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.
Recent transport industry coverage has again highlighted regulator attention on heavy vehicle roadworthiness, with roadside checks, defect management and maintenance systems remaining central safety themes for Australian operators. For trucking businesses, the message is not limited to avoiding fines or delays. Roadworthiness can also influence how insurers view risk, how smoothly a claim progresses and whether policy conditions have been met after an incident. - read more
Australia’s engineered stone ban and continuing regulator focus on silica exposure are more than a workplace safety issue for builders, renovators, tilers, stonemasons, plumbers, electricians and demolition contractors. They also create a practical insurance checkpoint for any trade business that cuts, drills, grinds, removes or works around dust-generating materials. - read more
Fresh motor insurance commentary across the Australian market is again pointing to a practical issue truck operators know well: repairing vehicles is becoming more complex, more expensive and, in some cases, slower. For heavy vehicle businesses, this is not just a workshop problem. It can influence claim outcomes, renewal pricing, excess settings and the amount of time a truck is off the road after an incident. - read more
Recent complaints data from the Australian Financial Complaints Authority has again highlighted a pressure point that matters to rural Australia: insurance claims can become difficult when expectations, policy wording and evidence do not line up. While the figures cover the wider insurance market rather than farms alone, the themes are highly relevant for agricultural businesses dealing with storm damage, fire losses, machinery failures, fencing repairs or interrupted operations. - read more
Fresh industry attention on ASIC's expectations for compensation arrangements is a timely reminder that professional indemnity insurance should not be treated as a once-a-year renewal task. For Australian professionals who provide advice, compliance support, financial services, consulting, design, technology or outsourced business services, the adequacy of cover depends on how closely the policy matches the work actually being performed. - read more
In today's digital landscape, Australian small businesses face a myriad of cyber risks that can threaten their operations and financial stability. From sophisticated phishing scams to debilitating hacking attacks, the need to safeguard against such digital threats has never been more pressing. This introductory guide serves to illuminate the complexities of the cyber risk environment within Australia, focusing on the small business sector's unique vulnerabilities. - read more
Many cyber insurance policies operate on a claims-made basis, which means timing can affect whether a cyber incident is covered. This guide explains policy periods, notification, retroactive dates, known circumstances and continuity of cover for Australian businesses reviewing cyber insurance wording. - 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
In today's digital environment, Australian businesses need practical cybersecurity protocols to help protect sensitive data, digital assets and networks. Phishing, ransomware and data breaches can disrupt operations, create financial loss and damage reputation, so cybersecurity should be treated as an ongoing business discipline rather than a one-off technology task. - 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
Knowledgebase
Claim Adjuster: An insurance professional who investigates and evaluates insurance claims to determine the amount the insurance company should pay.
No comments yet. Be the first to share your thoughts.