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AFCA Sides with Homeowners in Landmark Insurance Dispute Over Property Cracks

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Homeowners recently secured a favourable ruling against their insurer after a water leak led to significant structural damage.

After large cracks emerged on their property, Youi initially denied the insurance claim, attributing the damage to pre-existing issues like earth movement and tree root intrusion, both of which are exclusions in their policy.

Challenging Youi's stance, the homeowners took their dispute to the Australian Financial Complaints Authority (AFCA), which ultimately supported their case. The complainants argued that the damage, discovered shortly after the pipe leak in early 2023, was directly linked to the water escape.

An assessment by Youi's engineer had attributed the damage to ineffective drainage and was compounded by factors like inadequate footings and proximity to large trees. However, the homeowners countered this with their own engineer's assessment, indicating that the most severe damage occurred precisely where the leaked water had pooled, suggesting a strong correlation with the pipe burst rather than tree-induced movement.

AFCA emphasized the insurer's burden to establish that exclusions apply, noting Youi's lack of compelling evidence in their conclusions. The ombudsman's analysis favoured the complainants' expert findings, discounting the earth movement exclusion as unfounded given that the primary cause was the water leak.

The resolution mandates that Youi settle the claim, including coverage for temporary accommodations if necessary. Additionally, the insurer is required to compensate the homeowners with $1060 for professional fees alongside $4000 for non-financial losses, largely due to the distress caused by Youi's initial refusal to renew their policies. This decision was partly attributed to the insurer's premature policy termination despite the unresolved claim and ongoing case which involved credible external expert evaluations.

This development underscores the critical role of AFCA in ensuring that insurers adhere to fair practices and underscores the importance of homeowners closely documenting damage events to support their claims effectively.

The decision not only marks a significant outcome for consumer rights but also serves as a cautionary tale for insurers about the importance of comprehensive, evidence-based assessments before claim denial.

Published:Tuesday, 22nd Apr 2025
Source: Paige Estritori

Please Note: If this information affects you, seek advice from a licensed professional.

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Knowledgebase

Incontestability Clause:
A provision in a life insurance policy that prevents the insurer from voiding coverage due to a misstatement by the insured after a certain period.

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