Decision time: your most read AFCA rulings
Readers of the insuranceNEWS.com.au Daily news service will know that we provide regular summaries of key general insurance industry dispute rulings.
The Australian Financial Complaints Authority (AFCA) tackles about 17,000 general insurance complaints each year, with only a small percentage going all the way to determinations, which are published on its website.
Our summaries are among the most popular stories on our website – and here we provide a catch-up on the top five most-read AFCA rulings of the year so far.
1. Driver who crashed Mercedes after drinking wins repair costs
Disputes about motor insurance claims seem to strike a particular chord with readers.
As many will know, insurers don’t like paying out for damage if the insured has contributed to it through some kind of reckless behaviour.
Motor insurers will therefore often exclude damage caused by drivers being under the influence of alcohol or drugs.
In this case, the driver admitted drinking two whiskies before crashing his Mercedes on the way home, but AFCA found in his favour because Suncorp had not proven that the alcohol had impaired his driving ability.
This despite police reports on the night of “erratic” behaviour and bloodshot eyes.
It didn’t help Suncorp’s case that a breath test carried out at a police station recorded levels just below the legal limit.
2. Dad loses claims dispute after daughter crashes car
Here’s another ruling that hinges on a motor policy exclusion – but this one went in favour of insurer IAG.
The policy excluded drivers under the age of 25, but the insured argued his case after his vehicle was damaged while being driven by his daughter – who was under that age.
His daughter is not an unsafe driver, he said, and a glitch in the online system meant that when the policy was purchased he didn’t have the opportunity to select an optional extra for under 25s.
He also said when he lodged the claim he was told it would be paid.
None of this convinced AFCA, with no evidence supplied to back up claims of a glitch. AFCA says the insurer is also not obliged to pay the claim even if that indication was given in early communications.
3. AFCA rules $227,000 jewellery claim was fraud
Insurance fraud is a major problem, which can inflate claims costs and therefore premiums for all insureds.
But AFCA doesn’t accept fraud allegations lightly, and any insurer looking to decline a claim on this basis had better have the evidence to back it up.
In this case, AFCA agreed that a woman’s claim after an alleged jewellery theft was fraudulent.
Her account of the break-in didn’t tally with the evidence, and two years earlier she’d successfully claimed for a very similar event.
Suncorp was right to decline the claim, AFCA’s ombudsman said.
4. Gone in 90 seconds: insurer wins dispute over theft of unlocked car
If you want your motor insurer to pay a claim, don’t leave your keys in an unattended vehicle.
This type of claim dispute is common, and AFCA usually sides with the insurer.
Such disputes often hinge on the meaning of the word “unattended” – most insurance policies require that the driver be able to observe any interference with the vehicle.
This particular ruling may appear harsh – as the driver left the vehicle for just 90 seconds to go inside and pick up her baby – but AFCA ruled that the policy exclusion was clear and unambiguous.
5. Juice bar theft falls outside policy’s ‘forcible and violent’ coverage terms
This dispute surrounded the circumstances of a break-in, and acts as another reminder to small business owners to check very carefully what they are covered for.
The insured’s policy only covered theft if there was “forcible and violent” entry to the building.
There was no damage to the building and while the business owner suggested a locked box containing a key may have been forced, the box was not available for inspection and AFCA decided that the entry was not “violent” even if it was “forcible”.
The policy required the break-in to be both, so the claim was correctly denied, it said.
