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Goat hell: claimant refused to cooperate over 'unusual' claim

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A Suncorp motor policyholder who says his car was possibly damaged by his neighbour’s goats but refused multiple requests for more information to help the insurer with its investigation into his claim has lost his dispute before the Australian Financial Complaints Authority (AFCA).

The insurer opened an investigation after the claim was lodged in December last year, citing what it says were “unusual” circumstances that gave rise to the incident since the policyholder said the goats climbed on the vehicle.

Suncorp appointed an independent external investigator in January this year to look further into the claim. The policyholder insured his vehicle for an agreed value of $72,500.

The policyholder declined a request from the insurer that he be interviewed by the investigator and also refused to have the car available for forensic assessment at the insurer’s assessment centre.

Suncorp subsequently sent a follow-up letter to the policyholder in February, referring to its earlier mail the previous month requesting him to make himself available for an interview with the external investigator and to allow the insurer’s assessor examine the car.

The letter also referred to the product disclosure statement (PDS) and Insurance Contracts Act, explaining among other things, that a customer has to co-operate at all times when making a claim. This includes providing all proof, assistance and information when requested.

“As part of the investigation the insurer requested information that it consider was relevant to the claim,” AFCA says in its ruling of the dispute, adding the “insurer investigated the claim to the best of its ability".

“The complainant has been given sufficient time to provide the information requested and, in the circumstances, it would be unreasonable and unfair to require the insurer to meet the complainant’s claim.

“I am satisfied that the insurer acted in a timely manner and that the delays that occurred were as the result of the complainant’s failure to cooperate.”

AFCA says the insurer’s request for information was “reasonable” in light of the circumstances surrounding the incident.

Suncorp was not able to examine the vehicle until after it had cancelled the policy on March 9 and declined the claim.

The insurer sent a letter on March 2 to the policyholder, informing him that failure to provide the information requested amounted to a breach of the Insurance Contracts Act and advised him that the cover would be cancelled in accordance with the provisions provided by the law.

In the letter the insurer also said it would allow him to provide the information if he does decide to cooperate in the future.

He subsequently allowed the vehicle to be taken to the insurer’s assessment centre, where impact and old damage was found.

Suncorp in May asked for more information including his financial records, driving history and mobile phone call charge records.

While some information was provided, it was insufficient and on June 22 the insurer wrote to inform him after reviewing the claim, it was reducing the liability of the claim to nil on the basis that the complainant had not cooperated.

Click here for the ruling.