The Australian Financial Complaints Authority (AFCA) intervened, reducing the payout by $56,546. This amount corresponds to the difference the landlord would have owed AIG in premiums to insure a building unoccupied for more than 90 consecutive days — an arrangement the landlord neglected, despite receiving clear directives from a broker.
The landlord, with guidance from their broker, had filed a claim last July after criminals gained access through a leased security gate, prompting AIG to refuse the claim due to the structure’s vacant status, which wasn't covered under the policy.
Prior to the unfortunate event, the broker had made the building owner and managing agent aware of the need to refresh AIG of the vacant situation, potentially affecting claims, and the possibility of acquiring extra coverage by adjusting the premium.
Despite the advice, the owner failed to take action, leading to AIG being notified about the vacancy only post-theft. AFCA indicated that AIG would likely have underwritten the unoccupancy risk had they been told, and determined it fair to authorize the claim — factoring in the supplemental premium and other conditions like an excess charge.
Section 54 of the Insurance Contracts Act became pivotal, with AFCA stating that the breach pertained to not informing the insurer of the decision to leave the property vacant beyond 90 days without seeking written permission — not merely the fact that the premises were left empty.
An AFCA official explained, “I am not of the view that the complainant’s failure to request the insurer’s written consent ... can reasonably be regarded as being capable of causing or contributing to the malicious damage and theft event.”
They emphasized, “The insurer cannot refuse to pay the claim by reason only of the post-contractual act, that is, by reason only of the complainant’s failure to seek its written consent. The insurer is, however, entitled to reduce its liability to the extent that it has been prejudiced.”
AFCA specified that AIG had not proved the extent of its disadvantage equaled its ability to completely dismiss its liability under the policy. Instead, AFCA accepted that the liability compared to the additional premium deemed appropriate if the vacancy had been disclosed.
Arguments suggesting partial occupancy, due to daily visits from a property manager and maintenance by contractors, were rejected, as was the claim that it was unjust to deny coverage because the theft transpired over a weekend when the premises would be unoccupied even if tenanted.
This information originally featured in an article in Insurance News Magazine.
Published:Friday, 1st Nov 2024
Source: Paige Estritori
Insurers Face Intense Scrutiny Over Quake Claim Rejections 21 Nov 2024: Paige Estritori In recent months, Muswellbrook, a town in New South Wales, has experienced a series of earthquakes that have left residents grappling with both physical destruction and emotional distress. Criticism is mounting against insurers as more than 600 claims have emerged, following these seismic events, yet many remain unresolved or denied. - read more |
AI Regulations: A Web of Complications 20 Nov 2024: Paige Estritori The Insurance Council of Australia (ICA) has raised concerns about the potential fallout from a fragmented regulatory approach to artificial intelligence and automated decision-making in the industry. There is fear that this patchwork of reforms could result in conflicting requirements, heavier compliance burdens, and increased industry confusion. - read more |
APRA Survey Reveals Impact of Climate Change on Insurance Industry Practices 19 Nov 2024: Paige Estritori A recent analysis by the Australian Prudential Regulation Authority (APRA) reveals that over 90% of general insurers and reinsurers anticipate climate change will influence their underwriting procedures, posing new challenges to the industry. - read more |
Fraudulent Claims Lead to Complete Denial of Compensation 18 Nov 2024: Paige Estritori In a remarkable case highlighting the severe consequences of insurance fraud, an individual's attempt to inflate a theft insurance claim has resulted in the total denial of compensation. Despite a significant portion of the claim being genuine, fraudulent actions negated any potential payout. - read more |
Soaring Insurance Premiums Amid Changing Climate 14 Nov 2024: Paige Estritori As climate change persists, the impact of severe weather on insurance premiums is becoming more evident, pushing affordability out of reach for many Australians. Bernadette Systa, a mother of five, faced an undeniable financial strain as her annual home and contents insurance costs surged from a modest amount to more than twice what she initially paid. This experience echoes a growing dilemma faced by households across the country. - read more |
Is Private Health Insurance Worth It? Exploring the Benefits In Australia, health insurance plays a significant role in ensuring individuals can access quality medical care without incurring prohibitive costs. - read more
|
Keeping Your Family Protected: The Importance of Adequate Health Insurance Coverage The modern Australian family faces a dynamic and ever-evolving set of health needs, with access to quality healthcare remaining a cornerstone of managing our wellbeing. As these needs shift through the different stages of life, the assurance of having a safety net in place can provide unparalleled peace of mind. It's this sense of security that makes adequate health insurance coverage indispensable in today's fast-paced society. - read more
|
Understanding Health Insurance: A Starter's Guide for Young Australians Embarking on the journey of understanding health insurance is a pivotal stride for young Australians. It's a proactive step that embodies responsibility for one's well-being and financial foresight. Health insurance can often seem like a complex affair reserved for a future self, but grappling with its intricacies early can be both economically savvy and health-conscious. - read more
|
5 Tips to Save on Health Cover as an Australian Senior Finding the right health insurance coverage is a critical concern for Australian seniors, who often face the dual challenge of managing chronic health conditions and maintaining financial stability in retirement. As the cost of healthcare continues to rise, the importance of securing an affordable health cover that still meets their needs cannot be overstated. - read more
|
The Digital Age of Health Insurance: Comparing Policies Online The dawn of the digital age has significantly transformed the way we approach nearly every aspect of our lives, and the domain of health insurance is no exception. With the arrival of innovative digital tools, the health insurance landscape has undergone a striking evolution, allowing for unprecedented accessibility and convenience in managing healthcare coverage. - read more
|
Demystifying Individual Coverage: Your Guide to Personal Health Insurance in Australia In the realm of securing one’s health and wellbeing, navigating the Australian health insurance landscape can be as critical as the care received. It stands as a complex tapestry, woven with policies, premiums, and government incentives, affecting individuals and families nationwide. - read more
|
The Digital Age of Health Insurance: Comparing Policies Online The dawn of the digital age has significantly transformed the way we approach nearly every aspect of our lives, and the domain of health insurance is no exception. With the arrival of innovative digital tools, the health insurance landscape has undergone a striking evolution, allowing for unprecedented accessibility and convenience in managing healthcare coverage. - read more
|
Top 10 Tips to Find Affordable Health Insurance in Australia Finding affordable health insurance can be a daunting task, particularly in a landscape as diverse as Australia’s. With a myriad of options available, it's crucial to understand the financial support mechanisms in place that can ease the burden of healthcare costs. One such mechanism is the health fund rebate, a key feature of the Australian health insurance system designed to make healthcare more accessible. - read more
|
Health Fund Rebates 101: What Every Australian Needs to Know Exploring the realm of health insurance can be like navigating a labyrinth, replete with complex terms and varying policies. Among these, health fund rebates emerge as a crucial element, particularly for young Australians embarking on their journey of health coverage. Fund rebates can significantly lighten the financial burden, transforming the quest for health insurance from daunting to empowering. - read more
|
How to Choose the Best Family Health Cover for Your Needs With healthcare being a critical aspect of every family's well-being in Australia, securing the right family health insurance is not just a necessity but a responsibility. Recognizing the importance of this safety net is the first step towards safeguarding the future health needs of your loved ones. Balancing comprehensive coverage against affordable premiums can seem overwhelming with a multitude of plans available. - read more
|