Case Studies

Our case notes show how we deal with the many different issues that arise in our case investigations. The case notes aim to provide consumers and participants with guidance as to the approach we are likely to take in a particular type of case or highlight some of the many different ways in which a complaint can be resolved.

Search case studies

Title Year Case summary
In the line of fire 2017

A building suffers damage in an earthquake. The local council requires an upgraded fire protection system to be installed before it will give consent to the building repairs. Is the building’s insurer liable for the cost of the upgraded fire protection system?

“How accurate does my insurance claim need to be?” 2016

Millan ran a whiteware and electrical store. A fire broke out in the workshop after hours. The fire service contained the fire and it did not spread to the showroom or storeroom where much of Millan’s stock was stored. Millan claimed for a substantial amount of damaged stock. The insurer assessed Millan’s loss as much lower than his claimed loss. The insurer believed there was intent to defraud and declined to pay Millan’s claim. Can Millan still have this genuine loss paid?

A quick resolution 2017

A mobile trader pressures an illiterate customer to sign a direct debit form for a purchase he knew nothing about.

One man’s variation is another man’s vandalism 2016

Extensive renovations and alterations were done to June and Darren’s rental property by their tenant without their knowledge and consent. After their tenant disappeared, June and Darren claimed on their insurance that the property had been damaged. The insurance company declines June and Darren’s claim because it says the property has not been modified, not damaged. Can the insurer decline June and Darren’s claim to restore and repair the property?

“Inflated claim bursts cover” 2017

Dilip’s liquor store was robbed by gunmen who made off with alcohol, tobacco and cash. Dilip claimed under his general business insurance policy for the losses he suffered. The insurance company declined Dilip’s claim and cancelled his policy because they believed he had fraudulently inflated his claim. Does Dilip have any recourse for his genuine claim?

Where does the burden of proof lie? 2017

Ken had to return home early from a trip to Peru because his mother died. She was 82 and had dementia. Ken claimed insurance for the cost of curtailment. His claim was denied on the basis that his mother’s dementia was a pre-existing medical condition. Ken claimed that when he booked the travel, some 6 months earlier, he could have no idea that his mother would pass away during the three weeks he was away.

“Shouldn’t advisers advise?” 2017

Terry and Paul had been clients of an insurance adviser company for 10 years. An adviser from the company contacted them recommending to switch to policies with cheaper premiums and increased cover. Terry and Paul agreed to the move. Two years later they found they were paying premiums for both policies. They wanted to be reimbursed because they believed their adviser should have reminded them to cancel the outgoing policy.

“The great $6,300 disappearing act” 2017

What happens if you transfer funds to your credit card provider to pay your credit card balance, but your funds get lost?

“Who’s the wisest doctor of them all?” 2017

Bob and his wife were travelling to Norfolk Island. Because he had experienced previous heart issues, Bob purchased more expensive insurance with better cover. Before take-off Bob, who also had a history of panic attacks, had an ‘episode’ on the plane. The paramedics recommended he didn’t fly. The insurers declined his claim because of an exclusion clause to do with panic attacks. Bob believed he wasn’t allowed to fly because of his heart. Was the insurer right to attribute the episode to a ‘panic attack?’

‘All down south from here’ 2016

Kristi’s bag was stolen from a hotel courtyard while her boyfriend was supposed to be looking after it. Kristi filed a claim with her insurer, but her claim was declined due to her bag being unattended in a public place when it was taken. Kristi feels her insurer misunderstood her claim as she wasn’t in public and her bag was near her boyfriend. Has the insurer got it right?