Hacked Company Loses Insurance Battle Over Customer Payment Scam

2

The company, holding a management liability insurance policy, sought to claim under its third-party crime coverage to recover the outstanding bills from the customers. However, AIG Australia denied the claim, stating that the policy only addressed "direct financial loss" from theft or fraud by a third party, and argued that since the stolen money belonged to customers, the business itself did not suffer a direct loss.

The Australian Financial Complaints Authority (AFCA) reviewed the case and acknowledged the company's loss. However, it determined that the loss did not align with the policy's specific terms. The ruling emphasized that only the company's customers faced direct financial loss, whereas the company experienced an indirect one due to subsequent non-payments.

The AFCA explained that the hack did not meet the company's policy definition of theft, as the stolen funds belonged to the customers, not the business. This discrepancy meant that the policy's electronic and computer crime coverage was not applicable. Additionally, the policy's criteria for "fraudulent act," which required acts of forgery or counterfeiting the insured had acted upon, were not met since the company was unaware of the false invoices.

This case highlights the critical distinction between direct and indirect financial losses in insurance claims, emphasizing the importance of understanding policy terms. For businesses, particularly those prone to cyber threats, it underscores the significance of having insurance coverage that appropriately addresses loss scenarios stemming from such events. It also serves as a cautionary tale of the complexities involved in recovering from cybercrime attacks without adequate protection.

Moving forward, businesses should ensure robust cybersecurity measures to prevent similar email hacks, coupled with clarifying insurance policies for adequate coverage against indirect financial losses as a result of customer fraud. This scenario may lead insurance providers to reevaluate their product offerings, potentially driving the development of more comprehensive cybercrime coverages. Additionally, the financial sector might witness increased discussions on how to formulate clearer policy definitions that align with the evolving nature of cyber threats.

Published:Tuesday, 11th Mar 2025
Source: Paige Estritori

Share this news item:

Insurance News

Clear

Rising Life Insurance Coverage Highlights Persistent Knowledge Gap 23 May 2025: Paige Estritori New findings from NobleOak reveal an upward trend in life insurance coverage among Australians, alongside a persistent gap in understanding of fully underwritten policies. According to the NobleOak Life Insurance Pulse Report, 60% of Australians aged 30 to 60 now hold life insurance, a noticeable increase from 55% the previous year. - read more

Ombudsman's Decision Favors Claimants in Solar System Dispute 23 May 2025: Paige Estritori Homeowners grappling with damaged solar power systems are set to have a substantial portion of their repair costs reimbursed. This follows a significant ruling where an ombudsman overruled the insurer IAG's application of an electronic malfunction exclusion in the claim process. - read more

AFCA Upholds Pause on QBE Claim but Dismisses Fraud Allegation 21 May 2025: Paige Estritori The Australian Financial Complaints Authority (AFCA) has ruled on a dispute involving insurer QBE and a vehicle damage claim. While QBE has been permitted to halt the processing of the claim until the policyholder, a company director, provides additional information, the fraud allegations levied against the claimant remain unsubstantiated. - read more

AFCA Upholds Policyholder's Claim, Dismisses Fraud Allegation in Car Theft Case 19 May 2025: Paige Estritori The Australian Financial Complaints Authority (AFCA) has dismissed allegations of fraud against a policyholder by Auto & General Services following an unsatisfactory investigation related to a stolen and burnt-out vehicle. The ruling in favour of the claimant highlights procedural gaps in the insurer’s investigation. - read more

Asgard Announces Significant Hike in Insurance Premiums 16 May 2025: Paige Estritori Asgard, the investment platform owned by Westpac, has announced substantial increases in insurance premium rates, ranging from 0.7% to 94.6%. This decision comes in collaboration with AIA Australia following a review of its insurance offerings. The changes, which will affect clients with Asgard Personal Protection Packages, are attributed to rising costs, including claims expenses. - read more