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:

Insurance News

Australian Insurers Navigate AI Disruption Fears 05 Apr 2026: Paige Estritori In recent weeks, Australia's leading insurance companies, including Insurance Australia Group (IAG), Suncorp (SUN), and QBE Insurance (QBE), have experienced notable declines in their share prices. This downturn is largely attributed to growing investor concerns about the potential disruptive impact of artificial intelligence (AI) on the traditional insurance business model. - read more

Rising Premiums Challenge Australian Insurers in 2026 05 Apr 2026: Paige Estritori In 2026, Australian insurers are grappling with significant challenges as premium affordability becomes a pressing concern. A recent survey by Gallagher Bassett highlights that 70% of insurers have reported increased claim costs and frequencies over the past year. This surge is largely attributed to escalating climate-related losses and inflationary pressures affecting materials and labour costs. - read more

AI-Driven Cyber Insurance Now Available for Australian SMEs 05 Apr 2026: Paige Estritori In a significant development for Australian small and medium-sized enterprises (SMEs), Zurich has partnered with US-based cyber insurance specialist Cowbell to introduce an AI-driven cyber insurance product tailored for businesses with annual turnovers up to $100 million. This collaboration marks a pivotal step in enhancing cyber resilience among Australian SMEs. - read more

AFCA Rules in Favor of Restaurant in Arson Insurance Dispute 05 Apr 2026: Paige Estritori In a landmark decision, the Australian Financial Complaints Authority (AFCA) has directed an insurer to honor an arson-related claim for a restaurant, despite the non-disclosure of the director's criminal history during the policy's inception. This ruling underscores the complexities surrounding disclosure obligations and the interpretation of policy terms. - read more