Insurer Must Pay After Unfounded Fraud Allegations
Insurer Must Pay After Unfounded Fraud Allegations
The information on this website is general in nature and does not take into account your objectives, financial situation, or needs. Consider seeking personal advice from a licensed adviser before acting on any information.
A leading insurance company has been ordered to cover a fire damage claim submitted by a policyholder who passed away from cancer two years ago, highlighting the consequences of unjust fraud accusations.
The claim was initially submitted in January 2022 for damage incurred to the man’s remote metal home in New South Wales. The insurer denied the claim on the grounds that the property was fraudulently misrepresented in terms of its status and functionality.
The policyholder, under heavy medication due to his illness, was questioned by the insurance company’s investigators. Unfortunately, he passed away roughly five months following the submission of the insurance claim. His estate's executor took over the complaint afterwards.
Recently, the Australian Financial Complaints Authority (AFCA) determined that the insurer, IAG, did not provide adequate evidence showing that the policyholder had breached his disclosure commitments. Thus, they must honour the claim.
According to AFCA, “Even if there had been a breach, the insurer has not convincingly shown that it resulted in the renewal of the policy when it would not have been otherwise. Thus, it is fair that the insurer accepts the claim.”
AFCA pointed out that IAG did not submit a declaration from its underwriters to either prove it would not have undertaken or renewed the policy. Despite cautions regarding potential adverse inferences, the insurer failed to provide necessary documentation on its underwriting practices pertaining to this case.
Originally, IAG contended that the policyholder had wrongly described the condition of his property upon policy initiation in October 2019, claiming it was watertight, structurally sound, secure, well-maintained, and inclusive of functional kitchen and bathroom facilities, and specifying its construction date as approximately 2019.
The policy contained a clause explicitly stating, “We don’t insure buildings under initial construction.”
AFCA’s investigation found that, as of the relevant policy renewal date in October 2021, the property's construction was completed, and it had been continuously occupied for over a year, meeting structural and maintenance codes.
“Each renewal constituted a new insurance contract,” the ombudsman declared.
Moreover, AFCA emphasized that the allegation of fraud, which carries grave implications, wasn’t sufficiently supported given that for a misrepresentation to amount to fraud, it must be made either knowingly or recklessly.
EVEN if I had determined that the policyholder breached the disclosure duty-which I have not-the insurer did not provide necessary proof to show it would not have entered the 2021-22 policy period without the alleged breach,” AFCA noted.
In their ruling, AFCA also highlighted the insurance contract and product disclosure statements omitted critical information regarding the duty to avoid misrepresentation, relevant disclosure duties, or consequences of any such breaches.
For more information on the ruling, it can be reviewed here.
This article has been adapted from one originally published by Insurance News Magazine.
Please Note: We do not endorse any specific products or companies. Some content is sourced from third parties, including press releases, and may not be independently verified for accuracy or completeness.
Australia’s winter school holiday rush has put travel insurance back in the spotlight, with families heading to Bali, Fiji and Thailand, skiers travelling to New Zealand and domestic holidaymakers chasing either snow or sunshine closer to home. But this year’s peak period is unfolding against a more unsettled backdrop: geopolitical tension, airspace closures, airline disruption and a growing expectation that insurers should do more than reimburse costs after the event. - read more
The latest scrutiny of strata insurance arrangements is a timely reminder that insurance governance is no longer a back-office issue for property professionals. On 30 June 2026, the Insurance Brokers Code Compliance Committee released findings from a review of broker-agent arrangements in strata insurance. The review examined seven brokers with 1,088 strata representatives and identified weaknesses across representative agreements, remuneration disclosure, conflict management and oversight of conduct. - read more
Australia’s commercial insurance market may be softening on the surface, but the latest industry commentary suggests small businesses should be cautious about assuming every policy will automatically become cheaper. The emerging message is that the old idea of a single hard or soft insurance market is giving way to a more targeted pricing environment, where insurers assess each line of cover, occupation, location and claims history in much greater detail. - read more
Australian hospitality operators have another liability option to watch, after Haven Underwriting added broadform liability cover to its product line-up, backed by capacity from Mitsui Sumitomo Insurance. The product is aimed at several customer groups, including cafés, restaurants, wine bars and associated hospitality risks, with a stated limit of up to $20 million per policy. - read more
The ACCC’s fifth and final insurance monitoring report has given strata committees in cyclone-exposed regions a clearer view of what the Cyclone Reinsurance Pool is-and is not-achieving. Released on 25 June 2026, the report found that the pool has helped reduce or moderate premiums for policyholders in higher cyclone-risk areas, including residential strata schemes. - read more
Public liability insurance is a type of insurance policy that provides coverage for businesses and individuals against claims made by third parties for injuries or damages sustained while on their property or as a result of their activities. - read more
Running a business comes with inherent financial risks. Whether you own a small café or a large construction company, unforeseen incidents can lead to significant financial losses. - read more
The Australian labour hire industry has seen a significant rise in recent years, and with this growth, comes new and unique risks that companies in this industry must be prepared to navigate. One such risk is the potential for accidents or damages to occur in the workplace, which is where public liability insurance comes in. This article will explore the definition of public liability insurance and why it is so important for labour hire companies in Australia. - read more
For tradesmen and trade professionals, venturing into the world of business comes with its set of challenges and risks. Among the myriad of precautions to consider, one critical safeguard stands out for its ability to protect both the tradesperson and their clients: Public Liability Insurance. This form of coverage is not just a safety net; it is a cornerstone of a responsible business practice within the trade industry. - read more
Running a small business in Australia comes with its own set of challenges and risks. One crucial aspect that should never be overlooked is insurance, particularly public liability insurance. The reason is simple: it offers essential protection against claims of property damage or personal injury caused by your business operations. - read more
Start Here !
Knowledgebase
Exclusion: Specific conditions or circumstances for which the insurance policy does not provide coverage.
No comments yet. Be the first to share your thoughts.