A woman who claimed for a $30,500 watch stolen from her sister-in-law’s car has had her insurer’s decision to decline a payout overturned after a dispute ruling found the circumstances of the loss were credible. 

The claimant said the loss happened after her husband left the watch at her brother-in-law’s home, where he had taken it off to play with a toy car. On that same day, a pair of thieves broke into the sister-in-law’s car while she was taking out groceries, grabbing a handbag containing the watch.  

A police report filed for the theft did not identify that the watch was stolen, as the complainant had been unaware the watch was in the bag. 

Police later charged the crooks with several offences but the bag was not found. 

Allianz Australia declined the claim, saying the insured did not establish that the loss occurred and referring to the police report not mentioning the watch. 

The insurer did not allege the claim was fraudulent but questioned the truthfulness of statements provided by the complainant. It raised concerns about the circumstances of the loss and the insured’s claims history, which included a claim for a lost watch in 2015. 

The insurer also noted the insured added the watch to her policy in May 2017, despite not buying it until September 2017, and said the couple potentially had a financial motive for the loss, given a history of late payments with its business.  

The Australian Financial Complaints Authority has acknowledged the insurer’s commentary but questions the relevance of the information, given it was not alleging fraud.  

“While the insurer is not alleging fraud, it is clearly questioning the complainant’s truthfulness about the circumstances of the claim,” the authority’s ruling said. “In such cases, as with an allegation of fraud, the insurer will normally need to produce evidence of motive, opportunity, character and credibility, supported by expert evidence where appropriate. 

“Although I acknowledge the insurer’s comments on the complainant’s potential motive, as well as the complainant’s claims history, I am not satisfied, on the balance of probabilities, that this is enough to establish that the complainant has not been truthful and frank in statements made about the circumstances of the claim.”  

The authority says the available information shows the complainants proved the loss occurred and offered “reasonable assistance” to the insurer in assessing the claim.  

“I am not satisfied the insurer has established a basis to the decline of the claim. This is because I am satisfied the complainant has shown a theft has occurred and has established ownership of the watch.”

Click here for the ruling.