A homeowner who did not repair his property after receiving a claim settlement has lost a dispute over his insurer’s denial of a later claim.  

The complainant lodged his initial claim in 2020 after a flood damaged parts of his home. After assessing the impact, Suncorp agreed to cash settle the claim, awarding $58,045 for building damage and $29,250 for contents losses.

The insured filed a second claim in May 2022, reporting that a flood in February had again damaged the property and its contents. The insurer agreed to send a roofer to investigate the damage and complete makesafe works on the property.  

However, Suncorp’s assessor raised concerns after observing that the damage occurred to the same flooring affected by the 2020 flood. The assessor noted that photos of the two claimed incidents looked “extremely similar, if not identical”. They recommended that the insurer obtain evidence that the complainant had completed work to repair the initial damage before accepting the claim.  

The homeowner provided the insurer with copies of three invoices relating to painting works, flooring replacements, and wall replacements, which amounted to $49,133.90, as well as an invoice for ‘paint and patchworks’ to walls and ceiling, totalling $19,250.

Suncorp appointed an engineer to investigate the claim, who reported that the internal damage was caused by water ingress from “maintenance and construction-related deficiencies” and was not attributable to a single weather event. The engineer says the home contained “dilapidated roof elements, inadequate façade weatherproofing and lack of site drainage”.  

The insurer denied the claim in March last year, saying there was insufficient evidence to show that the damage had occurred from an insured event, and in the alternative that the policyholder had not established that damage following the previous claim had been repaired.  

The complainant challenged the denial, highlighting that a building inspection report found the damage to be caused by heavy rainfall, which flooded the area.   

The insurer acknowledged that the report confirmed the property had been affected by flooding but said it did not answer whether the damage was from the 2022 flood or if the damage from the 2020 claim was fixed. 

The Australian Financial Complaints Authority accepted that there had been “inconsistent” information that the complainant had replaced the contents with the money received from the 2020 settlement.   

The authority also agreed that no valid claim had been established concerning the building damage, noting that photos provided in the insurer’s assessment report show that the “vast majority of the damages” appeared to be identical between the two claims. It noted that the claimant had not provided photos of the affected areas, despite being asked.   

The ruling also highlighted evidence that the invoices sent by the insured had not been directed to him but to his employer, a business owned by his son. It agreed with the insurer that the information had been “conflicting” and that the man did not substantiate whether he had paid his employer for the work.   

“The complainant has not complied with the terms of the policy,” the authority said.  

“He has not given the insurer accurate and full details of what was damaged and has not proved his loss by ‘proof of loss, value and ownership of the items claimed’ when the insurer requested it.”  

“The complainant has been unable to substantiate his claim and the insurer was entitled, under the policy, to refuse to pay his claim.”  

Click here for the ruling.