Stress after the storm

Independent evidence can be critical to progressing insurance claims. The IFSO Scheme process brought the parties together to finalise the claim.

Stress after the storm

A massive storm caused damage and flooding to Priya* and Joe’s* house. Priya, who was undergoing cancer treatment and immune-compromised, was concerned about living in a damp, damaged house. The insurer accepted Priya and Joe’s claim, but ongoing issues about the scope of repair work continued for a year. Priya’s treatment, and a close relative’s death, further extended the duration of the claim.

Priya and Joe complained. They said the process had been stressful, the repair work hadn’t begun, and the insurer’s cash settlement offer wouldn’t cover the storm damage. The insurer was also keen to get the claim sorted and was supportive of the IFSO Scheme’s role.

The policy specified the insurer was to pay the estimated reasonable cost to repair the damage. The IFSO Scheme case manager supported Priya and Joe in getting an independent builder’s report and quote, which was significantly higher than the insurer’s cost estimate. The insurer agreed, on this basis, to increase the cash settlement offer by $62,995.

The case manager found the insurer was also required to pay an additional $30,135 for items not included in the scope, like temporary accommodation and outdoor cleaning. However, the insurer was not required to pay more than 50% of the fence or survey report costs, because the fence was not within the boundary.

The insurer agreed to appoint an independent builder to inspect the site when repairs began, to determine any hidden storm damage.

Complaint partially upheld

*Names have been changed.

See the full case study.