What to Do If You're Not Happy with Your Claim

I‘m always on the lookout for articles with the potential to positively change a business. What’s your take on the following points I came across recently?

If you are one of the very small percentage who has an insurance claim rejected each year, or if you are unhappy with the amount your insurer has deemed payable for a claim, it’s important that you know that there is a process in place through which you can make a complaint and seek an alternative resolution.

The law and the General Insurance Code of Practice

The laws and the Code are especially relevant where disputes and resolutions are concerned, as they lay out some steps and parameters of conduct. The Code is important here because it specifies that insurers must be fair and transparent with their customers — and this is especially pertinent where claims and complaints are concerned.

Meanwhile, the laws surrounding insurance in Australia make it compulsory for insurers to provide customers with an avenue to first make a complaint directly with the insurer (internal dispute resolution) and, then, if customers deem the outcome of the complaints process unsatisfactory, insurers are required to direct customers to an alternative outside avenue (external dispute resolution).

Internal dispute resolution

There are many reasons why an insurance company may legitimately deny a claim — your failure to disclose information relevant to the insurance policy, what you are claiming for falls within the exclusions category, your failure to meet your responsibilities as part of the insurance contract, your failure to pay the premium, etc. It’s really in your best interests to consider carefully the reasons why an insurer has come to their decision and do a little bit of research about whether or not their actions are justified before you make a complaint.

However, there are times where you may feel that an insurer’s decision on your claim is incorrect and you have grounds to challenge their decision. Your complaint might not actually relate to a claim, rather you may feel that the insurer did not adequately disclose information to you, or perhaps you have taken issue with how you have been treated by the staff at an insurance company or someone affiliated with the insurer. 

I’d be really interested to know your opinion. Check out the full article here and then I’d be happy to discuss with you by phone (07) 3243 0000 or email [email protected].

Thanks,

Mark