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:
| APRA Halts Unjustified Premium Increases in Commercial Auto Insurance 18 Apr 2026: Paige Estritori The Australian Prudential Regulation Authority (APRA) has recently taken decisive action to address significant concerns within the commercial auto insurance sector. In response to widespread industry protests over substantial premium increases, APRA has introduced emergency regulations aimed at safeguarding transport operators from financial hardship. - read more |
| Deloitte Forecasts Transformative Trends in Australian Insurance for 2026 18 Apr 2026: Paige Estritori As the Australian insurance industry navigates a rapidly evolving landscape, Deloitte's 2026 Insurance Predictions report highlights two pivotal trends poised to reshape the sector: the integration of artificial intelligence (AI) and the adoption of advanced climate risk modeling. - read more |
| TAL's Health Sense Plus Now Covers Income Protection Policies 17 Apr 2026: Paige Estritori In a significant development for policyholders, leading Australian life insurer TAL has announced the expansion of its Health Sense Plus program to encompass income protection (IP) policies. Effective from 8 August 2025, this initiative aims to incentivise proactive health management by offering premium discounts to clients who engage in preventative health checks. - read more |
| AFCA Directs Insurer to Reinstate Critical Illness Coverage After Miscommunication 17 Apr 2026: Paige Estritori The Australian Financial Complaints Authority (AFCA) has recently ruled in favour of a policyholder who inadvertently cancelled his critical illness insurance due to unclear communication from his insurer, TAL Life. This decision underscores the critical importance of transparent communication between insurers and their clients, particularly regarding the implications of policy modifications. - read more |
| Navigating Pre-existing Conditions in Income Protection Insurance Income protection insurance is a safeguard that provides individuals with financial stability in the event they are unable to work due to illness or injury. This type of insurance typically replaces a significant percentage of the insured's income, ensuring that their financial commitments can still be met during periods when they cannot earn an income through employment. - read more
|
| Top 5 Reasons to Consider Life Insurance While You're Young When you’re young, life is all about new experiences and making plans for a promising future. While factors like travel, career, and relationships often take centre stage, one aspect often overlooked is life insurance. It might seem like something to consider later in life, but starting a policy while you're young can be a savvy financial move. - read more
|
| Life Insurance for Entrepreneurs: Protecting Your Business and Family Life insurance is a financial product designed to provide a safety net for your loved ones and business in the event of your passing. At its core, life insurance aims to deliver financial protection by paying out a lump sum or ongoing payments to a designated beneficiary upon the insured's death. - read more
|
| Income Protection vs. Total Permanent Disability: Which Is Right for You? Financial security is crucial in today's unpredictable world, where unexpected events can disrupt the stability and comfort of our daily lives. For Australians, protecting one's income and lifestyle from unforeseen circumstances is a key component of personal finance. - read more
|
An insurance carrier may reserve the "right of subrogation" in the event of a loss. This means that the company may choose to take action to recover the amount of a claim paid to a covered insured if the loss was caused by a third party.