from the 82% reported in the previous year, signaling a notable change in leadership perspectives on workplace dynamics. - read more
Insurance Australia Group (IAG) has recently submitted its recommendations to the Federal Parliamentary Joint Committee on Corporations and Financial Services, focusing on the Inquiry into Small Business Insurance. In its submission, IAG outlines how small business insurance operates across its retail and intermediated channels and provides recommendations to support stronger, more sustainable outcomes for small businesses in Australia. - read more
The Australian Securities and Investments Commission (ASIC) has ordered 11 insurance companies to refund a total of $815 million to customers following an investigation into pricing failures and governance issues. The investigation revealed that these insurers engaged in complex and reckless pricing models, lacked appropriate governance systems, and failed to adequately monitor and control their distributors, leading to millions of customers being overcharged. - read more
Data breaches have become a significant concern for businesses in today's digital landscape. Simply put, a data breach occurs when sensitive, protected, or confidential information is accessed, disclosed, or used without authorization. The implications of such breaches can be far-reaching, affecting not just financial health but also the reputation of businesses and the security of individuals involved. - read more
Cyber insurance is a type of insurance designed to protect businesses from internet-based risks and, more generally, from risks relating to information technology infrastructure and activities. It covers losses related to data breaches, cyber extortion, and other kinds of cyber attacks. - read more
In today's digital age, the rising importance of cybersecurity for small businesses in Australia cannot be overstated. As technology permeates every aspect of business operations, it offers tremendous advantages but also exposes small businesses to a growing array of cyber threats. These threats are increasingly targeting small companies, seeking to exploit vulnerabilities and potentially cause significant financial and reputational damage. - read more
As we delve into the digital era, the number of cyber threats that challenge Australian small businesses is significantly on the rise. Cyber attacks have become more sophisticated, frequent, and continue to disrupt the operations of small enterprises, often with devastating consequences. The need to fortify defenses against such threats has never been more paramount. - read more
Cyber insurance is one of the most valuable business covers available today, but it is also one of the most confusing to apply for. Many business owners expect it to work like other insurance types, where you provide basic details such as turnover, industry, and location, then receive a quote. Cyber insurance is different. It behaves less like a simple application and more like a risk interview. - read more
Knowledgebase
Coverage: The amount of risk or liability covered for an individual or entity by way of insurance services.
