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.
Australia’s mandatory climate-related financial disclosure regime is moving from policy discussion into practical reporting, and consultants who support sustainability, governance, risk, data, finance or transformation projects should pay close attention. The rules initially apply to larger entities, but their impact is likely to spread through procurement, due diligence and supply chain expectations. - read more
Australia’s latest building approvals commentary has again highlighted a difficult reality for the construction sector: the national housing task is ambitious, but the project pipeline remains uneven. Industry groups have pointed to approvals volatility, planning delays and capacity constraints as continuing barriers to lifting housing supply at the pace governments want. - read more
NSW’s move to redesign the way emergency services are funded has put business insurance affordability back in focus. For personal trainers, bootcamp operators and small studio owners, the issue is more practical than political: when statutory charges are added to premiums, cover can become harder to maintain at the level a growing fitness business actually needs. - read more
The latest monitoring of Australia’s cyclone reinsurance pool has again highlighted a key reality for households and small businesses in cyclone-exposed regions: government-backed premium relief can help, but it does not remove the need to check whether cover is suitable, affordable and realistically sized for the risk. - read more
Fresh industry claims data has put a timely spotlight on the role life insurance continues to play for Australian families, workers and business owners. While premiums and affordability often dominate the conversation, the latest sector snapshot is a reminder that life cover is ultimately tested at claim time, when a death, serious illness, disability or extended inability to work can quickly become a financial shock. - 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
Cyber risk management involves identifying, assessing, and mitigating risks related to digital and online threats. These threats can include unauthorized access to sensitive information, data breaches, and other malicious activities targeting an organization’s digital infrastructure. - read more
In an age where digital presence intertwines with daily operations, the threat landscape in Australia has magnified, exposing businesses to an evolving array of cyber threats. From sophisticated phishing attempts to ransomware attacks, the risk of digital insecurity looms large. Australia, with its growing technological adoption, finds itself facing an upsurge in cyber threat incidents year over year. - 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 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
Insurance Deductible: the amount that an insured is required to contribute toward an insurance claim as stipulated in an insurance policy. Otherwise known as the "policy excess".
No comments yet. Be the first to share your thoughts.