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:
| Navigating the Surge in Insurance Risks for Australian Businesses 18 Feb 2026: Paige Estritori Australian businesses are currently grappling with a complex landscape of escalating insurance risks, driven by factors such as increased litigation, rapid technological advancements, supply chain disruptions, catastrophic events, and geopolitical tensions. These challenges necessitate a proactive approach to risk management and insurance coverage. - read more |
| Learning from Near Misses: Enhancing Farm Safety in Australia 18 Feb 2026: Paige Estritori In July 2025, Farmsafe Australia launched the 'Second Chances – Who Knows How Many You'll Get' campaign, aiming to transform near misses on farms into learning opportunities to prevent future accidents. This initiative underscores the critical importance of recognising and addressing close calls in agricultural settings. - read more |
| WFI's 2025 Farm Accident Insights: A Call for Enhanced Safety Measures 18 Feb 2026: Paige Estritori In October 2025, WFI Insurance unveiled its annual farm accident insights as part of Farmsafe Australia's 2025 Safer Farms Report. The findings paint a stark picture of the challenges facing Australian agriculture, with 2024 recording 72 farm-related deaths—the highest in over two decades. - read more |
| ASIC Highlights Deficiencies in Insurers' Complaint Handling Practices 18 Feb 2026: Paige Estritori The Australian Securities and Investments Commission (ASIC) has recently conducted a comprehensive review of insurers' complaint handling processes, uncovering significant deficiencies that fail to meet regulatory obligations. The findings indicate that insurers are not adequately identifying and addressing customer complaints, with one in six complaints going unrecognized. Additionally, systemic issues are often overlooked, communication timeframes are missed, and existing systems fail to record outcomes such as compensation payments. - read more |
| Comparing Income Protection Policies: What Australians Should Look For Income protection insurance serves as a financial safety net for countless Australians, offering a replacement income when unforeseen circumstances such as illness or injury impede their ability to earn. For the self-employed and entrepreneurs who may not have the safety nets offered by corporate employment, such protection is particularly important. - read more
|
| How Much Life Insurance Do You Really Need? A Family's Guide to Assessment Life insurance is one of those cornerstones of financial planning that often gets overlooked. Yet, the importance of life insurance in safeguarding your family's future cannot be overstated. It's a robust financial instrument that provides peace of mind, knowing that your loved ones will be financially secure in the event of your untimely passing. This introductory section lays the groundwork for understanding why life insurance is pivotal in your family's financial health. - read more
|
| Income Protection: How to Safeguard Your Earnings in Uncertain Times In the landscape of personal financial planning, income protection insurance emerges as a critical safeguard against the unpredictable nature of life's many uncertainties. As we navigate through economic turbulence and job market volatility, the importance of income protection becomes ever more apparent. This type of insurance serves as a financial backstop, designed to provide a stable flow of income when you're unable to work due to sickness or injury. - read more
|
| Understanding Income Protection Insurance: A Beginner's Guide for Australians Welcome to the essential guide on Income Protection Insurance for Australians. Whether you're just starting out in the workforce or you're well into your career, understanding how to protect your income is crucial. In this beginner-friendly article, we'll explore what income protection insurance is, why it's a vital safeguard for workers, and dive into some real-life scenarios illustrating its importance. - 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.