Insurer Ordered to Pay Full Claim for Confusing Patio Coverage
Insurer Ordered to Pay Full Claim for Confusing Patio Coverage
The complainant had argued that the storm-damaged items on the patio were enclosed enough to avoid the "open air" restriction, but the AFCA found the blinds in place did not ensure an enclosed space, lacking proper lockability. However, the authority noted the policy's language was not explicit in imposing the 10% limitation due to its placement under "additional benefits," which suggested the opposite of a restriction.
Moreover, the AFCA criticized the insurer for failing to present evidence that the policyholder neglected reasonable care of the items. In acknowledging the complainant's hardships, AFCA highlighted that the year-long exposure to mould had affected living conditions, despite the insurer disputing health impacts.
As part of the resolution, AFCA instructed a $4000 payment for non-financial losses, emphasizing that proof of health issues was unnecessary to confirm that the claimant's peace of mind had been compromised. The requirement for the insurer now includes engaging an expert for a comprehensive assessment of the storm and mould damage.
While the insurer can deduct the $1558 already issued as an ex-gratia payment and any policy excess, the decision underscores the necessity of precise and consumer-friendly contract wording to avoid customer disputes.
This case serves as a critical reminder for insurance companies to adopt straightforward language and place important limitations in unambiguous policy sections. As companies reassess contract terms, consumers might see increased clarity in coverage options, potentially averting future misunderstandings.
Published:Monday, 23rd Jun 2025
Source: Paige Estritori
Share this news item:
| ClearView Names New Underwriting Head Amidst Strategic Changes 30 Jun 2025: Paige Estritori ASX-listed life insurer ClearView has announced the appointment of Peter Tilocca as Head of Underwriting, coinciding with key updates to its underwriting standards and definitions. Tilocca's extensive two-decade career in Australian underwriting includes leadership roles at Zurich, Noble Oak, One Path Life, and RGA Australia. His new role with ClearView commenced on 30 June. - read more |
| Ombudsman Supports Theft Claimant in Home Business Coverage Dispute 30 Jun 2025: Paige Estritori A recent case has seen a policyholder triumph over her insurer after the Australian Financial Complaints Authority (AFCA) ruled in her favour following a contentious dispute regarding home business operations. The controversy arose when the woman's theft claim was denied by her insurance provider, IAG, over allegations of fraudulent misrepresentation about the use of her rental property. - read more |
| AFCA Upholds Insurance Fraud Ruling Over Disputed Possum Accident 26 Jun 2025: Paige Estritori A motorist's claim that he crashed into a tree to avoid a possum has been denied by the Australian Financial Complaints Authority (AFCA), which supported the insurer's fraud decision. The incident involved the driver crashing his Jeep—insured for over $20,000—on a dimly-lit street, purportedly avoiding the rain-soaked motorway en route to the store. - read more |
| Code Watchdog Criticises Insurer for Misleading Rejection Letters 24 Jun 2025: Paige Estritori The Life Code Compliance Committee has recently reprimanded a life insurance provider for issuing misleading rejection letters to policy applicants. These letters were deemed 'ambiguous and contradictory' and failed to clearly inform applicants of their review options after being denied coverage. - read more |
| Insurer Ordered to Pay Full Claim for Confusing Patio Coverage 23 Jun 2025: Paige Estritori A recent ruling mandates that an insurer must fully honor a storm-related claim due to ambiguous policy wording regarding items in open areas. The Australian Financial Complaints Authority (AFCA) determined that the insurer's restriction on coverage for items in a patio area was unfounded, as the policy's phrasing was not clear. - read more |
| The Impact of Health and Medical History on Insurance Premiums Life insurance is a critical component of a sound financial plan. It provides financial security and peace of mind to you and your loved ones, ensuring that they are taken care of in the event of your untimely death. - read more
|
| Starting Out: How to Pick the Right Insurance As a Young Professional in Australia Welcome to the journey of safeguarding your future! As a young professional in Australia, you're likely juggling the demands of a burgeoning career with personal goals and financial responsibilities. Navigating the world of insurance is critical in creating a safety net around these aspirations. But why exactly is insurance a cornerstone for those entering the professional realm, and how do you discern which coverage best aligns with your unique pathway? - read more
|
| How Pre-Existing Conditions Affect Your Income Protection Insurance Options Income protection insurance is a type of insurance policy designed to provide you with a continuous flow of income in case you are unable to work due to illness or injury. It's a safety net that helps ensure you can maintain your standard of living, even when unforeseen health issues arise. - read more
|
| Understanding the Role of Life Insurance in Your Estate Plan Estate planning is a critical process that often goes overlooked, but it's essential for securing the financial future of your loved ones and ensuring your assets are distributed according to your wishes. It involves the careful organization and protection of an individual’s estate to minimize uncertainties and facilitate the smooth transfer of assets after their passing. While it may seem complex, understanding the basics of estate planning is necessary for every Australian adult, regardless of wealth. - read more
|
| Strategies to Use Life Insurance in Funding Shareholder Agreements Shareholder agreements lay the cornerstone for stable business relationships and continuity in Australia. Acting as a contract among business owners, these agreements set forth the expectations, rights, and obligations of all parties involved. They are particularly vital in delineating clear paths for dispute resolution, succession planning, and the transfer of ownership shares under varied circumstances, including the untimely death or departure of a shareholder. - read more
|
Specific conditions or circumstances for which the insurance policy does not provide coverage.