Insurer Penalized for Mishandling Storm Damage Claim
Insurer Penalized for Mishandling Storm Damage Claim
1
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.
Published:Thursday, 23rd Jan 2025 Source: Paige Estritori
Please Note: If this information affects you, seek advice from a licensed professional.
Insurance Australia Group (IAG) has revised its annual profit forecast upwards by $100 million, attributing this positive adjustment to the recent acquisition of RACQ Insurance. The company now anticipates a reported insurance profit ranging between $1.55 billion and $1.75 billion for the current financial year, an increase from the previous estimate of $1.45 billion to $1.65 billion. - read more
Envest Group, a prominent entity in the insurance sector, has announced the launch of TLI Underwriting, a specialized heavy motor agency set to commence operations at the end of this month. This new venture is poised to cater specifically to the insurance needs of larger truck fleets, marking a significant expansion in Envest's service offerings. - read more
A recent report backed by the National Transport Insurance (NTI) has shed light on the predominant causes of major truck accidents in Australia, revealing that human error remains the leading factor. The findings underscore the critical need for enhanced safety measures and driver training within the transport industry. - read more
Insurance Australia Group (IAG), a leading insurer in the Australian market, has recently raised concerns about the escalating impact of climate change on home insurance premiums. The company warns that Australians should anticipate rising costs, attributing this trend to the increasing frequency and severity of weather events driven by climate change. - read more
The Australian insurance industry is facing mounting challenges as it falls behind international counterparts in preparedness levels, according to the latest PwC Insurance Banana Skins Survey. The findings come at a time when Australian insurers are grappling with multiple simultaneous threats ranging from digital security concerns to regulatory pressures and affordability challenges. - 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
In today's digital age, businesses are increasingly becoming more vulnerable to online threats. Cyber attacks are not just limited to large corporations. Small businesses are also at risk and can suffer severe financial losses due to cyber threats. It is essential for small businesses to invest in cyber insurance. Cyber insurance offers protection against online threats, providing financial assistance if a company experiences a data breach, cyber attack, or other forms of cybercrime. - 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
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
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
Endorsement: An amendment or addition to an existing insurance policy that changes the terms or scope of the original policy.
