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.

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.

Published:Wednesday, 3rd Jul 2024
Author: Paige Estritori

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.

Share this news item:

Insurance News

Clear

Why Climate Risk Is Back on the Truck Insurance Agenda

13 Aug 2026: Paige Estritori

A fresh round of insurance industry warnings about climate exposure is a timely reminder for Australian truck operators that weather risk is no longer a background issue. Floods, bushfires, severe storms and prolonged road closures can affect far more than a single damaged vehicle. For owner-drivers and fleet managers, the larger concern is often the chain reaction: stranded equipment, missed delivery windows, cargo complications, depot damage and extended downtime while repair networks are under pressure. - read more

Affordability Pressure Puts Trade Cover Back Under the Spotlight

13 Aug 2026: Paige Estritori

Fresh industry attention on insurance affordability is more than a household budget story. For Australian tradespeople, rising premiums, higher repair costs and uneven disaster exposure can flow directly into how clients fund work, how projects are scoped and how small trade businesses protect their own equipment, vehicles and liability risks. - read more

Why Claim Clarity Matters More Than Ever for Income Insurance

13 Aug 2026: Paige Estritori

Recent complaints reporting from Australia's financial dispute resolution system has put a practical issue back in front of workers: the value of income insurance is not only in the monthly benefit promised, but in how clearly a policy works when a claim is made. - read more

What electronic work diaries mean for truck insurance

13 Aug 2026: Paige Estritori

Recent transport industry coverage has again put electronic work diaries in the spotlight, as more heavy vehicle operators look for practical ways to manage fatigue obligations without relying solely on paper records. For Australian trucking businesses, the shift is more than an administrative upgrade. It has direct implications for compliance evidence, driver management, incident investigation and the way insurers assess operational risk. - read more

Life Code Findings Put Income Protection Claims Back Under the Microscope

12 Aug 2026: Paige Estritori

The latest industry attention on Life Insurance Code compliance is another reminder that income protection insurance is not just about having a policy in place. For working Australians, the real test comes when illness or injury interrupts earnings and a claim needs to move from paperwork to practical financial support. - read more

Click for more Insurance News