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
| Bupa's Strategic Expansion into Mental Health Services 29 Jan 2026: Paige Estritori Bupa, a leading health insurer in Australia, has unveiled plans to significantly enhance mental health services by establishing a network of clinics named Mindplace. This initiative aims to open 60 clinics nationwide by 2027, aligning closely with the government's objective of operating 61 walk-in Medicare Mental Health Centres by mid-2026. - read more |
| Federal Support Secures Cohealth's GP Services Amid Financial Strain 29 Jan 2026: Paige Estritori In response to financial challenges faced by Cohealth, a non-profit community health service, the federal government has allocated $1.5 million to maintain its GP services in Melbourne's inner north and west. This funding ensures that clinics in Collingwood, Fitzroy, and Kensington will remain operational until 31 July 2026, providing essential care to approximately 12,500 patients who were at risk of losing access to their GPs. - read more |
| Rising Out-of-Pocket Costs Challenge Australia's Universal Healthcare 29 Jan 2026: Paige Estritori Patients Australia, in collaboration with La Trobe University, has released the 2025 Patient View Report, shedding light on the increasing financial burden faced by Australians seeking healthcare services. The report indicates that 62% of patients incur out-of-pocket expenses when visiting their GP, with nearly half of these individuals paying an average gap fee of $51 or more. - read more |
| Australian Insurers Adapt Investment Strategies Amid Geopolitical and Economic Changes 29 Jan 2026: Paige Estritori Australian insurers are actively revising their investment portfolios in response to evolving geopolitical events and a stabilizing economic environment. A recent report by Janus Henderson Investors reveals that 47% of insurers plan to increase their investment portfolio risk in the next 12 months, with a significant focus on private markets. - read more |
| Insider Secrets to Finding Cost-Efficient Health Insurance Health insurance in Australia is a crucial aspect of ensuring you and your family receive the medical care needed without facing exorbitant costs. The healthcare system, consisting of both public and private sectors, offers various options to suit different needs and budgets. While the public sector (Medicare) provides essential services, private health insurance offers additional benefits such as faster access to services, choice of doctor, and coverage for services not included in Medicare. - read more
|
| The Role of Life Insurance in Your Overall Financial Strategy Financial planning plays a pivotal role in managing your economic resources effectively. By assessing your income, expenses, and goals, you can create a plan that helps achieve financial security. A comprehensive financial plan covers saving, investing, budgeting, and managing liabilities to secure your future. - read more
|
| Affordable Life Insurance: Finding the Right Fit for Your Family's Finances Life insurance is a crucial component in safeguarding your family's financial security. It offers peace of mind, knowing that your loved ones will be protected in the event of unexpected circumstances. Many Australians understand the value of having life insurance, but the task of finding a policy that fits within a family's budget can sometimes feel overwhelming. - 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
|