According to an ABC News report, the Australian Securities and Investments Commission (ASIC) is investigating an insurance claim from a women with a physical disability who has spent nine years battling to have her insurance claim with GIO Suncorp resolved. The report said the woman’s family have also filed three complaints with the Australian Financial Complaints Authority (AFCA) and are waiting for an ombudsman to be assigned to the case. .
AFCA sees claims handling as a 2026 enforcement priority with complaints concerning claims surging 20% to 36,260 last financial year. The pressure is on insurers and brokers to improve this "engine room" of the industry.
In a statement to ABC News, a GIO Insurance spokesperson acknowledged the difficulty of the situation: "This is a complex matter, and we acknowledge how difficult this has been for [the claimant] and her family. We have continued to engage constructively with the customer to progress the claim, including by providing additional assistance, but have ultimately been unable to reach an agreement. We have made a settlement offer to resolve the claim, which we believe is fair and appropriate. The matter is now before AFCA, and we welcome the independent review process."
According to the report, the ordeal began when a truck became entangled in powerlines outside the home of Lily — a 70-year-old grandmother who has asked to use only her first name. The impact dislodged guttering, fascia and roof tiles. What appeared to be straightforward cosmetic damage instead triggered the nine-year battle with GIO Suncorp that eventually forced Lily, who lives with a physical disability, out of the home she had owned since the early 1970s.
GIO contractors' repeated attempts to fix the roof resulted in tiles being improperly replaced, leading to water ingress and, ultimately, severe toxic black mould spreading throughout the property. According to the report, the insurer initially dismissed the family's concerns. It was only after Lily's daughter Lana lodged a complaint with AFCA that GIO agreed to inspect the property — but on three separate occasions, sent experts who failed to adequately test or remediate the mould.
An independent hygienist engaged by the family found mould levels in every bedroom were "extremely high" and directly caused by the roof leak. GIO's proposed solution, according to Lana, was to sand and paint over it.
In April last year, Lily moved into a rental while contractors made a fresh remediation attempt. By December, an independent report confirmed the attempt had failed and the home was no longer safe to occupy. Lily declined a cash settlement she described as inadequate, and now pays $1,000 a week across rent and storage costs.
The case is far from isolated. Delay in claim handling topped AFCA's complaint categories with 7,396 lodgements. Home building insurance complaints reached 7,328.
Australian Insurance Consumer Lobby (AICL) chair Tyrone Shandiman told the ABC that insurers can exploit their control over rental payments to pressure claimants into accepting inadequate settlements. He also flagged a structural problem with expert reports, suggesting some experts are effectively incentivised to favour claim declines — and that consumers currently have no formal avenue through AFCA to dispute an expert finding without commissioning their own report, at a cost of between $5,000 and $10,000.
The Insurance Council of Australia (ICA), in a statement to the ABC, reminded the industry that the General Insurance Code of Practice requires insurers to take extra care with vulnerable customers, including the elderly and those living with disability.
