The Critical Role of Thorough Investigations in Achieving Strong Claim Outcomes

This case study highlights the essential role that Adjusters play in determining liability and shaping the overall claim strategy. A well‑executed investigation forms the foundation of a robust defence and directly influences the outcome of a claim.

Our Adjusters, Chris Parkes and Yolanda Suarez, expertly managed this matter from initial assessment through to final resolution.

To protect the privacy of those involved, names and certain case details have been modified.

Claimant vs Beachfront Property

Background

The Insured owned a holiday accommodation property on the beachfront, listed through a well‑known online booking platform. Situated approximately 100 metres from the shoreline and surrounded by coastal bushland, the property featured a sandy driveway leading up to the front entrance.

The Claimant was staying at the property with a group of friends. After returning from a fishing outing, she remained seated in the back tray of a friend’s ute, which had been parked on the grassy and sandy front yard of the premises. The Claimant alleged that as she stepped down from the tray to exit the vehicle, she placed her foot directly onto a large rock concealed beneath long grass.

The Claimant sustained a fractured right heel and right ankle as a result of the incident and was transported by ambulance to the local hospital for treatment.

The investigation

A comprehensive investigation was undertaken to establish the circumstances of the incident and assess the credibility of the competing versions provided. Key steps included:

Information obtained from the insured

• Clarification of how frequently the Insured attended the property to clean and maintain the yard.
• Confirmation of the most recent visit to the premises, prior to the Claimant’s stay.
• Details regarding the layout of the yard and whether large rocks were present.
• The Insured advised no large rocks had ever been located at the front of the dwelling. They also noted that rainfall had been minimal in the weeks leading to the date of Incident, resulting in limited grass growth. The surrounding land consisted mainly of sand.
• The Insured provided a photograph taken within the week prior to the Incident, clearly showing an absence of long grass on the premises due to the prolonged lack of rainfall.

Site attendance

• Attendance at the property enabled our team to gather first‑hand observations and verify the physical layout and yard conditions.

Weather data validation

• Rainfall data obtained from the Bureau of Meteorology corroborated the Insured’s account of minimal rainfall in the lead‑up to the incident, supporting the assertion that long grass was unlikely to have been present.

Medical evidence

• Medical records confirmed the Claimant was under the influence of cannabis at the time of the incident.

Analysis of the claimant’s account

Several inconsistencies emerged during the review of the Claimant’s version of events:

• Photographs provided by the Claimant did not depict any large rocks or long grass at the front of the dwelling or at the alleged incident location. The area appeared flat, sandy, and either short‑grassed or grass‑bare.
• The Claimant reported consuming four beers over four hours within the 12 hours prior to the incident. However:
  • She stated the Incident occurred on the day of her arrival.
  • The time of Incident was reported as 1:00 pm.
  • Travel time from her residence to the premises was nearly two hours.
  • As she claimed the incident occurred upon returning from a fishing outing, she must have already been in the area for at least several hours prior.
  • Unless she consumed the beers during the drive that morning or began drinking at 1:00 am, it is highly probable the alcohol was consumed within only a few hours of the incident—raising legitimate questions regarding her level of intoxication at the time.

The defence

During our correspondence with the Claimant’s solicitors, and at the Compulsory Conference, we consistently maintained the following position:

1. No hazardous conditions existed—there was no large rock or long grass present on the property at or near the date of the incident.
2. The property was regularly maintained, with the Insured personally attending to cleaning and yard maintenance after each holiday booking.
3. A site assessment had been conducted by the Insured in the week prior to the Claimant’s arrival, confirming the property was in good condition.
4. Reasonable care had been exercised, meeting the Insured’s duty to maintain the premises.
5. The Claimant’s own photographs supported our position, showing no large rocks and a well‑kept exterior.
6. Medical evidence indicated impairment, confirming the Claimant was under the influence of alcohol and cannabis at the time of the incident.
7. Based on the above, we maintained a denial of liability.

The Claimant initially sought $358,058.28 in damages. However, during the Compulsory Conference it became clear that the Claimant could not substantiate her claim in light of the evidence gathered during our investigation.

We extended a commercial, costs‑inclusive offer of $20,000.00, while maintaining our denial of liability. Given the strength of the evidence, the Claimant accepted this offer.

Costs to insurer

• $28,564.38 – investigation and defence costs
• $20,000.00 – settlement

Practical takeaways

This matter showcased the importance of a thorough, evidence‑based investigation in achieving a strong and commercially sound outcome. By systematically gathering factual information—from site inspections and meteorological data to medical evidence and photographic analysis we were able to refute the Claimant’s version of events through objective, verifiable evidence.

Furthermore, we achieved a favourable commercial resolution for the Insurer, reducing the Claimant’s demand from $358,000 to a $20,000 costs‑inclusive settlement, while upholding the denial of liability.

Overall, the case reinforced that well‑executed investigations, timely evidence gathering, and consistent defence strategy are critical in mitigating exposure and securing successful outcomes for clients.