Insurance Dispute Settled with New Rulings

2

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 issue arose when the claimant noticed a malfunction in her dishwasher as early as April of the previous year and filed a claim in September. However, Strata Community Insurance Agencies challenged the claim arguing that the damage might engage exclusions pertaining to rodent activity.

Central to this case was a tax invoice detailing observations from a visiting plumber. According to the original report, the plumber suspected damage caused by rodents chewing on the hose. Yet, the said invoice was later altered to omit this suspicion, raising further questions about motive and clarity.

Further dialogue between the plumber and the insurer's representative disclosed that changes to the invoice were requested by the policyholder. Additionally, alternative explanations surfaced, such as potential damage from consistent interaction of the hose with the access hole each time the machine was used. The plumber did not exclude the possibility of continuous friction contributing to the damage.

The insurance provider's expert, however, observed extensive damage on the hose but reported an absence of signs that typical wear and tear would leave. The expert concluded that the use of the dishwasher was unlikely to generate sufficient force to result in such severe damage. They further stated that the condition of the hose strongly indicated rodent activity as initially suggested by the plumber.

During the dispute resolution hearing, the Australian Financial Complaints Authority evaluated the matter. They acknowledged the customer's view disputing the expert judgment but emphasized her failure to present any compelling evidence to counter the presented arguments.

The authority, after reviewing the diverse perspectives and the expert observations, ruled in favor of accepting the view that rodents were probably the primary cause of the damage. While this event originally triggered policy coverage, the clauses excluding rodent damage ultimately prevailed to deny the claim.

Echoing this outcome, an ombudsman for the AFCA commented, “I am satisfied, without evidence to contrary, it is fair that the insurer be permitted to rely on the opinions provided by the appointed consultants.” This position emphasizes the criticality of providing concrete evidence when challenging an insurer's expert analysis.

This case serves as a compelling reminder for policyholders of the complexities and critical nuances involved in insurance claims, especially those involving ambiguous causes like rodent activity. It underscores the importance of detailed documentation and professional assessments when navigating through such disputes.

Published:Thursday, 7th Nov 2024
Source: Paige Estritori

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

Share this news item:

Insurance News

Clear

Inattention and Speed: Key Factors in Major Truck Crashes

28 Jan 2026: Paige Estritori

The National Truck Accident Research Centre (NTARC) has released its latest Major Incident Investigation Report, shedding light on the predominant causes of significant truck crashes across Australia. The findings reveal that human factors, particularly inattention, distraction, and inappropriate speed, continue to be the leading contributors to these incidents. - read more

TAL's Health Sense Plus Now Covers Income Protection Policies

27 Jan 2026: Paige Estritori

In a strategic move to enhance the value of its offerings, TAL has announced the expansion of its Health Sense Plus program to encompass income protection insurance. This initiative, effective from 8 August 2025, aims to incentivise proactive health management among policyholders by providing premium discounts. - read more

Rising Mental Health Claims Reshape Australia's Insurance Landscape

27 Jan 2026: Paige Estritori

Australia's insurance sector is experiencing a significant shift as mental health conditions become the predominant cause of total and permanent disability (TPD) claims. Recent data from the Council of Australian Life Insurers (CALI) indicates that mental health issues now account for nearly one-third of all TPD claims, marking a substantial change in the industry's claim patterns. - read more

APRA Calls for Reforms in Income Protection Insurance Sector

27 Jan 2026: Paige Estritori

The Australian Prudential Regulation Authority (APRA) has raised concerns about the sustainability of income protection insurance, following industry losses amounting to $2.5 billion over five years. APRA has urged life insurers to implement reforms to enhance the viability of these products and ensure they continue to meet policyholders' needs. - read more

Marinex Underwriting Sets Sail in Australian Marine Insurance Market

27 Jan 2026: Paige Estritori

In a significant development for Australia's marine insurance sector, Rhodian Group has announced the launch of Marinex Underwriting, a new agency dedicated to providing specialised marine insurance products tailored to the Australian market. This initiative marks Rhodian's third agency launch, following the establishment of Halo Underwriting and Batch Underwriting in previous years. - read more

Click for more Insurance News