Published on May 21st 2021 in

AFCA denied claim over false disclosure

A woman whose claim for damage to her vehicle following a collision with several kangaroos was declined because she failed to comply with her duty of disclosure has lost her dispute with the insurer.

The woman says Auto & General Services should have indemnified her for the loss since she was not at fault in her previous four motor claims and the demerit points she had accrued within a so-called double demerit period did not make her a higher risk.

She also claimed she was on various medications that affected her ability to remember but did not provide any medical records to support her defence. In answering “no” to questions about her motor claims history in the last five years regardless of who was at fault and driving demerit points chalked up in the last three years, she failed in her disclosure duty, the Australian Financial Complaints Authority (AFCA) ruled.

Auto & General had put the specific questions to the woman when she applied online for her motor policy. AFCA says there is no dispute the woman answered “no” to the questions asked, had four motor claims in the last four years and had reached the maximum driving licence demerit points in the last three years and had opted for a good behaviour bond.

“The questions were clear and unambiguous,” AFCA says in its ruling. “[For] the claims history, the question clearly included claims where the complainant was not at fault. Regarding the demerit points, this specifically asked whether she reached the maximum driving licence demerit points. Therefore, I accept the insurer has shown it has been prejudiced to the full extent of the claim.”

According to AFCA, the information provided showed the insurer had clearly informed the woman of her duty of disclosure and, had she complied, the insurer would not have accepted the risk. Auto & General provided a copy of its underwriting guidelines at the time of the woman’s application for the policy and also a statutory declaration from its motor underwriting manager to confirm that cover would have been denied had she accurately answered the questions.

It also submitted a copy of the relevant screenshots of the application process that would have been presented to the complainant when she applied for the policy.

One of the screen shots contained information about the duty of disclosure and the risk of having a policy cancelled or size of claim payout reduced if an applicant does not tell the insurer anything he or she is required to reveal.

“The complainant does not dispute the insurer’s screenshots accurately represent this process,” AFCA said. “I am satisfied this clearly explains the general nature and effect of the duty of disclosure. Also, it shows the complainant could not proceed without pressing the button ‘I Agree & Continue’.”

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