Recent Claims and Outcomes

Type of Claim: Fire

Details: The house along with the majority of the contents were destroyed in the fire

Complaint: The builder appointed by the insurer did not document all the fire damage as a result the scope of works was inadequate and the cost to rebuild the house was under quoted. The contents were also not fully documented by the insurance adjuster and would have been settled for a much lesser amount. The insurer was not initially willing to appoint an engineer to advise on the damage and the scope of works.

Outcome: Through our skills in interpreting policy conditions a cash settlement of $390,771 for the building and $35,221 for the contents was achieved.

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Type of Claim: Escape of Liquid    

Details: Bathroom damaged as a result of a bathroom breecher leak

Complaint: The claim was denied by the insurer due to the policy exclusion “loss or damage caused by any gradual escape of liquid”

Outcome: Following our experience in lodging disputes with the Australian Financial Complaints Authority it was established that the insurer had no evidence that the loss was caused by the gradual escape of liquid. A cash settlement of $28,000 plus interest was awarded.

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Type of Claim: Fire

Details: Fire badly damaged the house

Complaint: The insurer wanted to repair the house that was so badly damaged the only sensible outcome was to demolish the house and rebuild it.

Outcome: After engaging many experts, interpreting policy conditions and lodging the claim with the Financial Ombudsman Service a cash settlement of $307,000 was awarded which was the sum insured.

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Type of Claim: Escape of Liquid

Details: A plumber identified leaking pipes underground suspecting they were the cause of cracking to the house

Complaint: The claim was denied by the insurer due to the policy exclusion “settling, shrinkage or any movement of earth”.

Outcome: After engaging an engineer who identified the cause of the damage to the house as the leaking pipes a cash settlement of $65,857 to repair the cracking damage was paid by the insurer.  

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Type of Claim: Escape of Liquid

Details: A lot of cracking damage had been sustained to the house which was suspected to be caused by leaking pipes  

Complaint: The claim was denied because in the insurer’s engineer’s opinion the cause of the cracking was due to tree induced drying on reactive foundation soils and there was nothing to suggest leaking pipes had adversely affected foundation soil moisture conditions. As a result, the insurer did not want to engage a plumber to investigate.

Outcome: Once we took over the conduct of the claim a plumber was engaged who found major water leaks in sewer and stormwater drains. Expert reports were gained resulting in the awarding of a cash settlement by the Financial Ombudsman Service of $100,304 for the repairs to the house.

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Type of Claim: Theft

Details: A fence and letter box had been stolen from the insured’s property while the property was unoccupied.

Complaint: The insurance company appointed a private investigator and the insured was worried about the proposition of an interview and that his claim might be denied due in part to the unoccupancy of the property at the time of the theft.

Outcome: We became an advocate for the insured at the interview and our experience in interpreting policy conditions and our investigation skills meant we were able to justify that the claim fitted the terms of the policy. The claim was accepted and a settlement of $6,741.47 was made to replace the fence and letterbox.             

                                                                                                                                                                                              

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