Travel Insurance Online :: News

Share this news item!

Insurer Must Pay After Unfounded Fraud Allegations

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.

A leading insurance company has been ordered to cover a fire damage claim submitted by a policyholder who passed away from cancer two years ago, highlighting the consequences of unjust fraud accusations.

The claim was initially submitted in January 2022 for damage incurred to the man’s remote metal home in New South Wales. The insurer denied the claim on the grounds that the property was fraudulently misrepresented in terms of its status and functionality.

The policyholder, under heavy medication due to his illness, was questioned by the insurance company’s investigators. Unfortunately, he passed away roughly five months following the submission of the insurance claim. His estate's executor took over the complaint afterwards.

Recently, the Australian Financial Complaints Authority (AFCA) determined that the insurer, IAG, did not provide adequate evidence showing that the policyholder had breached his disclosure commitments. Thus, they must honour the claim.

According to AFCA, “Even if there had been a breach, the insurer has not convincingly shown that it resulted in the renewal of the policy when it would not have been otherwise. Thus, it is fair that the insurer accepts the claim.”

AFCA pointed out that IAG did not submit a declaration from its underwriters to either prove it would not have undertaken or renewed the policy. Despite cautions regarding potential adverse inferences, the insurer failed to provide necessary documentation on its underwriting practices pertaining to this case.

Originally, IAG contended that the policyholder had wrongly described the condition of his property upon policy initiation in October 2019, claiming it was watertight, structurally sound, secure, well-maintained, and inclusive of functional kitchen and bathroom facilities, and specifying its construction date as approximately 2019.

The policy contained a clause explicitly stating, “We don’t insure buildings under initial construction.”

AFCA’s investigation found that, as of the relevant policy renewal date in October 2021, the property's construction was completed, and it had been continuously occupied for over a year, meeting structural and maintenance codes.

“Each renewal constituted a new insurance contract,” the ombudsman declared.

Moreover, AFCA emphasized that the allegation of fraud, which carries grave implications, wasn’t sufficiently supported given that for a misrepresentation to amount to fraud, it must be made either knowingly or recklessly.

EVEN if I had determined that the policyholder breached the disclosure duty-which I have not-the insurer did not provide necessary proof to show it would not have entered the 2021-22 policy period without the alleged breach,” AFCA noted.

In their ruling, AFCA also highlighted the insurance contract and product disclosure statements omitted critical information regarding the duty to avoid misrepresentation, relevant disclosure duties, or consequences of any such breaches.

For more information on the ruling, it can be reviewed here.

This article has been adapted from one originally published by Insurance News Magazine.

Published:Wednesday, 3rd Jul 2024
Source: Paige Estritori

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

Share this news item:

Insurance News

Medical Emergencies Lead Australian Travel Insurance Claims in 2024

28 Nov 2025: Paige Estritori

In 2024, medical incidents emerged as the leading cause of travel insurance claims among Australian travellers, accounting for more than 40% of all claims handled by nib Travel. This trend underscores the critical importance of securing comprehensive travel insurance to mitigate the financial risks associated with medical emergencies abroad. - read more

Allianz Partners Highlights Risks of Travelling Uninsured

12 Nov 2025: Paige Estritori

Recent research conducted by the Insurance Council of Australia (ICA) and the Department of Foreign Affairs and Trade (DFAT) has unveiled a concerning trend: approximately 14% of Australian travellers embark on international journeys without any form of travel insurance. This statistic has prompted Allianz Partners to urge Australians to reconsider the importance of securing adequate coverage before travelling abroad. - read more

Unveiling Hidden Exclusions in Travel Insurance Policies

12 Nov 2025: Paige Estritori

Australian travellers are being urged to carefully review their travel insurance policies to identify potential exclusions that could affect their coverage. Legal expert Peter Carter from Carter Capner Law highlights that certain activities, such as riding motorbikes or jet skis and consuming alcohol, are often classified as high-risk by insurers. Incidents occurring during these activities may lead to claim rejections. - read more

Qantas Travel Insurance Honoured with Mozo Experts Choice Award 2024

04 Nov 2025: Paige Estritori

Qantas Travel Insurance has been recognised in the 2024 Mozo Experts Choice Awards for Travel Insurance, showcasing its exceptional value for their Annual Multi Trip Travel Insurance policy. - read more

SCTI Highlights Top 10 Costliest Travel Insurance Claims of 2024

04 Nov 2025: Paige Estritori

Southern Cross Travel Insurance (SCTI) has unveiled its top 10 most expensive international travel claims made by Australian travellers in 2024, shedding light on the significant financial risks associated with unforeseen incidents abroad. - read more

Click for more Insurance News

Travel Insurance Articles

How to Ensure Your Travel Insurance Covers Your Next Adventure Sport

Australians are known for their adventurous spirit, often seeking thrills through activities such as bungee jumping, surfing, and skiing. Adventure sports provide an adrenaline rush and an escape from the everyday routine, making them highly appealing to those who crave excitement and challenge. - read more

Clever Ways to Save on Accommodation: Budget Travel Hacks for Aussies

The concept of travel in Australia inherently brings to mind sweeping landscapes, rugged coastlines, and vast outback adventures. For many Australians, the dream of traversing this scenic wonderland is often tempered by the cold reality of expenses, with accommodation often being a prominent budgetary concern. Yet, far from dimming the wanderlust, this challenge invites a more clever approach to journeying through the land Down Under. - read more

The Savvy Traveller's Checklist for Affordable Travel Insurance

Travel insurance is an indispensable component for any savvy traveller from Australia, playing a protective role in a myriad of situations that may occur away from home. Whether it's encountering flight delays, requiring medical assistance, or facing luggage theft, having a solid travel insurance policy can convert potential nightmares into manageable inconveniences. Yet, despite its importance, the process of finding a policy that won't break the bank is increasingly challenging. - read more

From Flight Cancellations to Lost Luggage: Why Travel Insurance is Crucial

Picture this: You're all set for your dream vacation. Suitcases packed, tickets in hand, and the excitement building. But then, an unexpected disappointment hits. Your flight is cancelled. Suddenly, your well-laid plans are thrown into disarray. - read more

10 Common Travel Expense Mistakes and How to Avoid Them

Travel can be an exciting adventure, but it often comes with a myriad of expenses that can quickly add up. From flights and accommodations to meals and entertainment, the costs can take a toll on your budget. - read more

Knowledgebase

Surrender Value:
The amount of money an insurance policyholder will receive if they voluntarily terminate the policy before it matures.

This website is owned and operated by Clark Family Pty Ltd (ACN 010 281 008) as Trustee for the Clark Family Trust (ABN 35 957 893 714), 43 Larch Street Tallebudgera QLD 4228. Clark Family Pty Ltd is an Authorised Representative (AR 1298860) of Unique Group Broker Services Pty Ltd (AFSL 509434) for financial product referrals and an Authorised Credit Representative (ACR 401491) of Saccasan Pty Ltd (ACL 386297). Check our licensing details on the ASIC registers: Clark Family Pty Ltd ACR, Clark Family Pty Ltd AR, Saccasan Pty Ltd, Unique Group Broker Services.

IMPORTANT: We do not provide financial product advice or credit assistance. We act solely as an introducer and refer enquiries to licensed third-party intermediaries, insurers, and lenders - with whom you can then deal directly. We may receive a fee or commission from these third parties in consideration for the referral. Before any action is taken to obtain a product or service referred to by this website, advice should be obtained (from either the third party to whom we refer you or from another qualified intermediary) as to the appropriateness of obtaining those products having regard to your objectives, financial situation and needs. Whilst we have our own process for validating the legitimacy of our referral partners, you should always verify the credentials of your financial adviser before proceeding with recommendations that they may present. Visit the ASIC website for further information.