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.
The Australian Medical Association (AMA) has intensified its call for comprehensive reforms in the private health insurance sector, particularly in response to the recent 4.41% average premium increase effective from April 2026. This hike, the largest in nearly a decade, has raised concerns about the affordability and value of private health coverage for Australians. - read more
The Australian government has introduced legislation to prohibit the practice known as 'product phoenixing' within the private health insurance sector. This move aims to enhance transparency and fairness for consumers by preventing insurers from closing existing policies and reintroducing nearly identical ones at higher premiums. - read more
HCF, Australia's largest not-for-profit health fund, has announced the extension of its major partnership with Netball Australia and Super Netball, continuing as the sport's official health insurance partner through to the end of 2027. This renewal underscores HCF's dedication to improving the health and wellbeing of Australian women by supporting netball at all levels-from grassroots participation to elite competition. - read more
Recent analysis by consumer advocacy group CHOICE has revealed that Australians holding gold-level health insurance policies may face premium increases of up to 25% starting in April 2026. This substantial hike significantly exceeds the average 4.41% increase approved by the government for private health insurance premiums. - read more
Instanda, a leading provider of insurance technology solutions, has unveiled an artificial intelligence (AI) system designed to revolutionize commercial underwriting. This innovative system addresses the longstanding challenge of balancing speed and accuracy in the underwriting process, a critical aspect for consultants seeking efficient and reliable insurance coverage. - read more
Remote work has seen a significant rise in Australia, especially following the COVID-19 pandemic. More businesses are embracing flexibility, allowing employees to work from home or other remote locations. - read more
Cybersecurity incidents are a growing concern for small businesses. These incidents can have disastrous consequences on the affected businesses and their customers. Cyber insurance policies provide a form of financial protection for small businesses in the event of a cyber-attack. This article will provide an overview of cyber insurance claims and its importance for small business owners. - 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
Cyber insurance, also known as cyber liability insurance, is a type of coverage designed to protect businesses from the financial repercussions of cyber attacks and data breaches. As cyber threats become more sophisticated, the need for a safety net to mitigate the impact of such incidents has grown significantly. - read more
Knowledgebase
Replacement Cost: The amount it would cost to replace or rebuild an insured asset with one of similar kind and quality, without depreciation.
