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So you’ve had a claim denied. What next?

Filing a claim can be an arduous task – but having a claim denied is even worse.

The stress of thinking that you may have to finance repairs or payments yourself, when you thought that they would be covered by the insurer, can be overwhelming.

But if you genuinely believe you have a valid claim denied, there are options.

Before firing up a complaint to internal dispute resolution with the insurer, or the Australian Financial Complaints Authority (AFCA), it’s worth checking with us to see if there is anything we can do to help.

An experienced broker can act as a reliable advocate, utilising their expertise to provide valuable advice on the claims process and analyse any areas that need a different approach.

Sometimes providing additional documentation, evidence or a second opinion against an insurer-appointed expert can make all the difference. When it comes to disputed policy exclusions, a broker’s advice can also be helpful.

If required, you can ask your insurer to launch a formal internal dispute resolution to review the decision to deny the claim and any specific issues raised with its handling.

The insurer will appoint a decision-maker to review the dispute. If you are unhappy with the outcome, you can take your case to a third party, such as AFCA or a court.

The AFCA process will investigate the claim’s validity, placing the onus on the complainant to prove that a loss occurred and that it falls within the terms of the policy. If accepted, the responsibility will then be placed on the insurer to show that it was entitled to deny the claim, due to policy exclusions or other reasons.

A decision will be made by an ombudsman or panel who will resolve the dispute. Although AFCA decisions are typically binding for financial firms, complainants do not have to accept them and can take their complaints to court.

If you are unhappy with an AFCA decision or your claim does not fall under its jurisdiction, you can take your case to court. However, this will likely result in a costly and lengthy process and should be considered a last resort.

When making a claim, remember to give us all the information you have, and we can give you the best chance of a successful outcome.

But should a claim be denied, talk to us about the best next steps.

General Advice Warning: This advice is general and does not take into account your objectives, financial situation or needs. You should consider whether the advice is appropriate for you and your personal circumstances. Before you make any decision about whether to acquire a certain product, you should obtain and read the relevant product disclosure statement.

All information above has been provided by the author.


Adroit Insurance & Risk, ABN 75 078972 700, AFSL 244 348

This article originally appeared on Adroit Blog and has been published here with permission.

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