Homeowner Successfully Challenges Insurer in Disclosure Dispute

9

According to Auto & General Services, it denied the claim for flood damage because the homeowner failed to disclose that he had been running an air conditioner and refrigerator retail business from the shed. The insurer pointed out that during the most recent policy renewal, the homeowner confirmed that no part of the property was used for business activities or for buying, selling, or storing business products or equipment.

The homeowner admitted to operating a business out of the shed but argued that he was not required to disclose the details because the policy specifically excluded coverage for business and farming structures, including sheds. He emphasized that the policy referred to the insured dwelling as a "freestanding house" and that any losses to the shed were covered by a separate business insurance policy.

The Australian Financial Complaints Authority (AFCA) sided with the homeowner, stating that the home and contents policy did not cover the shed and it was fair for him not to disclose the business. AFCA ruled that when the homeowner answered the insurer's question about whether any part of the "property" was being used as a business premises, he understood the question to refer only to the freestanding residential dwelling where he lived. AFCA also noted that the certificate of insurance specifically mentioned the freestanding home and did not include any reference to outbuildings or sheds.

As a result of the ruling, Auto & General is now required to accept the claim and appoint a qualified expert to prepare a scope of works for repairs to the insured property. The insurer must arrange and complete the repairs or provide a cash settlement with a 15% contingency. AFCA has also instructed Auto & General to assess the homeowner's entitlement to temporary accommodation benefits and reinstate his policy.

Published:Saturday, 9th Dec 2023
Source: Paige Estritori

Share this news item:

Insurance News

Clear

Call for Stricter Timelines on Insurance Claims and Renewals 06 May 2025: Paige Estritori The Insurance Brokers Code Compliance Committee is advocating for significant changes to improve transparency and clarity in their industry standards, amidst ongoing reviews of the National Insurance Brokers Association (NIBA) code. This call to action coincides with the recent closure of feedback collection from stakeholders, setting the stage for a draft report expected next month. - read more

Insurers Under Scrutiny for Response to Alfred Flood Claims 05 May 2025: Paige Estritori In a recent development, Queensland MP David Lee has raised concerns about how insurance companies are addressing claims following the devastating floods caused by Ex-Tropical Cyclone Alfred. Businesses in Hervey Bay, a region heavily impacted by the floods, report facing significant hurdles in having their damage claims recognized. - read more

AFCA Rules Against Engine Theft Coverage in Motor Policy Dispute 04 May 2025: Paige Estritori An applicant's attempt to claim insurance coverage after the theft of an engine designated for his 1993 Nissan Skyline has been denied. Despite holding a comprehensive motor policy with IAG, the insured's claim was rejected after multiple engines were stolen in a brazen ram-raid at his vehicle repairer's workshop in November 2023, prompting an appeal to the Australian Financial Complaints Authority (AFCA). - read more

ACCC Strengthens Position Against Broker Commissions 02 May 2025: Paige Estritori In a recent submission to the professional code of practice review, the Australian Competition and Consumer Commission (ACCC) has reiterated its position against broker commissions. Echoing findings from its 2020 Northern Australia Insurance Inquiry, the ACCC advocates for extending the ban on conflicted remuneration to include brokers. - read more

Partial Settlement Reached in Homeowner's 'Slow Leak' Insurance Dispute 01 May 2025: Paige Estritori A recent ruling by the Australian Financial Complaints Authority (AFCA) has determined that Auto & General Services must cover a portion of a homeowner's insurance claim related to long-term water damage caused by a leaking pipe. The decision comes after a protracted dispute regarding the coverage of damages arising from a leak that reportedly developed over 12 months, spanning both before and during the insurance policy period. - read more