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:
| Significant Decline in Australian Commercial Insurance Rates 25 Mar 2026: Paige Estritori In the final quarter of 2025, Australian commercial insurance rates experienced a substantial decline of 12%, marking the most significant drop among the eight regions monitored by Marsh Risk's Global Insurance Market Index. This trend reflects a broader pattern of decreasing rates that began in early 2024, with the Pacific region, predominantly Australia, leading the way. - read more |
| Human Factors Dominate Causes of Major Truck Crashes in Australia 25 Mar 2026: Paige Estritori The National Truck Accident Research Centre's 2025 Major Incident Investigation Report, supported by NTI, has identified human error as the predominant cause of major truck crashes in Australia. The report indicates that factors such as inattention, distraction, and inappropriate speed account for a significant proportion of these incidents. - read more |
| ASIC Launches Review into Motor Insurance Pricing Practices 25 Mar 2026: Paige Estritori The Australian Securities and Investments Commission (ASIC) has initiated a comprehensive review into the accuracy and transparency of motor insurance pricing among major insurers, covering approximately two-thirds of the car insurance market. This investigation aims to ensure that insurers comply with legal disclosure requirements and provide clear explanations for premium calculations. - read more |
| 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 |
| The Digital Age of Health Insurance: Comparing Policies Online The dawn of the digital age has significantly transformed the way we approach nearly every aspect of our lives, and the domain of health insurance is no exception. With the arrival of innovative digital tools, the health insurance landscape has undergone a striking evolution, allowing for unprecedented accessibility and convenience in managing healthcare coverage. - read more
|
| How Tradespeople Can Maximize Tax Deductions Through Insurance Tradespeople work hard to earn their income, often facing unique expenses that can impact their bottom line. Understanding and maximizing tax deductions is crucial for minimizing these costs and keeping more of what they earn. By making informed decisions about expenses, tradespeople can significantly reduce their taxable income. - read more
|
| Strategies to Use Life Insurance in Funding Shareholder Agreements Shareholder agreements lay the cornerstone for stable business relationships and continuity in Australia. Acting as a contract among business owners, these agreements set forth the expectations, rights, and obligations of all parties involved. They are particularly vital in delineating clear paths for dispute resolution, succession planning, and the transfer of ownership shares under varied circumstances, including the untimely death or departure of a shareholder. - read more
|
| Deciphering Your Policy: A Beginner's Guide to Insurance Terminology Welcome to the world of insurance – a domain where words like 'deductible' and 'premium' can significantly impact your financial protection and peace of mind. As a beginner, grasping the basics of insurance terminology is the first step towards making informed decisions about the policies that safeguard your assets and future. In this guide, we will embark on a journey through the language of insurance, which can often seem as complex as the policies themselves. - read more
|
A clause or provision in a life insurance policy that doubles the payout in cases of accidental death.