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

Queensland's Persistent Flood Woes: A Call for Resilient Rebuilding 05 Feb 2025: Paige Estritori The recent floods in northern Queensland have left a significant mark, with the Insurance Council of Australia reporting 1,435 insurance claims following the heavy rains. As the weather slowly begins to clear, residents of Townsville have started returning home, heaving a sigh of relief as the city narrowly avoided severe flooding. - read more

ACCC Scrutinizes Major Motor Insurance Mergers 05 Feb 2025: Paige Estritori The Australian Competition and Consumer Commission (ACCC) has opened a detailed examination into significant mergers in the motor insurance market. The acquisitions under review include Insurance Australia Group's (IAG) endeavor to acquire RACQ Insurance and Allianz Australia's agreement to purchase RAA Insurance. - read more

Urgency in Financial Reform: A Call for Swift Action 04 Feb 2025: Paige Estritori Christine Cupitt, CEO of the Council of Australian Life Insurers, has strongly expressed the urgent need for rapid legislative reform in financial advice. With an upcoming election threatening to stall legislation, time is of the essence to ensure timely implementation. - read more