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.
A fresh review of Australia’s cyclone reinsurance pool has put insurance access and affordability back in the spotlight for communities and small businesses across northern Australia. The pool was designed to reduce pressure on premiums for cyclone and cyclone-related flood damage by giving insurers access to government-backed reinsurance. - read more
Recent industry reporting has put renewed attention on how artificial intelligence and automated decision-making are being used across insurance. For life insurance customers, the issue is not whether technology is good or bad. It is whether faster systems are being used in ways that remain fair, explainable and properly supervised. - read more
Tax treatment of business-owned life insurance is again attracting attention as accountants and advisers work through year-end planning with SME clients. The central message is not new, but it remains widely misunderstood: business life insurance is not treated as one simple tax category. The purpose of the cover, who owns the policy and how any claim proceeds are intended to be used can all affect the outcome. - read more
Australia’s life insurance sector is again focusing on the advice gap, with industry bodies and policy participants continuing to press for reforms that could make practical insurance guidance easier for consumers and businesses to access. The debate sits within the Federal Government’s broader financial advice reform agenda and is particularly relevant for business owners who need cover that is both affordable and properly structured. - read more
Recent industry reporting has again put Australia’s life insurance protection gap in the spotlight, with the life insurance sector warning that too many households and businesses remain exposed if illness, injury or death removes a major income source. While much of the public discussion focuses on families, the same issue applies to companies that depend heavily on a founder, director, rainmaker or technical specialist. - read more
As we dive deeper into the digital era, the topic of cyber security becomes increasingly critical. With businesses and individuals relying heavily on digital technologies, the threat of cyber attacks looms larger than ever. This introductory section aims to unpack the concept of cyber insurance as a tool to mitigate these risks. - 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
Australian businesses that experience a data breach may need to assess whether the Notifiable Data Breaches scheme applies, notify the OAIC and affected individuals, report cybercrime through ReportCyber, and carefully document their response. This guide explains the key notification and reporting steps in general terms, and how cyber insurance may support breach response planning. - 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
In this digital age, online liabilities have become a crucial concern for individuals and businesses alike. At its core, an online liability refers to the potential risks and responsibilities associated with using the internet. These risks can range from data breaches to financial theft, and they have significant implications in our increasingly connected world. - read more
Knowledgebase
Underwriting: The process by which an insurer determines the risk of insuring a client and decides the terms of coverage.
No comments yet. Be the first to share your thoughts.