How to Challenge Unfair Insurance Disputes & Rejections

Insurance Disputes

How can I challenge my insurance claim rejection if I feel it was unfair?

The information on this website is general in nature and does not take into account your objectives, financial situation, or needs. Consider seeking personal advice from a licensed adviser before acting on any information.

Just because your insurer has rejected your claim, does not necessarily mean that your case is closed. If you think that you have been unfairly treated, here are some ways to get the insurer decision overturned.

What to do

Inform the insurance company as soon as you can following the event. It is sometimes a good idea to write the details of the event as soon as you can, and then use that as a reference to make the written claim.
Be consistent. Remember, it will be awkward if you want to change your story later on.
Keep all documents that are relevant to the claim.
Make sure the staff of the insurance company can get in touch with you.

If the claim is rejected?

Insuring your most valuable asset

While many people would consider their home or their car to be their most valuable asset, it's your ability to earn an income that is most important in shaping your financial future. Statistically, two thirds of working Australians will suffer an injury or illness that will sideline them for 90 days or more. The majority of these people would not be able to pay their mortgage or meet car finance and other loan commitments without adequate income insurance.

... compare rates & options ...

There are circumstances where you may in fact have the legal right to be reimbursed for your loss even though the insurer refused to pay the claim. Although you can sometimes make this judgement yourself, it is sometimes a good idea to get legal advice. See our fact sheets on "Disputes".

Check the policy

If the claim is rejected ask your insurer to identify specifically the clause of the contract on which they rely. If you do not have a current policy make sure they supply one.

What caused the loss?

If the insurer claims that you caused the loss, and this is in breach of the policy, make sure that this is so.

For instance, if you were smoking in bed at the time of a fire, and a fire caused this way is a breach of your policy, you may not in fact be in breach if the fire was caused by an electrical fault. In this case the fact that you were smoking in bed would be coincidental and not the cause of the fire.

Pre-existing conditions

The policy may stipulate that a known pre-existing situation or condition is not covered. For instance, if you have disability insurance but at the time you signed the policy you had a tumor. However, under the law it would be crucial whether you actually knew you had this condition. If you were unaware of it you should still be covered.

Ignorance of the terms

Under the law the insurer has a legal obligation to inform you about the restrictions in the insurance policy. This must be done before you sign the application and the policy is issued. This means (in part) that:

you must be given a copy of the policy; and
the wording of the policy must be clear and unambiguous.

If these pre-conditions were not met it may be possible to retain your coverage for your loss. Again, it may be necessary to obtain legal advice.

Is it worth the claim?

Many types of insurance contracts will have an excess. This is common in a car insurance contract, or similarly you may lose part of the no-claims bonus. Some companies now reward rating one drivers with a lifetime rating one guarantee. At times you will have to decide whether the amount of the claim is worth the long term loss that results from the effect on rating or no-claims bonuses, especially after taking into account the amount of the excess.

Published: Sunday, 1st Aug 2021
Author: Paige Estritori

Life Insurance Articles

Single or Married: How Life Insurance Needs Vary Across Different Life Stages

Life insurance is a financial product that provides a lump sum payment to your beneficiaries in the event of your death. It is designed to offer financial security by covering debts, daily living expenses, and future financial obligations. - read more

How Much Life Insurance Do You Truly Need? Assessing Your Personal Coverage

There's often confusion surrounding the amount of life insurance one truly needs. Common misconceptions cloud our judgment, leading some to undervalue their coverage, while others may overinsure, unnecessarily straining their financial resources. It is a delicate balance to strike, and understanding the nuances of life insurance is pivotal to making informed decisions. - read more

Understanding Life Insurance Needs: A Guide for Australian Families

Life insurance is a financial product designed to provide peace of mind by offering a safety net for your loved ones in the event of your passing. The primary purpose of life insurance is to ensure that your family is financially protected, allowing them to maintain their standard of living even without your income. - read more

The Single Parent’s Guide to Securing Your Child’s Financial Future

Single parenting brings with it a mosaic of responsibilities and challenges, not least of which is securing a stable financial future for your child. The rollercoaster of raising a child alone often means that planning for the future can take a back seat to the day-to-day demands of parenting. Unexpected illnesses and injuries can compound these challenges, causing stress to multiply and plans to go awry. - read more

Understanding the Role of Life Insurance in Your Estate Plan

Estate planning is a critical process that often goes overlooked, but it's essential for securing the financial future of your loved ones and ensuring your assets are distributed according to your wishes. It involves the careful organization and protection of an individual’s estate to minimize uncertainties and facilitate the smooth transfer of assets after their passing. While it may seem complex, understanding the basics of estate planning is necessary for every Australian adult, regardless of wealth. - read more

Insurance News