A home and contents insurer is not required to confirm that its accidental damage protection will cover the actions of a policyholder with advanced dementia, the industry ombudsman has ruled.

The decision comes after a man whose mother had the condition asked RACV Insurance to state upfront that it would generally regard damage caused by her as unintentional, “subject to the specific circumstances surrounding a claim”.

The insurer declined to provide that assurance, saying claims were assessed on a case-by-case basis and its policy contained no specific exclusions relating to disability or cognitive impairment.

An AFCA member has backed this stance, saying insurers are not required to provide interpretations or commitments beyond the terms of their policies before a claim is made.

“I accept the policy applies on its terms and assessment of the facts of a claim is required when it occurs,” the adjudicator said.

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“This would include an assessment of whether the damage was unintentional, which will depend on how the loss occurred and may include consideration of a person’s mental state and intention if relevant.”

The son argued the issue was of wider public interest, because many elderly insureds had dementia and their families and carers needed certainty about what was covered.

However, AFCA says it cannot compel the insurer to commit to additional policy terms or provide assurances about hypothetical future claims.

The determination also considered the insurer’s communications, after the son requested contact by email because phone calls distressed his mother.

AFCA says the insurer “could have been more accommodating” once it became aware of the family’s circumstances, but its overall handling was reasonable and does not warrant compensation.

See the ruling here.