Insurer Prevails in Fraudulent Rental Claim Dispute

2

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 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.

Share this news item:

Insurance News

Clear

Significant Increase in Health Insurance Premiums Anticipated for 2026

21 Jan 2026: Paige Estritori

Health insurance premiums are set to experience a substantial increase in 2026, with projections indicating a global rise of 10.3%. This marks the third consecutive year of significant hikes, following increases of 10% in 2025 and 9.5% in 2024. These figures are highlighted in WTW's 2026 Global Medical Trends report, underscoring the persistent inflationary pressures affecting insurers and employer-sponsored health plans worldwide. - read more

Private Health Insurers Under Scrutiny for Profits Amid Rising Premiums

21 Jan 2026: Paige Estritori

Recent analyses have brought to light significant concerns regarding the profit margins of private health insurers in Australia, especially in the context of rising premiums. The Australia Institute has highlighted that major insurers are reporting substantial profits while simultaneously increasing premiums, a situation that has sparked criticism and calls for greater transparency within the industry. - read more

Health Minister Puts Private Health Insurers on Notice Over Pricing Practices

21 Jan 2026: Paige Estritori

Health Minister Mark Butler has issued a stern warning to private health insurers in Australia, cautioning them against employing underhanded tactics to increase premiums. This comes in response to findings from the Commonwealth Ombudsman, which revealed that some insurers have been closing old policies and introducing more expensive new ones, effectively circumventing regulatory limits on premium hikes. - read more

AUSactive Unveils Comprehensive Insurance Solution for Fitness Professionals

21 Jan 2026: Paige Estritori

AUSactive, Australia's leading body for the exercise and active health sector, has announced the launch of a new insurance product tailored specifically for fitness professionals. This initiative, developed in collaboration with global insurance broker Marsh, aims to provide enhanced protection while offering lower premiums compared to existing market options. - read more

Health Insurers to Include Natural Therapies in Coverage from 2026

21 Jan 2026: Paige Estritori

In a significant policy shift, Australian health insurers will begin offering rebates for a range of natural therapies, including Yoga, Pilates, Tai Chi, Shiatsu, Naturopathy, Western herbal medicine, and the Alexander Technique, starting early 2026. This change follows legislative amendments allowing these therapies to be covered under private health insurance for the treatment of health conditions or as part of health management programs. - read more

Click for more Insurance News