Insurer Penalized for Mishandling Storm Damage Claim
Insurer Penalized for Mishandling Storm Damage Claim
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
Share this news item:
| Understanding AustralianSuper's Income Protection Reduction 16 Apr 2026: Paige Estritori AustralianSuper, one of Australia's largest superannuation funds, has announced a significant change to its default income protection insurance. Effective from 28 February 2026, the fund will reduce the default income protection cover to $1,000 per month. This adjustment aims to align insurance coverage with members' actual income levels and prevent over-insurance, which can erode retirement savings. - read more |
| CareSuper Enhances Income Protection Benefits for Members 16 Apr 2026: Paige Estritori CareSuper has announced an enhancement to its income protection insurance offerings. Starting 1 April 2026, members can apply for income protection cover up to 87% of their current income, including up to 12% super contributions. This is an increase from the previous limit of 85% of income, which included up to 10% super contributions. - read more |
| APRA Enhances Capital Requirements for Sovereign Insurance Australia 16 Apr 2026: Paige Estritori The Australian Prudential Regulation Authority (APRA) has recently mandated an additional capital requirement of $2 million for Sovereign Insurance Australia Pty Ltd. This directive is part of APRA's ongoing efforts to bolster the financial stability and resilience of insurers operating within Australia. - read more |
| Europ Assistance Australia Enters Market with APRA's Approval 16 Apr 2026: Paige Estritori The Australian Prudential Regulation Authority (APRA) has granted a new general insurance licence to Europ Assistance Australia, marking the company's official entry into the Australian insurance market. This development introduces additional competition and diversity within the sector. - read more |
| How to Compare Income Protection Policies When You Have a Medical History In today's ever-changing world, financial security is a cornerstone of peace of mind, particularly for Australians grappling with medical histories. Income protection insurance emerges as a pivotal solution, safeguarding not only the individual’s fiscal health but the well-being of their dependents. This introduction explores the nuances of income protection insurance and its particular significance for those with pre-existing medical conditions. - read more
|
| The Myth of Unaffordability: How to Find Value in Income Insurance Policies Income protection insurance is often surrounded by the myth of being unaffordable, deterring many Australians from safeguarding their most valuable asset—their ability to earn. This introduction aims to address this misconception head on, revealing the real value that income insurance policies can provide. It is crucial to understand that the cost of such a policy pales in comparison to the potential financial hardship faced without one. - read more
|
| Tax Deductions and Income Protection: Maximizing Your Benefits When life throws unexpected health challenges your way, having a solid plan to protect your income is crucial. Income protection insurance is designed to provide financial support if you're unable to work due to illness or injury, allowing you to focus on recovery without the added stress of financial burden. - read more
|
| How to Compare Life Insurance Policies in Australia Without Overpaying Life insurance stands as a pillar of financial stability in the lives of many Australians, providing peace of mind and security for families and individuals facing the uncertainty of the future. The importance of life insurance cannot be overstated; it offers a safety net that serves to protect your loved ones in the event of a tragedy, ensuring their financial well-being during difficult times. - read more
|
The person or entity designated to receive the death benefit from a life insurance policy.