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 industry attention on insurance claims handling has put a practical issue back in front of Australian households: a policy is only as valuable as the support it provides when a claim is made. For income protection insurance, that moment often arrives during illness, injury, stress and reduced cash flow, so clear communication and timely assessment matter enormously. - read more
Fresh industry data has again put the spotlight on the financial health of Australia's life insurance sector, with the latest APRA reporting indicating that insurers remain in a more stable position than during the most difficult years of claims volatility and pandemic disruption. For households, however, the important message is not simply whether insurers are profitable. It is whether the cover sitting behind a mortgage, young family, business loan or superannuation account is still suitable, affordable and clearly understood. - read more
Fresh insurance industry concern about underinsurance is especially relevant for Australian farmers as rebuilding and replacement costs remain stubbornly high. While the issue is often discussed in relation to houses, the same pressure applies across rural assets: sheds, fencing, pumps, tanks, grain storage, livestock yards, irrigation equipment and machinery can all cost significantly more to replace than they did when a policy was first arranged. - read more
Following recent complaints data, fresh industry attention on ASICs reportable situations regime is another reminder that professional risk rarely appears without warning. Breach reporting, client complaints, remediation delays and internal control failures can all become early indicators of a larger professional indemnity exposure, particularly for firms that provide financial advice, credit assistance, compliance support, accounting, consulting or outsourced professional services. - read more
Australia’s insurance complaints environment remains a useful warning sign for real estate agencies, particularly those relying on multiple policies across professional indemnity, public liability, cyber, office contents, business interruption and commercial motor cover. Recent dispute trends reported through the financial complaints system continue to show that customers are most likely to become frustrated when claims are delayed, declined, poorly explained or affected by policy exclusions they did not fully understand at the outset. - 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
As the digital economy flourishes, Australian businesses are enjoying the fruits of their own cyber-infrastructure but are also becoming increasingly susceptible to cyber threats. The era of the internet has ushered in a wave of new opportunities, yet it also demands vigilance in the face of growing cyber risks. With cyberattacks becoming more sophisticated and frequent, the imperative for robust cyber security measures has never been more pronounced. - 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 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
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
Knowledgebase
Elimination Period: The time period between an injury and the receipt of benefit payments from an insurer, particularly in disability insurance.
No comments yet. Be the first to share your thoughts.