The financial services ombudsman has allowed QBE to pause a vehicle damage claim until its policyholder provides more information, but it says the insurer’s fraud allegation remains unproven. 

A company lodged the claim, saying its director accidentally drove its Audi into another vehicle in June 2023.  

But QBE said the claim was fraudulent, arguing the insured’s account of the crash lacked “credible circumstances consistent with known and confirmed evidence”.

The insurer flagged “serious concerns” with the director’s credibility, noting he failed to provide information on the friend he was visiting and that he gave several contradictory times for leaving his home and the time of the crash.  

QBE pointed to financial motives for faking the claim, given the vehicle was insured for $25,800.  

It said the claimant unreasonably refused to provide bank and phone records, which “bears unfavourably on the complainant’s credibility”.  

A mechanical engineer said the insured vehicle appeared poorly maintained and that photos of the third-party car suggested it was damaged by a pole rather than a vehicle collision.  

The director took his case to the Australian Financial Complaints Authority, saying the insurer’s requests were unreasonable and irrelevant to the loss, given the third party had accepted fault.  

He argued “little weight” should be given to the engineer’s report because they had not inspected the accident site and relied on low-quality photos of the third-party vehicle.  

AFCA says there is not enough information to show the claim was fraudulent, noting the director had a stable income and the insurer’s assessor indicated the damage was “consistent with one impact and claim circumstances”.  

It says the insurer should reinstate the man’s policy and reopen the claim.  

However, the authority says the claimant should comply with QBE’s requests for bank and phone records, which are relevant to its assessment of liability and investigation into financial motives.  

Until this happens, QBE is not required to proceed with the claim.  

The policyholder also complained about the insurer’s decision to sell the Audi at auction for $900. The director said this was done without his consent and it sold below the salvage value of $1500.  

QBE said it told the man he was responsible for picking up the vehicle and he had not done so for several months.  

AFCA agrees the complainant was given reasonable time to collect the car, so no compensation is required. It says the insured should receive the $900 sale proceeds if the claim is denied.   

Click here for the ruling.