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:
| Australian Life Insurers Report Significant Profit Increase in June 2025 Quarter 26 Dec 2025: Paige Estritori The Australian life insurance sector has reported a substantial after-tax profit of $360 million for the June 2025 quarter, marking a significant increase from the $116 million recorded in the same period the previous year. This impressive growth is primarily attributed to a sharp rise in investment income and improved underwriting performance across key product lines. - read more |
| Rising Mental Health Claims Impact Australian Life Insurance Industry 26 Dec 2025: Paige Estritori The Australian life insurance industry is witnessing a significant surge in mental health-related claims, reflecting broader societal challenges and increasing awareness of mental health issues. AIA Australia, a leading life insurer, has reported that mental health claims now account for 23% of its total claims, up from 15% in 2014. This trend underscores the growing prevalence of mental health conditions and their impact on individuals' ability to work and maintain financial stability. - read more |
| Decline in Australian Life and Income Protection Insurance Premiums 26 Dec 2025: Paige Estritori Recent data indicates a notable decline in life and income protection insurance premiums across Australia, providing consumers with more affordable coverage options. According to the latest Direct Life Insurance Report from Rainmaker Information, direct life premiums have decreased by 7% since 2024. Similarly, direct income protection premiums have seen significant reductions, with average premiums for waiting periods of 30 days and 90 days decreasing by 12% and 13%, respectively. - read more |
| Club Marine Marks 65 Years of Leadership in Australian Boating Insurance 26 Dec 2025: Paige Estritori Club Marine, Australia's largest recreational boat insurer, is celebrating its 65th anniversary in 2024. Since its founding in 1959 as Marine Hull & Liability, the company has grown from a small operation in Victoria to a nationwide provider of insurance services for the country's boating community. - read more |
| Why Income Protection Insurance is Essential for Self-Employed Australians Income protection insurance is a type of coverage designed to provide you with a steady income if you are unable to work due to illness or injury. Unlike other types of insurance, which may focus on lump-sum payments, income protection insurance prioritises regular income replacement to help cover your everyday expenses. - read more
|
| Too Young to Insure? and Other Life Insurance Misconceptions in Australia Many Australians recognise the importance of life insurance, yet a substantial number believe that it's a concern for the later stages of life. This common oversight can lead to missed opportunities for financial security and peace of mind. In this introductory section, we'll address why life insurance is a pivotal component of financial planning for individuals at any age, including the young adults just starting their careers. - read more
|
| Breaking Down the Barriers: Understanding Income Protection for Self-Employed Aussies Hello to all the self-employed Aussies out there! Embarking on the journey of self-employment brings with it a unique set of challenges and freedoms. One area we often overlook is the need for a solid financial safety net, customized to our varied incomes and work lifecycles. That's where income protection insurance steps in as a critical component for ensuring financial stability. - read more
|
| What Hospitality Business Owners Need to Know About Income Protection Insurance The Australian hospitality industry is renowned for its vibrancy, yet it also faces significant challenges. With fluctuating demand, seasonal changes, and unpredictable external factors such as economic downturns and pandemics, hospitality businesses often operate in a high-risk environment. For hotel operators, the stakes are even higher due to substantial investments in property, staff, and customer service. - read more
|
A very broad term for insurance covering liability exposures for individuals and business owners. It provides broad coverage, generally including all exposures for property damage and bodily injury.