Insurer Penalized for Mishandling Storm Damage Claim
Insurer Penalized for Mishandling Storm Damage Claim
1
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.
Published:Thursday, 23rd Jan 2025 Source: Paige Estritori
Please Note: If this information affects you, seek advice from a licensed professional.
In a significant development for Australia's agricultural sector, Rural Affinity has renewed its partnership with Munich Re Specialty - Global Markets under a new five-year agreement. This collaboration, which began in 2006, is set to enhance the availability and scope of agricultural insurance products across the country. - read more
WFI Insurance has reported a notable decrease in farm liability claims across most categories, signaling a positive trend in safety practices within the Australian agricultural sector. The insurer observed a 75% reduction in falls from height over the past year, alongside a 30% decline in impact injuries, marking the lowest level in four years. - read more
Elders Insurance is urging Australian farmers to prepare for another damaging summer, with claims data revealing the scale and financial impact of storm activity across the country's agricultural regions. Analysis of storm-related farm insurance property claims over the last two years indicates that summer accounts for the highest number of claims nationally. - read more
Insuregroup, a specialist insurance brokerage serving Australia's transport and logistics sector, has recently achieved a significant milestone by processing over 10,000 insurance policies since its inception. This accomplishment includes a 25% year-on-year increase in policy count, highlighting the escalating demand for comprehensive truck insurance solutions among Australian freight operators. - read more
In a significant move towards regulatory consistency, Queensland has transferred its heavy vehicle compliance responsibilities to the National Heavy Vehicle Regulator (NHVR). This transition aligns Queensland with New South Wales, Victoria, South Australia, Tasmania, and the Australian Capital Territory, all of which have already integrated their heavy vehicle regulations under the NHVR's oversight. - read more
Cyber risk management involves identifying, assessing, and prioritizing potential risks to an organization's digital assets and implementing measures to mitigate these threats. - read more
In today's digital age, understanding the cyber threat landscape in Australia is not just important—it's essential. Cyber attacks are becoming more sophisticated and are affecting businesses and individuals at an alarming rate. Common types of cyber attacks include phishing, ransomware, and data breaches, each with the potential to cause significant harm. The impact of cybersecurity breaches on both the economy and the reputation of affected entities is profound, ranging from financial loss to long-lasting reputational damage. - read more
In today's rapidly evolving cyber landscape, Australian businesses must prioritize data security more than ever before. As companies continue to digitize operations and store sensitive data electronically, the need for robust cybersecurity measures has become paramount. This introduction lays the foundation for understanding the criticality of protecting your company's most valuable asset—its data. - read more
Cybersecurity refers to the measures and practices put in place to protect digital information and systems from attacks, unauthorized access, damage, and disruption. - read more
In today’s digital landscape, Australian companies face an increasing threat from cyber criminals. The paramount importance of cybersecurity has never been more evident, with the surge of incidents exposing the vulnerabilities in organizations' digital defenses. As we usher into an era where data breaches and cyber attacks are commonplace, protecting digital assets becomes a crucial part of doing business. - read more
Knowledgebase
Trauma Insurance: An insurance that pays a lump-sum amount on the diagnosis of one of several critical illnesses or events
