Hi all, just after some advice.
Just 6 years into a complaint against our insurer for a failed car repair back in 2012. They went for a PDR to fix significant hail damage. Paint fell off. They painted clear over top. That fell off in 2015. They tried again (another dodgy effort). Fell off again in 2021. In 2021 they said it's our problem.
This is a clear breach of their T&Cs (repairs and materials are covered for life of vehicle ownership). They did the repair, we still own the car.
I was amazed that the insurer tried to fight it. They even submitted a bogus independent report to try and dodge liability. The dates listed and location were location our car had never been to So I called the said person on the report, and they stated they were never at the stated location or made the statement. So I think that is fraud. But it didnt matter anyway as the insurer were still liable under their t&cs anyway.
So we fought the case, with AFCA intervention. 1000's of hrs over 9 years. Then another 5 years via complaint escalation. 14 years total. AFCA first rejected our case citing, what I believe to be, a fraudulent report as evidence. Basically, the AFCA agent had no knowledge of how paint works, so was not clear on what has happened. I said to them quite simply, why not? How do AFCA make decisions on matters they know nothing about. Employ a professional to decipher it. It is a black and white case. I said to simply call the number on the report and he will tell you it's fraudulent. But AFCA will not chase evidence (again…why not).
I asked to speak to the AFCA reps team leader. He basically said we can take it to another, and final decision maker. But make sure it is without any doubt what has happened. It needs to be from a professional in legal terms. For example, the crash repairer stated "the paint failure was caused by the use of a low grade clear coat that has failed extremely prematurely". Cause and effect. ..or so I thought…AFCA would not accept this. I still don't understand why not. It's a mystery.
It was ridiculous. Large chunks of paint around fist sized each over 80% of the vehicle had come off. But this was not sufficient. The agent said "this maybe normal". So I found 10 of each professional (repairer and paint manufacturer) all saying the paint had failed in their terms. Huge amounts of time, travel and stress. Each professional needed to be briefed in full on the back story/ history of the vehicle. Also, there was nothing in it for them to say anything. So I had to visit 50 or more to get 10 willing to go on record. I feel they should be remunerated as well.
So, I needed to take the car to multiple professional repairers, independent paint specialists (couldn't simply send in photos). Had to be physically assessed to be legally binding apparently. So I had to take leave without pay to do it. This is approx. $550 per day for me. I then had 'paint and failure' from basically every imaginable angle and professional covered. 14 years in, I had one last shot, and I needed this to stick.
So I then submitted the new evidence to the pile for the AFCA 'decider'. Just over 100 documents, 300 emails involving 47 professionals (including Allianz's own assessors who cant see why this was rejected), and an endless time line and call log. They never asked for our financial loss etc caused by this.
I then received a letter from AFCA that found in our favour, and we have until July 17 to accept the decision. However, the NFL (Net Financial loss) element was adjudicated at just $750!
I was/ still am without speech… $750 after all these years, time and financial costs…which they (AFCA) never even asked for yet. $750…in todays world! Even at minimum wage, losses would have a bigger loss than that. $750 will get a lawyer to read 15 lines on an email, and respond with 10. Basically $750 will cover a single email. Just crazy they would come up with that figure. No wonder the insurer just makes up evidence.
I reached out to them outlining that we do accept/ embrace the decision that Allianz are indeed liable, but our financial costs of this case are way off. There is a provision for $6300 here. After 14 years, 1000+ hrs, travel and loss of work time. We are definitely significantly above $750. Work time loss alone is over $5k..for an event that is covered in the T&Cs.
I was just informed the decision is final, and the NFL element cant be changed!
What on Earth is going on?
We haven't even accepted the decision yet. AFCA haven't presented a single figure on how much Allianz need to cover for the repair, never asked for a single piece of NFL substantiation.
This is not my first dealing with AFCA. Previously step one was adjudication on who is liable, then quotes to determine the payout figure, then NFL from all this process is decided. All then wrapped up in a final payout figure.
We dont have a single figure on paper yet, accept the $750 NFL!
I am without speech, and looking for guidance here. Is there an entity that oversees AFCA? (do we go to ASIC). They have lost the plot on this one.
Cheers all.
I don't want to bite, but those last couple of lines are doozies!
I agree with the $5400 part. But AFCA today put in writing the max is $6300. I think they are wrong. Basically know they are wrong as this document says otherwise. So make of that what you will
https://www.afca.org.au/what-to-expect/outcomes-afca-provide…
But, as per this document. There are multiple compensation allowances capped at $5400 (now $6300) EACH.
While I wish I could leave work for just an hr (and even get all the assessments done in an hour), reality is a bit different. If I'm not at work, I must take a full day. There are no 1hr options. They were long full days..period (which reflects on the time of the report submissions). After the conversation today, they "didn't have that information"..but they never asked.
My previous issue (different insurer) for a water leak was much easier / quicker. The AFCA rep took the time to call me and check the compensation figure. His words were worse case "house was burnt down and the insurer left you nowhere to go" would be max payment. I suggested $4k. He put it to the insurer. They accepted within the day. None of this happened this time. Not a word. They didn't even look at all report evidence to ascertain a time line.
None of it was ultimately required, as she said a piece of evidence I submitted at the very start was what she based her decision on…. But the insurer required me to establish in their words force majeure. This I did.
Not sure how an insurer can be liable for loss of limbs (other than a life ins policy). But that isn't relevant to my case.
Either way. I'll leave the link and if anyone ever needs It, don't worry about what me or any other user says.
Have a read, and at every step that you submit to AFCA attach a foot note on how long it took, how much it cost you, what you lost by doing it and how it made you feel. The last seems weird. But it's how their system works.