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:
| Acenda's Workforce Reductions Post-Merger Raise Union Concerns 31 Mar 2026: Paige Estritori In the wake of the merger between MLC Life and Resolution Life Australia, the newly formed entity, Acenda, has implemented significant workforce reductions, leading to union criticism over the consultation process. - read more |
| APRA Reports Significant Increase in Life Insurance Underwriting Profits 31 Mar 2026: Paige Estritori The Australian Prudential Regulation Authority (APRA) has released data indicating a substantial rise in underwriting gains within the life insurance sector for the December quarter of 2025. - read more |
| IBISWorld Forecasts Surge in Life Insurance Mergers Amid Market Challenges 31 Mar 2026: Paige Estritori According to a recent IBISWorld report, the Australian life insurance industry is poised for increased merger activity as companies strive to achieve economies of scale in response to market challenges. - read more |
| Australian Insurers Tackle Premium Affordability Challenges in 2026 31 Mar 2026: Paige Estritori In 2026, Australian insurers are prioritizing premium affordability and insurability as they confront escalating claims costs, climate-related losses, and technology-enabled fraud. According to Gallagher Bassett's 2026 global claims study, these factors are significantly influencing pricing, underwriting, and capital allocation decisions. - read more |
| What Australians Need to Know Before Choosing an Income Protection Plan Income protection insurance is a critical safety net for Australians, offering financial security in the event that one is unable to work due to illness or injury. The peace of mind it brings cannot be overstated, as it ensures that individuals and their families can maintain their standard of living even when the unexpected happens. - read more
|
| How to Choose the Right Income Protection Insurance as a Freelancer Income protection insurance is a type of coverage designed to replace a portion of your income if you're unable to work due to illness or injury. It's an incredibly vital form of insurance for freelancers, who may not have the same safety nets as traditional employees, such as paid sick leave or disability benefits. - read more
|
| Navigating Pre-existing Conditions in Income Protection Insurance Income protection insurance is a safety net that many Australians rely on to secure their financial future in the event of illness or injury preventing them from working. It's a type of policy that provides a replacement income if you are unable to earn your regular income due to a health-related absence from the workplace. - read more
|
| How Life Insurance and Estate Planning Work Together for Your Benefit For many Australian families, the concept of estate planning might evoke imagery of vast wealth and complex legal documents, reserved for the very affluent. However, this misconception overshadows the universal importance of having an estate plan, which at its core, is about ensuring your loved ones are cared for and your wishes are honored upon your passing—even if you don't consider yourself wealthy. - read more
|
The person or entity designated to receive the death benefit from a life insurance policy.