Vulnerable claimant wins payout after storm damage dispute
The industry ombudsman has told Auto & General to accept a vulnerable homeowner’s claim for a collapsed ceiling after finding a storm caused the loss.
The claimant contacted the insurer in September 2024 after hearing cracking sounds in his ceiling.
Auto & General inspected and found the lounge room ceiling had collapsed, plus cracking and sagging in the kitchen ceiling.
The insurer’s notes also indicated damage to several roof tiles and cracking in gutter cement and ridge capping.
Auto & General’s assessor initially concluded the ceiling damage was caused by strong wind and heavy rain that entered through the broken roof tiles.
The insurer accepted a separate claim for storm damage to a window shutter.
However, after receiving new reports, it suggested the ceiling collapse was caused by the failure of nail fixings rather than water damage.
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It noted a lack of damage to the lounge room’s plasterboard and insulation as indicators the loss was caused by nail fixings failing, which would not be covered.
It also referenced Bureau of Meteorology data showing light rainfall and wind at a weather station about 10km from the insured property on the day of the reported storm.
In a dispute ruling, the Australian Financial Complaints Authority says the loss was probably caused by a storm, noting the insurer did not deny “a storm event” occurred.
If the damage was “due to the failure of the screws and nails, the whole property would likely be affected.
“The damage being limited to the kitchen, hallway and lounge room is more consistent with water ingress in that area.”
The complainant also reported suffering distress after the insurer’s agents referred him to a community service provider and allegedly told him to “have an afternoon nap” following the claim denial.
AFCA acknowledges there was no recording of this incident but says the referral to the support service was in line with industry obligations for vulnerable policyholders.
It notes the insurer has waived a $2000 excess, and this would exceed any compensation it might have awarded for non-financial loss.
See the ruling here.