A homeowner engaged in a heated legal battle with his insurer over a fire damage claim has secured a favorable outcome, demonstrating the importance of accurate communication and thorough documentation in insurance disputes.
The dispute began when the homeowner, whose house was devoured by flames, submitted a claim to Allianz on April 1 of the previous year. Allianz denied the claim, arguing the policyholder had not been truthful regarding his residential status in the policy documents. According to the insurer, he was a "non-resident" frequently oscillating between his home and a monastery.
The initial conclusion Allianz drew was based on the policyholder's statements during a phone interview. The man, assisted by a translator, reportedly mentioned living at a nearby monastery for nearly two years, with no one occupying his house for the four months leading up to the fire. Further claims were supported by a conversation with a neighbor.
According to Allianz, their underwriting department deemed any property uninhabited for more than 60 days as an "unacceptable risk" and reasoned they would not have issued the policy if aware of his actual living conditions.
In response, the homeowner vehemently refuted these claims, insisting his information on the policy forms was correct. He clarified in a subsequent interview that there had been translation errors affecting his initial responses. He elaborated, stating his familiarity with the monastery stretched back two years, but he was a frequent visitor rather than a resident. Moreover, he spent weekends at his own home despite short stays at the monastery.
To support his assertions, the claimant presented a letter from the abbot of the monastery, identifying him as a regular but non-permanent visitor. The abbot also confirmed temporary accommodation was provided only after the devastating fire. Additional affidavits from the man's ex-wife and the neighbor countered Allianz's stance, attesting his occupancy at the house.
The Australian Financial Complaints Authority (AFCA), siding with the homeowner, stated there was insufficient evidence to indicate any misrepresentation of his residency status. They acknowledged potential miscommunication due to the nature of the phone interview and the involvement of an interpreter.
"There's a lack of direct statements from the complainant regarding his non-occupancy," AFCA's panel highlighted. Subsequent claims that suggested the homeowner did not reside at the property appeared to be based on the initial interview rather than verified sources. AFCA deemed the claimant's evidence comprehensive and convincing, portraying him as a consistent resident based on governmental, medical, and personal records.
"Furthermore," AFCA added, "the letter from the monastery’s abbot provides a trustworthy narrative that refutes multiple residency and overwhelmingly supports the claimant's account. With no alternative narrative or contravening evidence, the panel views the complainant did not reside at the monastery."
Consequently, Allianz has been instructed to reinstate the policy and approve the claim for the fire damage incurred.
Original article sourced from Allianz claim statement.
