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:
| Australian Medical Association Advocates for Reforms in Private Health Insurance 19 Apr 2026: Paige Estritori The Australian Medical Association (AMA) has intensified its call for comprehensive reforms in the private health insurance sector, particularly in response to the recent 4.41% average premium increase effective from April 2026. This hike, the largest in nearly a decade, has raised concerns about the affordability and value of private health coverage for Australians. - read more |
| Australian Government Outlaws 'Product Phoenixing' in Health Insurance 19 Apr 2026: Paige Estritori The Australian government has introduced legislation to prohibit the practice known as 'product phoenixing' within the private health insurance sector. This move aims to enhance transparency and fairness for consumers by preventing insurers from closing existing policies and reintroducing nearly identical ones at higher premiums. - read more |
| HCF and Netball Australia Strengthen Commitment to Women's Health 19 Apr 2026: Paige Estritori HCF, Australia's largest not-for-profit health fund, has announced the extension of its major partnership with Netball Australia and Super Netball, continuing as the sport's official health insurance partner through to the end of 2027. This renewal underscores HCF's dedication to improving the health and wellbeing of Australian women by supporting netball at all levels—from grassroots participation to elite competition. - read more |
| Gold-Level Health Insurance Premiums to Surge by Up to 25% in 2026 19 Apr 2026: Paige Estritori Recent analysis by consumer advocacy group CHOICE has revealed that Australians holding gold-level health insurance policies may face premium increases of up to 25% starting in April 2026. This substantial hike significantly exceeds the average 4.41% increase approved by the government for private health insurance premiums. - read more |
| The Single Parent’s Guide to Securing Your Child’s Financial Future Single parenting brings with it a mosaic of responsibilities and challenges, not least of which is securing a stable financial future for your child. The rollercoaster of raising a child alone often means that planning for the future can take a back seat to the day-to-day demands of parenting. Unexpected illnesses and injuries can compound these challenges, causing stress to multiply and plans to go awry. - read more
|
| 5 Tips to Save on Health Cover as an Australian Senior Finding the right health insurance coverage is a critical concern for Australian seniors, who often face the dual challenge of managing chronic health conditions and maintaining financial stability in retirement. As the cost of healthcare continues to rise, the importance of securing an affordable health cover that still meets their needs cannot be overstated. - read more
|
| Starting Out: How to Pick the Right Insurance As a Young Professional in Australia Welcome to the journey of safeguarding your future! As a young professional in Australia, you're likely juggling the demands of a burgeoning career with personal goals and financial responsibilities. Navigating the world of insurance is critical in creating a safety net around these aspirations. But why exactly is insurance a cornerstone for those entering the professional realm, and how do you discern which coverage best aligns with your unique pathway? - read more
|
| Top 5 Life Insurance Myths Debunked for New Parents For young families in Australia, life insurance is not just a policy; it's a crucial part of financial planning that ensures your loved ones are protected. Navigating the world with a newborn or growing children brings immense joy and responsibility. Amidst this joy, safeguarding a family's future financially is an essential consideration. - read more
|
A legal principle that stipulates that insurance policies should restore the insured to the financial position they were in before the loss.