Insurer Penalized for Mishandling Storm Damage Claim

1

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

Rising Insurance Premiums Challenge Australian SMEs 29 Dec 2025: Paige Estritori Small and medium-sized enterprises (SMEs) across Australia are increasingly burdened by soaring insurance premiums, with many facing hikes of 30% or more within a single year. This surge has led some businesses to either reduce their coverage or forgo insurance altogether, exposing them to significant financial risks. - read more

Upcover's New Management Liability Insurance for SMEs 29 Dec 2025: Paige Estritori Australian insurtech company Upcover has unveiled a new management liability insurance product designed specifically for small and medium-sized enterprises (SMEs) and sole traders. This offering aims to provide comprehensive protection against a range of risks that business owners may encounter. - read more

QBE Strengthens Cyber Insurance Offerings 29 Dec 2025: Paige Estritori In response to the growing prevalence of cyber threats and increasingly stringent regulations, QBE Insurance has announced a strategic initiative to bolster its cyber insurance capabilities. This move aims to provide brokers and their clients with more robust support in navigating the complex landscape of cyber risks. - read more

Australian Insurers Report $1.11 Billion Profit in Q1 2025 29 Dec 2025: Paige Estritori The Australian insurance industry has reported a net profit after tax of $1.11 billion for the first quarter of 2025, according to the latest data from the Australian Prudential Regulation Authority (APRA). This figure includes contributions of $990 million from insurers and $123 million from reinsurers. The insurance service result, a key measure of underwriting performance, stood at $1.32 billion for the quarter, complemented by investment returns totaling $1.18 billion. - read more