A business policyholder has lost a claim dispute with Guild Insurance after it declined to settle his claim for a faulty vaccine fridge.

The insured said the fridge exceeded the appropriate temperature range and, despite two hard resets, would not work.

He said the control chip was faulty and he wanted the fridge covered under equipment failure.

But Guild said he had not established a claimable loss, and it would withhold a decision until he could back up his contention.

The claimant said obtaining a damage report was cost-prohibitive considering the value of the fridge and the excess owed.

The Australian Financial Complaints Authority says it is not satisfied the policyholder has established a claimable loss, although there is no dispute the fridge stopped working about December last year.

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“The insurer is entitled to withhold a claim decision until the complainant provides the required information,” AFCA said.

“When making a claim, the complainant has the onus to show he suffered a loss of a type covered under the policy.

“The complainant must show this on the balance of probabilities (that it is more likely than not). If a claimable loss is shown, then the onus transfers to the insurer to show, on the balance of probabilities, it is entitled to deny the claim or reduce its liability.”

AFCA says the policy’s terms and conditions state the insured must co-operate with reasonable requests from the insurer.

“An assessment report to establish the cause and the extent of the damage is reasonable. It would be unfair to require the insurer to accept the claim when the complainant has not discharged his onus to establish a valid claim.”

See the ruling here.