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Determination
Case number | 12-00-1037020 |
Financial firm | Chubb Insurance Australia Limited |
Case number: 12-00-1037020 30 September 2024
The complainant held a home insurance policy underwritten by the financial firm (insurer). She lodged a claim in July 2021 saying numerous contents were taken from her home between February 2021 and May 2021. Their estimate value is over $200,000.
The insurer denied the claim. The insurer says there is no evidence of the alleged theft which was the subject of the claim.
The complainant disputes this and wants the claim to be accepted.
No. The complainant has shown the items being claimed were lost during the policy period. This falls within the insuring provision. The insurer has not referred to any exclusions or conditions to enable it to deny the claim.
This determination is substantially in favour of the complainant.
The insurer is to accept the claim and assess it in line with the policy and section 2.1.
No. The complainant has shown the items being claimed were lost during the policy period. This falls within the insuring provision. The insurer has not referred to any exclusions or conditions to enable it to deny the claim.
Policy covers loss of contents and valuable
The policy responds for contents in the following circumstances:
This section of Your Policy Wording provides You with cover for physical loss or damage to Your Contents occurring anywhere in the world during the Policy Period.
Similar wording applies to ‘Valuables’ as defined by the policy.
As evident, the provision is broad. It only requires the complainant to show there was loss of contents or valuables during the policy period.
Parties dispute a theft occurred
The complainant says items were stolen from her property during the period claimed. In her police statement, she set out various events that led to this with her suspicions being against C.
C was interviewed by the insurer’s investigator and denied any involvement. C says the complainant suspected others, such as her daughter’s ex-partner or friend. C provided various text messages setting out the complainant’s suspicions.
The insurer also interviewed the complainant’s ex-husband, P. According to the investigation report:
P was surprised to hear that the claim had been re-opened as it was previously closed due to there not being any evidence of the alleged theft.
P doesn't think any theft occurred as he did not see any proof that convinced him that anything had been stolen.
However, P sent an email saying while he could find no evidence to prove theft, he did not doubt the complainant’s statement one had occurred.
In a statement to the investigator, the complainant’s daughter, M, said she did not believe the theft took place. However, she confirmed she wasn’t present at the time of the incident.
The insurer says the police closing its investigation cast doubts on whether a theft took place. According to the insurer’s notice of response to AFCA, the police closed their investigation as the complainant had not provided them with requested information and they were unable to identify the perpetrator.
The insurer also says the lack of consistent evidence and testimony does not support the complainant’s position that a theft occurred.
The panel accepts there is minimal objective evidence confirming a theft occurred. However, the panel notes the following.
The insurer accepts the complainant has provided proof of purchase of the items claimed. Therefore, she owned the items being claimed. The complainant’s evidence that these items have been missing since 2021 is not disputed. She was also in a vulnerable state in that period of time due to an injury. The panel accepts it is possible the items claimed could have been stolen from someone who had access to the home during that period.
However, even if the information is unclear if/how/when a theft occurred, the panel accepts the complainant’s evidence the items have been lost since that time. This is because no evidence has been produced to suggest the complainant still retains possession of any of the items claimed or had sold them for a profit. For instance, none of the witnesses interviewed suggest they have seen the items being claimed. No other information shows she dispensed such expensive items in a different way and with her knowledge and consent. Instead, based on the exchanged information, it appears undisputed the items have been lost during the period of time claimed, albeit it is not clearly established how.
The policy responds if there is physical loss or damage during the policy period. The exchanged information shows the items were lost during the policy period. This means the complainant has established a claim within the insuring provision.
In its AFCA submissions, the insurer has not chosen to rely on any exclusion or condition. Instead, the insurer has referred to the fact a theft has not been proven. However, the complainant does not need to do this to satisfy the insuring provision. She only has to show she lost the items during the policy period. She has done so.
Given this, and the fact the complainant has shown her claim falls within the insuring provision, the insurer must accept the claim and assess the items claimed in line with the policy.
In the event the insurer cash settles any aspect of the claim, it must pay interest pursuant to section 57 of the Insurance Contracts Act 1984. Interest applies from 25 September 2023, being when the insurer denied the claim, until payment is made.
AFCA has determined this complaint based on what is fair in all the circumstances, having regard to:
The respective parties have completed a full exchange of the relevant information, and each party has had the opportunity to address any issues raised. We have reviewed and considered all of the information the parties have provided.
While the parties have raised a number of issues in their submissions, we have restricted this determination to the issues that are relevant to the outcome.
Due to the nature of this complaint, we referred it to a panel for determination. The panel includes:
AFCA is not a court of law. We do not have the power to take or test evidence on oath, or to require third parties to give evidence.
When we assess complaints, we consider:
We give more weight to documents created at the time the events occurred. If there are no relevant documents, we will decide what most likely occurred based on the available information.
If there are conflicting recollections and these are evenly weighted, we may find that a claim cannot be established.
