SERVICE: House
OUTCOME: Not upheld
Issues: Delays; Scope of cover
Summary: Ms J’s* complaint was not upheld, because the costs she claimed were not covered by the policy and the insurer’s offer and apology for service issues were reasonable.
Ms J held insurance on her house.
In July 2021, she made claim for damage caused by a leak in the lounge ceiling and a damaged retaining wall at the house. The insurer accepted the claim.
In 2023, with repairs not completed, Ms J complained to the insurer about how it had progressed the claim. There had been multiple delays, issues with the repair of the wall and, because the repairs had left the gate out of alignment with the fence, Ms J’s dog had been able to escape.
Ms J said she had to keep her dog inside and it caused damage and then she had to keep it in a crate which was detrimental for them both. She said she had to keep a rope tied around the fence to keep it together, which meant she could not use the main entrance of the house.
Ms J said she did not feel safe because she was not able to properly secure the house. She said she had a protection order in place and, when the Police attended, she was unable to let them in. She said if she had needed to exit the property in an emergency, her exit was impeded. She said she was experiencing anxiety knowing she could not leave her dog secure in her backyard. Ms J said she had been extremely depressed and confused about how to contact the insurer.
The insurer apologised that no-one had responded to Ms J’s complaint and for the stress that she and her dog had experienced. The insurer said it would appoint a new assessor and work with Ms J to have the repairs completed as soon as possible, or she could choose a cash settlement. The insurer said that Ms J had experienced unacceptable delays, and it had not met its obligations to her.
The insurer offered Ms J an ex gratia payment of $2,000 by way of apology, and said it would reimburse her excess.
Ms J said she had agreed to the insurer appointing a new assessor to determine, with her, the best way to rectify the retaining wall, trellis and gate damage. Ms J said she did not agree with the insurer’s estimate of the internal repair cost, because nobody went into the house to assess the damage. Ms J said she wanted the insurer to pay her $2,500 to compensate her for putting her dog at risk and under stress, and she wanted the insurer to pay for the repairs to the house and contents caused by her dog. Ms J also wanted a full policy refund.
The insurer responded and said the policy did not cover the dog’s distress, or damage caused by domestic pets. Further, it did not agree to reimburse the premiums, because the policy had been cancelled for non-payment of premium. The insurer said it was not liable to pay Ms J’s accommodation or security camera costs. However, it said it was willing to consider costs in relation to Ms J’s garden beds, as determined by its assessor. It also agreed to reimburse Ms J’s tip costs.
The case manager’s assessment
The case manager could not compel the insurer to pay Ms J’s costs which were not covered by the policy. However, the case manager discussed the complaint with the insurer, and it agreed to increase the payment for internal damage. It also agreed to increase the goodwill payment from $2,000 to $3,500. In the circumstances, the case manager believed the offer, and the insurer’s apology, was reasonable.
*Name has been changed
Complaint No: 00227047