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Insurer Prevails in Fraudulent Rental Claim Dispute

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The insurer QBE has successfully reversed a payout concerning a fraudulent rental claim, as determined by the Australian Financial Complaints Authority (AFCA).

The controversy arose from a claim lodged under an owners’ corporation residential strata plan for water damage and subsequent rental losses dating back to a January 2022 storm.

The claimant asserted the lot was leased to a company as a conference facility, incurring a monthly rent of $3300, but became uninhabitable due to water damage. While QBE compensated the water damage, initially declining the rental loss claim, they later approved it after a review, disbursing $31,818 from January to October 2022.

However, concerns about the rental claim's legitimacy were raised by the owners' corporation, prompting further investigation. The claimant had provided a formal lease agreement purportedly made on October 1, 2021, but the incorporation of the tenant company occurred almost six months later. The claimant's director admitted the written lease was backdated in tandem with the claim submission, originally having only a verbal agreement, believing the document was necessary for the claim's success.

Furthermore, a rental ledger indicated payments for October through December 2021, which the director later conceded were never made, fabricated to bolster claim acceptance. QBE branded these actions as attempts to unjustly secure entitlements, enabling them to retrieve $46,830 in payments and costs.

Despite opposing the fraud accusation, stating the ledger mistake was not intended to mislead, AFCA concluded the claim was deceptive. They highlighted misrepresentations regarding the timeline of the lease agreement and rent payments as intentional efforts to deceive the insurer. Given the rent claim constituted a major part of the payout, AFCA deemed it justifiable for QBE to reclaim funds.

This resolution underscores the stringent expectations on claim accuracy and integrity, flagging potential repercussions for misleading insurance practices.

Published:Monday, 17th Mar 2025
Source: Paige Estritori

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

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Knowledgebase

Loss Ratio:
The ratio of claims paid by an insurer to the premiums earned, used as a measure of profitability.

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