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AFCA rules $227,000 jewellery claim was fraud

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An unemployed Suncorp policyholder seeking a pay out of almost a quarter of a million dollars for the theft of 74 items, mostly jewellery, has lost an insurance dispute after the claim was deemed fraudulent.

Two years earlier, a previous insurer had settled $220,000 for a similar claim, and she had also recently received $230,636 in a disability claim.

Suncorp raised concerns regarding the similarity between her previous claim, the current claim and claims lodged by her mother.

The 2018 claim was for the theft of a safe containing jewellery and two paintings, while the current claim was for the theft of a safe containing jewellery and two tapestries - made by her mother which she valued at a considerable sum - as well as some crystal items.

After she lodged a claim on April 16 2020 for the theft of 74 items worth $227,028, Suncorp denied it, saying it was fraudulent after determining the circumstances of the loss were not consistent with her version of events.

The Australian Financial Complaints Authority (AFCA) ruled in Suncorp’s favour, saying there were inconsistencies that “go to the complainant’s character and credibility” and agreeing that the claim was fraudulent and the complainant breached her duty of utmost good faith.

"I accept that the complainant provided false and misleading information for the purpose of deceiving the insurer into making payment of the claim. The insurer is entitled to refuse payment,” AFCA’s ombudsman said.

“The number of inconsistencies in the information provided by the complainant as well as the questionable circumstances of the event, impact the validity and credibility of the complainant and her position.”

Forensic evidence indicated the dead lock to the property was not disengaged and a lack of damage or tool marks did not establish a bona fide forced entry event. The building foyer doors were closed and could only be accessed by a key or being buzzed in by a resident, and AFCA said that “raises significant issues with the complainant’s credibility”.

"A successful insurance claim would in these circumstances provide a significant financial windfall for the complainant,” the ruling said.

The jewellery owner said she was approached by two men outside her property on April 8 2020, a few months after her policy commenced, and informed her psychiatrist, security and police. The psychiatrist, who was treating her for post-traumatic stress disorder and other things, recommended she stay with her mother and she arrived there on April 12 2020.

The next day, she updated her Suncorp policy, adding items and increasing her sum insured. A day after that, she returned to her property in the afternoon, her birthday, for some clothing.

After some difficulty reaching her, security informed her of a communication error with her alarm shortly after midnight and a patrol was sent to the premises at around 1am. It reported the door into the foyer was securely locked.

The next evening, she returned to her property with her mother and a friend. The trio said they noticed part of a door lock on the ground, opened the door and found the premises ransacked and multiple contents items missing, including those in a safe which had been removed from the bedroom wall.

She contacted the police and security, who arranged a guard until the next morning.

After her claim was lodged on April 16 2020, the claim was assigned to Suncorp’s investigations team, who spoke with the police, security, the real estate company, a forensic locksmith and jewellers.

Several inconsistencies were raised during the interviewing process, with contradictory versions provided by the trio about when the piece of lock was noticed and whether a scream was heard.

AFCA said it was "difficult to see ... how someone entered the building, made their way to the third floor, chose the complainant’s unit, forcefully entered the unit, disabled the alarm, removed the safe from the wall along with tapestries and crystal ornaments, then exited the building within that timeframe and without being seen or heard by any persons”.

Her jeweller maintained items listed in a $100,000 invoice were different to those in her previous claim, while her mother confirmed the sale of many jewellery items and several crystals to her daughter, however Suncorp questioned whether invoices, valuations and photographs provided were sufficient to establish proof of ownership or value. It also noted other tapestries and crystal ornaments were not stolen.

“There has been significant back and forth regarding the proof of ownership of many items claimed and the similarity of many items that were part of the 2018 theft claim,” AFCA said.

The security company attempted to call the policy holder at least six times on the night of the theft, yet only the 12.33am call was successful. The Suncorp customer said that was because she fell asleep, yet records showed she was active on her phone until 3:26am, including making phone calls.

“The complainant has provided no logical explanation as to why she didn’t answer any of security’s calls beyond the 12:33am call. I find the inconsistencies in the information presented - and the inability of the complainant to address these inconsistencies - concerning,” AFCA’s ombudsman said.

Social media photos from the night of the theft established she was at her mother’s house, she argued, but AFCA said "this alone does not establish the theft occurred in the manner the complainant suggests”.

See the full ruling here.