Home / Daily / Insurer must pay $40,000 after unjustified fraud accusation
5 December 2019
The Australian Financial Complaints Authority has ordered an insurer to pay a builder more than $40,000 after it unfairly declined a vehicle theft claim.
The complainant held a comprehensive motor policy with Auto & General and lodged a claim after his 2012 Toyota Hilux valued at $45,000 was stolen from outside his property, along with a trailer and work tools.
He says he was home all night and in possession of all three keys to the vehicle, but the claim was declined after the insurer rejected the man’s version of events, saying he had not provided “true and complete” information and the vehicle was not stolen in the manner alleged.
The vehicle had an engine immobiliser, and a “balloon payment” – the amount still to be paid to a lender at the end of a loan – of more than $26,000 was due the next day.
But AFCA says an expert locksmith determined that, while difficult, it was possible for the vehicle to have been stolen without a correctly coded key.
It says that as a self-employed builder the complainant needed use of a vehicle, and had sufficient funds in his bank account to cover the balloon payment.
“There is no indication the vehicle was mechanically unsound or that there were other issues with the vehicle,” AFCA says.
“What financial motive there might be is clearly outweighed by the inconvenience to the complainant in having lost a work trailer and tools.”
AFCA says Auto & General’s response to the claim “effectively amount to allegations of fraud” and that the complainant and his wife answered questions openly during three separate interviews.
“Such allegations are serious and where made, require clear and cogent evidence in support of the allegations.
“There is little evidence of motive, little evidence to attack the complainant’s character and credibility and whilst opportunity might exist, there is no evidence to dispute the complainant’s statements as to his activities on the evening of the theft of the vehicle.”
AFCA says there is not enough information to “establish the complainant has breached the terms and conditions of the policy or that the claim is fraudulent” and ordered Auto & General to pay the complainant $41,175.