A driver who collided with a pole after swerving off the road to avoid a kangaroo has won a dispute against her insurer, who alleged the claim was fraudulent.

The complainant crashed her 2016 Ford Kuga Wagon on September 15 last year and lodged a claim the next day under her comprehensive motor vehicle policy.

She said she had been travelling on a street when the kangaroo suddenly appeared, causing her to swerve and lose control of her vehicle before colliding with the pole.

Suncorp’s notice of response stated that the vehicle had been facing the wrong way, that the woman said her head was spinning, and that she was concerned the car would explode.

The insurer’s claim notes said it intended to accept the claim before a report from a forensic accident investigator, referred to as MF, raised doubts about its legitimacy.

The report contained information from a tow truck driver who picked up the damaged vehicle and said their account appeared consistent with the complainant’s statement.

A police report showed that the vehicle sustained damage to its left side after hitting the pole and alcohol was not a factor.

MF reported that forensic information showed that the car drove in a straight direction to the pole rather than swerving, as the complainant alleged.

The report also disputed the driving speeds mentioned by the driver and said she did not brake before the crash occurred.

MF said it was “highly implausible” that the complainant would have been able to react to a kangaroo coming onto the road given her limited point of view from driving at night.

The Australian Financial Complaints Authority (AFCA) accepted that most of the details in the report appeared accurate but said the data did not disprove the driver’s version of events.

It said while some inconsistencies did exist between the claimant’s account and MF’s report, the information to indicate that the crash was not accidental was “limited”.

Suncorp alleged that the motorist had a financial motive, saying the windfall from a successful claim would have eased her limited financial position.

The insurer referenced previous statements from the complainant indicating that she was bankrupt and had to pay off loan expenses.

Suncorp said the complainant had ample reason to commit a fraudulent claim because her vehicle was no longer manufactured, and the policy benefits would have provided an expensive replacement car. It also suggested the car had mechanical issues and that the driver needed funds to repair it.

The policyholder refuted the insurer’s allegations that the car needed repairs and submitted information from her mechanic that said it was in good condition.

AFCA rejected Suncorp’s argument, saying that the complainant’s limited funds were insufficient evidence to prove she had a valid motive to submit a fraudulent claim.

It acknowledged that the crash circumstances provided her with an opportunity to commit a fraudulent claim but said that was not enough to prove that she did.

The decision considered the claimant’s cooperation with the insurer’s claim handling and investigation and that she had no previous criminal history.

It also said an anonymous and unrecorded call to Suncorp’s “fraud hotline” provided by the insurer was limited in questioning the woman’s credibility.

AFCA determined, on the balance of probabilities, that Suncorp could not prove that the claim had been fraudulent and required the insurer to cover it. In accordance with the Insurance Contacts Act 1984 (Cth), the insurer was also required to pay interest on the settlement price from the date of denial if the claim was cash settled.

The determination mandated that Suncorp remove any reference to the claim denial and allegations of fraud from the complainant’s records.

Click here for the ruling.