Liability Insurance :: News
SHARE

Share this news item!

Insurer Ordered to Pay Full Claim for Confusing Patio Coverage

Insurer Ordered to Pay Full Claim for Confusing Patio Coverage

Insurer Ordered to Pay Full Claim for Confusing Patio Coverage?w=400
A recent ruling mandates that an insurer must fully honor a storm-related claim due to ambiguous policy wording regarding items in open areas.
The Australian Financial Complaints Authority (AFCA) determined that the insurer's restriction on coverage for items in a patio area was unfounded, as the policy's phrasing was not clear.

The complainant had argued that the storm-damaged items on the patio were enclosed enough to avoid the "open air" restriction, but the AFCA found the blinds in place did not ensure an enclosed space, lacking proper lockability. However, the authority noted the policy's language was not explicit in imposing the 10% limitation due to its placement under "additional benefits," which suggested the opposite of a restriction.

Moreover, the AFCA criticized the insurer for failing to present evidence that the policyholder neglected reasonable care of the items. In acknowledging the complainant's hardships, AFCA highlighted that the year-long exposure to mould had affected living conditions, despite the insurer disputing health impacts.

As part of the resolution, AFCA instructed a $4000 payment for non-financial losses, emphasizing that proof of health issues was unnecessary to confirm that the claimant's peace of mind had been compromised. The requirement for the insurer now includes engaging an expert for a comprehensive assessment of the storm and mould damage.

While the insurer can deduct the $1558 already issued as an ex-gratia payment and any policy excess, the decision underscores the necessity of precise and consumer-friendly contract wording to avoid customer disputes.

This case serves as a critical reminder for insurance companies to adopt straightforward language and place important limitations in unambiguous policy sections. As companies reassess contract terms, consumers might see increased clarity in coverage options, potentially averting future misunderstandings.

Published:Monday, 23rd Jun 2025
Source: Paige Estritori

Share this news item:

Insurance News

Impact of Trump Tariffs on Global Insurance Industry Impact of Trump Tariffs on Global Insurance Industry
11 Jul 2025: Paige Estritori

According to Swiss Re’s latest Sigma report, the growth of property and casualty premiums is moderating in both Australia and globally. This moderation is primarily driven by a slowdown in rate hikes. Additionally, the Trump administration's America First trade policy is putting further pressure on the insurance sector. - read more
Navigating Changes in Australia's Life Insurance Advice Landscape Navigating Changes in Australia's Life Insurance Advice Landscape
10 Jul 2025: Paige Estritori

The conversation on the shifting dynamics in Australia's life insurance advice sector featured Zurich Australia's head of adviser channel, Kieran Forde, and Hayes & Co director, Katherine Hayes. They engaged with editor Chris Dastoor to spotlight the current market conditions and future prospects for financial advisers in this domain. - read more
ASIC Challenges Federal Court's 'Fair Term' Ruling ASIC Challenges Federal Court's 'Fair Term' Ruling
09 Jul 2025: Paige Estritori

The Australian Securities and Investments Commission (ASIC) is appealing a Federal Court decision regarding the wording of a 'pre-existing condition' clause in certain HCF Life insurance products. The court previously determined that while the wording had the potential to mislead consumers, it did not constitute an unfair contract term under the current laws set out in the ASIC Act 2001. - read more
ICA Advocates for Strata Law Reform in the ACT to Enhance Building Management ICA Advocates for Strata Law Reform in the ACT to Enhance Building Management
08 Jul 2025: Paige Estritori

The Insurance Council of Australia (ICA) is urging the Australian Capital Territory (ACT) to adopt strata transparency regulations, aiming to enhance oversight of building repairs and maintenance by owners’ committees. This call was made during a parliamentary inquiry, where the ICA pushed for measures akin to recent legislative changes in New South Wales. - read more


Business Insurance Articles

Freelancer or Employee? Understanding the Difference and the Liability Implications Freelancer or Employee? Understanding the Difference and the Liability Implications
The contemporary business landscape in Australia is witnessing a significant shift towards the gig economy, with a growing number of professionals opting for the flexibility and autonomy that freelancing offers. This trend has not only revolutionized the way work is performed but has also introduced new dynamics in the legal distinctions between freelancers and traditional employees. - read more
Professional Indemnity vs Public Liability: What's the Best Choice for Your Small Business? Professional Indemnity vs Public Liability: What's the Best Choice for Your Small Business?
As a small business owner, understanding the intricacies of liability insurance is pivotal to safeguarding the fruit of your hard work. Insurances such as professional indemnity and public liability are not just safety nets; they are vital components that can mean the difference between bouncing back and closing down following unforeseen legal hurdles. - read more
Public Liability Insurance Claims: What to Expect and How to Prepare Public Liability Insurance Claims: What to Expect and How to Prepare
When it comes to navigating the complex waters of insurance, understanding public liability insurance claims is crucial for businesses and individuals alike. Public liability insurance serves as a safeguard, protecting against the financial repercussions that arise from accidents or injuries that occur on your premises or through your operations. In this introductory section, we will delve into the essence of public liability insurance and underline its significance. - read more
How to Choose the Right Public Liability Insurance for Your Business How to Choose the Right Public Liability Insurance for Your Business
Public liability insurance is a key consideration for business owners in Australia. This type of insurance helps protect businesses against claims made by third parties for injuries or property damage. But what exactly does it do? In simple terms, public liability insurance covers legal costs and expenses, as well as any damages awarded, if your business is found liable for an incident. - read more
How to Assess Your Risk Exposure and Select the Right Indemnity Coverage How to Assess Your Risk Exposure and Select the Right Indemnity Coverage
Professional indemnity insurance stands as a pivotal safeguard for Australian professionals navigating the intricacies of liability in their work life. This form of insurance is designed to protect professionals against legal costs and claims for damages arising from acts, omissions, or breaches of professional duty in the course of their practice. Whether it's due to an honest mistake or an unforeseen error, the ramifications of such professional oversights can be financially crippling. - read more
The Cost of Being Uninsured: Why Every Australian Small Business Needs Liability Coverage The Cost of Being Uninsured: Why Every Australian Small Business Needs Liability Coverage
Welcome to the complex world of running a small business in Australia where navigating through liability risks is as crucial as managing daily operations. This article is crafted to illuminate why every Australian small business needs liability coverage — a shield to protect against potential financial catastrophes. - read more
Liability Risks: What Small Businesses in Australia Should Know Liability Risks: What Small Businesses in Australia Should Know
Welcome to our comprehensive guide on liability risks for small businesses in Australia. The world of business is fraught with challenges, and one often overlooked aspect is the array of potential liabilities that can stifle growth or even lead to catastrophic financial loss. It's crucial for small business owners to grasp the critical role that insurance plays in the protection and longevity of their ventures. - read more
The Essential Guide to Liability Insurance for Freelancers The Essential Guide to Liability Insurance for Freelancers
Liability insurance is a type of coverage designed to protect you from claims arising out of injuries or damages to other people or property. For freelancers, who often juggle multiple projects and clients, liability insurance can offer a safety net that reduces financial risk and instability. - read more


Start Here !
Your free liability insurance quote comparison starts here!
Cover Amount:
Postcode:

All quotes are provided free and without obligation. We respect your privacy.

Knowledgebase
Replacement Cost:
The amount it would cost to replace or rebuild an insured asset with one of similar kind and quality, without depreciation.