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Debbie does damage: how insurers became the bad guys

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General insurance has an uneasy reputation with the general public, but it doesn’t often deserve the hammering it takes from so-called expert commentators and current affairs shows.

So while insurers have closed 99% of claims from Cyclone Debbie, the slow resolution of a few hundred outstanding cases sees the industry cast yet again as a villain.

The “dodgy insurer” narrative is a standard feature of Channel Nine’s A Current Affair, alongside others such as dishonest businessmen, sick children, neighbour conflicts and cute animals.

Last week viewers were treated to a segment suggesting insurers are doing everything they can to avoid paying claims post-Cyclone Debbie, particularly using pre-existing property problems as a way out.

Insurance Council of Australia (ICA) spokesman Campbell Fuller says allegations raised in the program are “absurd” and that, for the most part, the industry has responded very well to $1.78 billion in losses generated when the cyclone hit Queensland and swept inland in March last year.

Of more than 75,000 claims, about 99% are closed and less than 0.6% have ended up with the independent Financial Ombudsman Service (FOS).

A Current Affair’s report followed hard on the heels of the Hayne royal commission hearings where two insurance companies were dragged over the coals for their poor responses after natural catastrophes. It all comes as consumers are taking an increasingly dim view of financial services.

Cyclone Debbie’s damage to a home near Airlie Beach was among case studies presented at the commission, with residents fighting inadequate “make-safe” work and stressful repair delays.

It’s not unusual for such cases to emerge after a cyclone has struck in the far north. insuranceNEWS.com.au has reported the existence of many such cases after previous cyclones, usually in areas where a cyclone has not struck for some years.

It’s here that the owners of old properties, some of them appallingly maintained and some carrying damage from previous cyclones, expect insurers to restore their buildings to as-new condition. Negotiations invariably take a long time.

The royal commission was told some Debbie claimants turned to David Keane, who runs an advocacy service called Solve My Claim and who has become a target of criticism in the insurance industry.

People like Mr Keane are solid gold for programs like A Current Affair. They get a story with a classic miserable victim and a corporate villain, and he gets to spruik his business, make some pretty savage allegations and even – if he’s lucky – scare a media-skittish insurer or two into settling early.

Mr Keane also wanted to appear at the royal commission. A media release he distributed in August said he had hoped to appear “as a claims professional, loss adjuster, insurance risk surveyor and claims preparer over the past 23 years” who has “witnessed first-hand the many tactics and strategies insurers use to ‘mitigate their losses’.”

However, the royal commission chose not to address any of the issues he raised.

Never mind, there’s always A Current Affair. Mr Keane says Solve My Claim has taken on around 300 claims resulting from Cyclone Debbie, which he says were collectively valued at over $50 million, “and we have managed to overturn denied or reduced claims by over $10 million so far, with well over 100 claims still unresolved at this time”.

His very long list of allegations ranges across insurers’ panels of loss adjusters, builders and engineers, where he asserts there are links between providers which reduce their independence.

“The insured is in the dark until all the collusion has happened and all the decisions are made,” he told insuranceNEWS.com.au. “By the time the insured gets anything, the insurance company has built its entire case.”

What about the Financial Ombudsman Service? Mr Keane says while it’s an independent arbiter, FOS is not an adviser – a distinction that’s a bit difficult to understand.

Mr Keane’s business promotes itself as expert and effective, and charges claimants for its services when there’s an expert and effective free service available – the Financial Ombudsman Service, which has demonstrated its decision-making independence over many years.

The ombudsman, which will become part of the Australian Financial Complaints Authority next month, received 374 disputes related to Debbie claims – primarily for domestic cover. The main issues were denials, claim amounts or delays in handling.

“There are 40 cases that are still with FOS and are being actively considered,” a spokeswoman told insuranceNEWS.com.au. “FOS is continuing to receive disputes related to Cyclone Debbie and these will be dealt with under the FOS terms of reference.”

After the cyclone FOS staff visited affected areas and met consumers at community forums to highlight the service and explain how it could help. It has liaised closely with ICA.

So let’s just for a moment consider Mr Keane’s ability to dispense an equally qualified and useful service to claimants who, for whatever reason, have paid for his services rather than rely on FOS.

His website says he has 19 years’ experience in insurance, primarily in claims, although his Linkedin profile says only that he was engaged in “various insurance roles” at AAMI for four years and one month, and was NSW motor claims supervisor at Lumley for another six years and five months.

He departed the industry in 2006 to become the business manager of a Christian School, setting up Alice Springs-based Integrity Assessing Services at the same time.

While his company is already armed with what he defines as “vast experience” in residential and commercial property, motor vehicle fleet insurance, risk reviews and assessments, Mr Keane’s Linkedin entry says he has been studying for a diploma of loss adjusting since 2014. He also has a bachelor degree in theology and biblical studies.

He and his “team of experts” charge an undisclosed upfront fee for claimants – and a percentage of any increased settlement on completion of the claim.

Now let’s consider the nature of the 1% of Debbie claims that haven’t so far been settled. ICA’s Mr Fuller says most open claims concerning Cyclone Debbie are from the Whitsundays, Proserpine and Airlie Beach areas. The region has one of the highest proportions of old housing stock in Queensland, with about 45% built before 1984.

“Many claimants’ properties had old cyclone and storm damage that had not been properly repaired, or properties that were poorly maintained,” Mr Fuller told insuranceNEWS.com.au.

Insurers are not obliged to fix problems left unrepaired after previous incidents, which increases the potential for arguments over assessments of damage and pre-existing condition.

Mr Fuller cautions that the use of claims advisers is not without cost, and customers should make sure they understand fee structures and commissions, and how this might influence advice and services provided.

“Claims advisers may not lead to better outcomes for customers than they could generate for themselves,” he says.

Youi highlights insurer frustrations in its recent response to the royal commission, which flagged potential misconduct in two case studies, including another Airlie Beach claim involving Mr Keane.

“The two case studies are not only unrepresentative of the vast majority of cases dealt with by Youi, particularly following natural disasters, but are case studies that counsel assisting has sought to portray in the worst possible light,” it says.

“No attention was given to the many claims dealt with in an outstanding manner by Youi in difficult circumstances, or the care and attention Youi tried to bring to those affected by these events.”

It’s up to Youi to prove that its claims management abilities are up to par with its promises, just as it’s up to Mr Keane to prove that his fee-paying clients wouldn’t have had their claims paid without his intervention. A non-refundable fee for achieving nothing should prompt some hesitation, at least.

Meanwhile, ICA is this month hosting community forums in north Queensland to let homeowners and small businesses share their experiences, and to help avert future problems. Areas for discussion include mitigation, local issues driving premiums, as well as avoiding underinsuring and future claims difficulties.

A Current Affair won’t be there, because promoting understanding is neither controversial nor likely to lead to conflict. But better understanding will nevertheless achieve far more for communities than a TV show that undermines trust in the competence of the insurance industry.