NCR AFCA
Published on June 10th 2020 in

AFCA supports insurer in questionable claim

A motor insurance customer has lost a dispute over damage to her car following a hailstorm after investigators found that almost half the dents appeared to have been made using a tool.

The woman lodged a claim with IAG in December 2018 for hail damage to her vehicle, which was only one year old. However, the insurer appointed an expert who confirmed that of 295 dents, only 162 were caused by hail. The remaining 133 dents had a scratch or marking or significant point – which was not consistent with hail damage.

IAG paid more than $2,500 to the claimant for the genuine hail damage, but she disputed the outcome and took her case to the Australian Financial Complaints Authority (AFCA), also alleging that her car was further damaged while being assessed. However, AFCA backed the insurer’s stance and agreed the other dents were not caused by hail but “by other means”.

“The insurer also noted that it did consider whether the non-hail damage may have resulted from other events covered by the policy,” it said in a determination.

“However, the insurer said that the 133 dents (not caused by hail) were caused on multiple panels of the car with a tool or rigid object. Therefore, the insurer was unable to accept the damage occurred accidentally. The insurer is entitled to deny the complainant’s claim for the cost of repair of the remaining 133 dents.”

AFCA also said the complainant did not provide evidence that her car was damaged while being assessed by the insurer. “The insurer is not responsible for the alleged damage to the car.”

Visit https://service02.afca.org.au/CaseFiles/FOSSIC/658103.pdf for the full ruling.

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