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:
| Strata Communities Endorse Call for Enhanced Resilience Reforms 15 Feb 2026: Paige Estritori Strata communities are at the forefront of Australia's resilience battle, facing escalating costs, declining coverage, and prolonged recovery periods following disasters. Strata Community Association Australasia (SCA) has expressed strong support for the Insurance Council of Australia's (ICA) recent call for coordinated, long-term resilience reforms to protect communities from these challenges. - read more |
| Artificial Intelligence Revolutionises Australian Insurance Sector 15 Feb 2026: Paige Estritori The Australian insurance industry is undergoing a significant transformation, with companies increasingly integrating artificial intelligence (AI) into their operations. This shift aims to enhance efficiency, improve customer service, and strengthen risk management practices in a rapidly evolving market. - read more |
| Australian Insurers Confront Financial Risks Amid Climate Change 15 Feb 2026: Paige Estritori Climate change is increasingly impacting the Australian insurance industry, presenting significant financial risks as the frequency and severity of natural disasters escalate. Insurers are grappling with the challenge of adapting to this new reality while maintaining financial stability and providing affordable coverage to consumers. - read more |
| Budget Direct Triumphs as 2026 Insurer of the Year 15 Feb 2026: Paige Estritori Budget Direct has been honoured with the inaugural 'Insurer of the Year' title at the 2026 Finder Provider of the Year Awards, marking a significant achievement in the Australian insurance sector. This accolade underscores the company's commitment to delivering exceptional value and service to its customers. - read more |
| From Illness to Injury: Understanding the Scope of Income Protection Insurance In the uncertain times we face today, where both health and economic climates are unpredictable, safeguarding your financial stability becomes paramount. This is where income protection insurance steps in as an essential safety net. For many Australian families, it's the buffer that ensures life's financial commitments are met, even when ability to work is compromised. - 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
|
| Why Income Protection Insurance is Vital for Your Financial Security Income protection insurance is a type of coverage that provides you with a financial safety net in case you are unable to work due to illness or injury. It typically pays up to 75% of your regular salary, helping you to continue meeting your financial obligations during difficult times. - read more
|
| A Guide to the Australian Income Protection Insurance Landscape Income protection insurance stands as an unsung hero in the tapestry of financial security, often overlooked but irreplaceable in its role. Designed to provide a safety net, it ensures that individuals can continue to receive a portion of their income should they become unable to work due to illness or injury. It’s about peace of mind, knowing that life's unforeseen events won't sweep the ground from beneath you. - read more
|
A time period after the premium is due during which an insurance policy remains in force even if the premium has not yet been paid.