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[2016] NSWDC 170
District Court of NSW
2016-06-28
Mr P
Original judgment source is linked above.
NATURE OF PROCEEDINGS
THE FIRE
THE ISSUES
THE POLICY
"You are not covered under any section of the policy for loss, damage, cost or liability caused by or arising from or involving: ... fraud or fraudulent means or devices used by you or anyone acting on your behalf to obtain benefit under this policy, deliberate or intentional acts committed by you or someone acting on your behalf..." "What we will pay When an insured event causes loss or damage to your home during the period of the cover, we will pay up to the amount covered. We will decide either to repair, rebuild or replace your home or to pay the cost of repairing, rebuilding or replacing your home. Our payment will be the reasonable cost of returning your home to the same condition it was in immediately before the loss or damage occurred. Our payment will be on the basis that new materials will be used. Where possible, we will match materials. Where this is not possible, materials that match as near as reasonably practicable will be paid for by us. We will not pay to replace unrepaired materials so as to achieve a match with repaired or replaced materials. Our payment will include, where applicable, the following costs and these costs will be included within the home building amount covered. Demolition and removal of debris We will pay the reasonable cost of, and, at our option, arrange for the demolition of your destroyed home, removal of debris from the site necessary for repairing or rebuilding, removal from the site of fallen and unsafe parts of a tree when the tree or part of it has impacted with your home causing loss or damage. Making safe We will pay the reasonable cost of, and, at our option, arrange for any temporary work required to make safe your destroyed or damaged home. Professional fees We will pay the reasonable fees for the services, if necessary, of an architect or surveyor. Extra costs In repairing or rebuilding your home, we will pay the extra costs necessary to satisfy the current requirements of any local council or government authority." "Additional benefits and protection When the insured event causes loss or damage to your home during the period of cover, we provide the following additional benefits. Any payment we make will be additional to the home building amount covered and will include GST. We help with the cost of temporary accommodation We will pay for the reasonable cost incurred by you for comparable accommodation while your home is being rebuilt or repaired, provided: you have claimed on this policy and we are satisfied everything is in order, we are satisfied that your home is no longer habitable, and you were living permanently in your home at the time. Our payment will be the lesser of: an amount equal to 10% of the amount covered, and the actual cost incurred by you during the reasonable period up to 12 months required to repair or rebuild your home. ... We help replace garden beds, trees, shrubs and other plants We will pay you the cost of up to $1,000 of making good the damage to trees, shrubs, plants, hedges or garden beds on your site caused by fire or the impact of vehicles (not driven by you or by any person living at your home)." "What happens when you claim on your AAMI policy When you tell us about the loss or damage to your home, where necessary and as soon as possible, we arrange: for our assessor to meet with you, inspect your home and confirm the full details of the loss or damage, temporary repairs to and the securing of your home, temporary accommodation for you and your family... We discuss with you what is necessary to make good the loss or damage and then we will decide either to repair, rebuild or replace your home or pay the cost of repairing, rebuilding or replacing your home up to the amount covered. We ordinarily obtain independent, competitive quotes, from repairers recommended by AAMI. If you want, you can choose a repairer to provide one of the quotes. We will review the quotes, including any quote from a repairer you choose, and what is necessary to properly repair your home. We will select the repairer who has submitted the more competitive and complete quote and they will be the repairer who repairs your home. We have your home repaired, keeping you informed all the way along. What happens to the amount covered after the claim has been paid? If we do not consider your home to be a total loss and the payments made by us are less than the amount covered, there is no change to the original amount covered and your policy continues to remain to the period of cover. However, if we do consider your home to be a total loss, or we pay the amount covered for your home building, then the policy comes to an end… Changes to your home You can have changes made to the design and structure of your home before repair or rebuilding. Any extra cost of such changes will be your responsibility. We may decide to pay you the reasonable cost of rebuilding or repairing your home without the changes you require. What we do if your home cannot be repaired If your home is destroyed or so badly damaged that it cannot be economically repaired, we declare it a total loss and pay you the amount covered. What happens to your policy when we make that total loss payment When we make a total loss payment: we pay the amount covered for your home building, we agree to pay any outstanding additional benefits, your policy, including the legal liability it provides, comes to an end. Because our payment meets all our obligations to you in full, there is no refund of any portion of the premium." "Your responsibilities include ... Allowing us access You must provide us with access to your home for the inspection of loss or damage, arranging quotations, repair or rebuilding, progress inspections if required. ... Giving assistance - information, notices, negotiating, defending and settling claims You must give us the information and assistance we reasonably request in evaluating the cause, extent and value of any claim. This may include: providing us with full details of the claim in writing, providing valuations, receipts or other evidence of ownership, providing written statements, undergoing an interview or interviews about the circumstances of the claim, appearing in court and giving the evidence. ... If you fail to assist us or do not abide by any of these terms, we may reduce or refuse to pay your claim."
"ACCIDENTAL" FIRE AND THE MEANING OF "AMOUNT COVERED"
(a) TIMING OF MRS COLLINGS' DEPARTURE
(b) FINANCIAL STRUGGLES AND PERSONAL STRESSES
(c) ACCESS TO THE PREMISES
(d) THE EXPERT EVIDENCE
(e) CONCLUSION
(a) MRS COLLINGS' AWARENESS OF HER LACK OF INSURANCE IN EARLY JUNE 2007
(b) THE $10,000 CASH
(c) $25,000 JEWELLERY
(a) THE BUILDING CLAIM
(b) RENTAL CLAIM
(c) CONTENTS
(d) CREDITS
DISCLAIMER - Every effort has been made to comply with suppression orders or statutory provisions prohibiting publication that may apply to this judgment or decision. The onus remains on any person using material in the judgment or decision to ensure that the intended use of that material does not breach any such order or provision. Further enquiries may be directed to the Registry of the Court or Tribunal in which it was generated. Decision last updated: 18 August 2016
Collings
Australian Associated Motor Insurers Limited