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

AFCA Upholds Insurance Fraud Ruling Over Disputed Possum Accident AFCA Upholds Insurance Fraud Ruling Over Disputed Possum Accident
26 Jun 2025: Paige Estritori

A motorist's claim that he crashed into a tree to avoid a possum has been denied by the Australian Financial Complaints Authority (AFCA), which supported the insurer's fraud decision. The incident involved the driver crashing his Jeep—insured for over $20,000—on a dimly-lit street, purportedly avoiding the rain-soaked motorway en route to the store. - read more
Code Watchdog Criticises Insurer for Misleading Rejection Letters Code Watchdog Criticises Insurer for Misleading Rejection Letters
24 Jun 2025: Paige Estritori

The Life Code Compliance Committee has recently reprimanded a life insurance provider for issuing misleading rejection letters to policy applicants. These letters were deemed 'ambiguous and contradictory' and failed to clearly inform applicants of their review options after being denied coverage. - read more
Insurer Ordered to Pay Full Claim for Confusing Patio Coverage Insurer Ordered to Pay Full Claim for Confusing Patio Coverage
23 Jun 2025: Paige Estritori

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. - read more
Australia Sees Dramatic Drop in Catastrophe Losses Australia Sees Dramatic Drop in Catastrophe Losses
23 Jun 2025: Paige Estritori

Last year saw Australia's insured catastrophe losses plummet to just $500 million, marking the lowest level since 2004, according to Aon's latest Climate and Catastrophe Insight report. Notably, the Insurance Council of Australia reported no disasters for the year, a situation not seen since 1982. This comes in stark contrast to 2023, when disaster-related insured losses soared to over $3.6 billion. - read more


Business Insurance Articles

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
Critical Risk Management Strategies for Every Australian Tradesman Critical Risk Management Strategies for Every Australian Tradesman
Welcome to the crucial world of risk management for Australian tradesmen. Whether you're a seasoned professional or just starting, understanding and mitigating the inherent risks in the trades industry is paramount to both the safety and sustainability of your business. This article intends to guide you through the world of risk management, emphasizing the pivotal role of liability insurance. - read more
The Role of Insurance in Protecting Your Small Business Assets The Role of Insurance in Protecting Your Small Business Assets
In the bustling world of small businesses, the phrase 'expect the unexpected' captures the essence of entrepreneurship. While you can plan for success, unforeseen risks are always lurking around the corner. That's where the importance of insurance comes into play. It acts as a safeguard, protecting the lifeblood of your business against potential perils. - 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
How to Lower Public Liability Insurance Premiums Without Sacrificing Coverage How to Lower Public Liability Insurance Premiums Without Sacrificing Coverage
In the ever-evolving landscape of Australian commerce, business insurance stands as a crucial bulwark, safeguarding enterprises against unforeseen financial perils. Recognizing this, our in-depth exploration begins with an overview of the monumental role business insurance plays for Australian companies, both large and small. It's a cornerstone for risk management, providing business owners with peace of mind as they navigate the intricacies of their industries. - 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
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 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


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
Trauma Insurance:
An insurance that pays a lump-sum amount on the diagnosis of one of several critical illnesses or events