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:
| AIA Australia's Latest Enhancements to Priority Protection Insurance 24 Mar 2026: Paige Estritori AIA Australia has recently updated its Priority Protection life insurance suite, introducing changes designed to simplify discounts, enhance policy clarity, and support premium affordability. These enhancements, effective from 9 November 2025, reflect AIA's commitment to providing value-driven solutions for policyholders. - read more |
| Australia's Life Insurance Coverage Falls Short of Global Standards 24 Mar 2026: Paige Estritori Recent findings from a survey conducted by Zurich and the University of Oxford reveal that Australia has one of the lowest life insurance penetration rates globally. The study indicates that only 27% of Australians have income protection insurance, and 25% possess life insurance coverage. These figures are notably lower than the global averages of 33% for income protection and 32% for life insurance. - read more |
| Zurich's Pioneering Women's Health Benefit in Income Protection 24 Mar 2026: Paige Estritori Zurich has introduced a groundbreaking Women's Health Benefit within its Corporate Care Income Protection product, marking the first dedicated corporate income protection benefit in Australia designed specifically for female health conditions and events. This initiative aims to provide targeted support for women experiencing health issues that can impact their professional lives. - read more |
| Club Marine Introduces Land-Based Insurance for Race Boats 24 Mar 2026: Paige Estritori Club Marine, Australia's leading boat insurance provider, has announced a new partnership with the Australian Offshore Powerboat Club (AOPC) to offer specialised insurance coverage for race boats while they are on land. This initiative addresses a significant gap in the market, providing protection against accidental loss, damage, theft, or malicious damage to vessels during storage and transit. - read more |
| Life Events That Should Trigger a Life Insurance Review for Aussie Families Life insurance is a cornerstone of financial planning for Aussie families, offering protection and peace of mind. But what happens when the bustling flow of life brings changes? This is where a life insurance review comes into play. A life insurance review is a thorough analysis of your existing policy to ensure it aligns with your current life circumstances and financial goals. - read more
|
| Understanding Health Insurance: A Starter's Guide for Young Australians Embarking on the journey of understanding health insurance is a pivotal stride for young Australians. It's a proactive step that embodies responsibility for one's well-being and financial foresight. Health insurance can often seem like a complex affair reserved for a future self, but grappling with its intricacies early can be both economically savvy and health-conscious. - read more
|
| A Guide to Choosing Income Protection Insurance for Tradespeople Income protection insurance is a vital safety net for those who earn their livelihood through skilled trades. It is designed to replace a portion of your income if you're unable to work due to illness or injury, ensuring that you can meet your financial obligations while you recover. This type of insurance provides peace of mind, knowing that even if the unexpected happens, your bills can still be paid and your lifestyle maintained. - read more
|
| The Importance of Comparing Health Insurance Extras for Maximum Savings Health insurance is more than just a precautionary measure; it's a vital component in managing both your health and financial well-being. In Australia, where healthcare costs can quickly escalate, health insurance extras serve as a buffer, ensuring that services like dental, optical, and physiotherapy remain within reach. These extras can significantly reduce the out-of-pocket expenses you might otherwise encounter for non-hospital treatments. - read more
|
The amount it would cost to replace or rebuild an insured asset with one of similar kind and quality, without depreciation.