Insurer Penalized for Mishandling Storm Damage Claim

1

The information on this website is general in nature and does not take into account your objectives, financial situation, or needs. Consider seeking personal advice from a licensed adviser before acting on any information.

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

Please Note: If this information affects you, seek advice from a licensed professional.

Share this news item:

Insurance News

Clear

IAG and Ag Guard Forge Partnership to Elevate Crop Insurance for Australian Farmers

14 Nov 2025: Paige Estritori

In a significant development for Australia's agricultural sector, Insurance Australia Group (IAG) has announced a strategic partnership with Ag Guard, a specialist rural underwriting agency. This collaboration will see Ag Guard managing the underwriting for IAG-owned CGU and WFI's crop insurance portfolios starting June next year. - read more

WFI Insurance and AgCarE Collaborate to Incentivize Sustainable Farming Practices

14 Nov 2025: Paige Estritori

In a move to promote sustainable agriculture, WFI Insurance has partnered with AgCarE, a certification program developed by AgForce, to offer premium reductions to farmers who achieve AgCarE certification. This collaboration aims to enhance financial, environmental, and social outcomes for Australian farmers and rural communities. - read more

Diversification in Small Farms Creates New Avenues for Insurance Brokers

14 Nov 2025: Paige Estritori

The landscape of Australian agriculture is undergoing a significant transformation as small commercial farms increasingly diversify their operations to enhance income and sustainability. This shift presents both challenges and opportunities for insurance brokers, as new ventures introduce complex risk management needs. - read more

Urgent Call for Enhanced Farm Safety Amid Rising Fatalities

29 Oct 2025: Paige Estritori

In 2024, Australian agriculture faced a significant safety crisis, recording 72 farm-related fatalities-the highest in over two decades. This alarming statistic underscores the urgent need for enhanced safety protocols and awareness within the farming community. - read more

Soaring Insurance Costs Challenge Australian Farmers

29 Oct 2025: Paige Estritori

Australian farmers are confronting a significant surge in insurance premiums, a trend largely attributed to the increasing frequency and severity of extreme weather events. Over the past few years, many farmers have reported that their insurance bills have more than doubled, with annual premiums exceeding $100,000. - read more

Revolutionising Crop Insurance with Satellite Technology

29 Oct 2025: Paige Estritori

In a significant advancement for Australian agriculture, Insurance Facilitators (IF), a family-owned underwriting agency, has introduced a data-driven crop insurance solution leveraging satellite technology. This innovative approach aims to address longstanding challenges in the industry, including premium leakage and risk accumulation, by providing more accurate and efficient risk assessments. - read more

Click for more Insurance News