After purchasing the house, renovations were ongoing when a group of painters caused damage to several walls and windows in November 2021. The homeowners lodged a claim with IAG, and the male claimant alleged that the workers had "turned on him" during a meeting over workmanship issues and attacked him before causing damage to the property. The painters were later arrested for assault.
An assessment from an insurer-appointed builder recommended that the matter be handled with a cash settlement, as repairs might not match the existing texture. The scope of works (SOW) for the repairs quoted by the builder was $13,203 in early December. Despite this, the complainants were not satisfied with IAG's offer, and the insurer's requested the builder to revisit the initial quote. AI updated the initial quote, and IAG offered a cash settlement based on the revised quote in April last year, which the homeowners dismissed again.
They had instead obtained a report from a quantity surveyor, referred to as JB, which stated that AI's SOW was insufficient to cover the rectification works and "not a genuine quotation". JB observed that the property had sustained water and ceiling damage, which led to mold growth. The surveyor quoted a repair cost of $120,000 to $130,000.
However, IAG denied responsibility for the mold or water damage and advised that the complainants would have to file a separate claim for the damage to be assessed. In August, IAG offered to increase its cash settlement by 25%, taking its offer to $24,765, which the claimants also rejected.
The insurer then engaged a building consultant, referred to as CF, to inspect the property and report on the damage. However, the complainants denied them access. But CF provided a desktop report based on an analysis of the various quotes. The consultant estimated that the repair cost amounted to $39,504, which IAG uplifted with a 20% contingency and fees to cover four weeks of temporary accommodation. This led to the insurer’s offer amounting to $53,000.
The homeowners disagreed that the offered settlement was inadequate since it did not consider rectification works for mold damage, which had worsened due to the insurer's delays. However, the Australian Financial Complaints Authority (AFCA) determined that there had been no evidence to show "a causative link" between the malicious damage and water ingress, leading to mold growth.
"Given that the malicious damage involved scratching and gouging to internal walls and a window frame, the panel on balance considers it unlikely any such link exists," AFCA stated.
The panel further revealed that the delays that led to the mold growth could be attributed to the complainants' failure to provide an itemized counter-quote until mid-June last year, more than seven months after the claim had been lodged. If the homeowners wished to have the mold damage covered, they would have to file a separate claim.
The AFCA acknowledged that IAG's offer was "overall reasonable" and required the insurer to waive the $1000 policy excess. The ruling also stated that IAG's offer for temporary accommodation was fair, despite assessments that suggested it would not be required. The homeowners' request for ten months' worth of accommodation, estimated to cost $23,336, was turned down by AFCA.
In summary, the insurer denied a request by complainants for a higher payout over damages caused by violent painters who were also charged with assault in November 2021. This decision was supported by AFCA, which found IAG's offer reasonable and fair, and the homeowners would need to file a separate claim for mold damage.
Published:Wednesday, 31st May 2023
Source: financialservicesonline.com.au
![]() | 'Confusing Question': Insured Successfully Challenges Home Insurance Claim Denial 29 Sep 2023: .financialservicesonline.com.au In a recent dispute ruling, a homeowner has successfully contested her insurer's decision to deny a storm damage claim, highlighting an issue with questions regarding the property's condition at the time of purchase. The complainant's victory was based on the finding that she had answered the questions honestly and in good faith, based on her genuine belief about the condition of the property. - read more |
![]() | Crop Insurance Claim Denied Due to Fungal Disease 28 Sep 2023: .financialservicesonline.com.au A recent claims dispute regarding a farmer's faba bean crops has garnered attention, as the insurer has denied the claim based on the presence of a fungal disease. The farmer argued that a hailstorm was the cause of the disease outbreak, but the decision went against him. Let's delve into the details of this case and understand the ruling. - read more |
![]() | Health Insurance Premiums Set to Rise: What You Need to Know 28 Sep 2023: .financialservicesonline.com.au Next week, almost five million Australians will see a substantial increase in their private health insurance premiums as major insurers begin to pass on delayed price hikes from October 1st. - read more |
![]() | Landlord loses dispute over drug farm fire 27 Sep 2023: .financialservicesonline.com.au A recent dispute ruling has resulted in a landlord losing her claim after a fire caused by a tenant's illegal drug operations. Despite the severe damage to the property, the landlord's insurer has relied on a policy exclusion to deny the claim. - read more |
![]() | Prepare for Unpredictable Weather as El Nino Looms, Insurers Warn 25 Sep 2023: .financialservicesonline.com.au Insurers in Australia are urging citizens to be proactive in preparing for unexpected and extreme weather conditions. With the Bureau of Meteorology declaring an El Nino event this week and issuing severe weather warnings for several regions in the country's southeast, Australians are being reminded not to be complacent. - read more |
![]() | Understanding the Differences: Income Protection vs Total and Permanent Disability Insurance Income protection insurance is a type of policy that provides financial support to individuals who are unable to work due to an illness or injury. The insurance company will pay a portion of the policyholder's earnings, which can be used to cover everyday living expenses and bills. This type of insurance is different from total and permanent disability insurance (TPD) in a few key ways. - read more
|
![]() | Life Insurance for Millennials: Why It's Essential. As a millennial, you may believe that you're young, healthy, and have plenty of time to prepare for the future. However, it's essential to understand that life is unpredictable, and unexpected events can occur at any time. This is why it's essential to consider life insurance, particularly if you have financial responsibilities, dependents, or both. - read more
|
![]() | How Much Life Insurance Do I Need? There are many different reasons to purchase life insurance (generation skipping tax, estate plan, estate preservation, surviving spouse needs, planning for your children's future and more). There is no right amount of life insurance, but here are some guidelines that might help you decide how much life insurance you need. - read more
|
![]() | Covering the Unexpected: A Guide to Trauma Insurance for Australian Families Trauma insurance, also known as critical illness insurance, is a type of coverage that provides a lump sum payment in the event that the insured suffers from a critical illness or injury. Unlike health insurance, which covers medical expenses, trauma insurance is designed to provide financial protection by helping to cover the additional costs associated with recovery from a severe illness or injury. - read more
|
![]() | Income protection insurance It's trite but true to say that, for most people, their most valuable asset is their ability to earn an income. But how relevant is income insurance to most Australians? - read more
|