Understanding Insurance Claims and Complaints Process

If you find yourself in a dispute with your insurer over a claim, seeking legal advice promptly is crucial. PK Simpson has a strong track record of successfully challenging insurer decisions and fighting for clients’ entitlements.

The Australian insurance industry operates under strict regulations requiring insurers to maintain transparent and fair dispute resolution processes. These rules protect consumers and ensure valid claims are handled appropriately.

Whether you’re dealing with property damage, vehicle accidents, or other insurance matters, understanding how to navigate the complaints process can significantly affect the outcome of your claim.

If you believe your insurer’s service, product, or response to a claim is incorrect, you are entitled to make a complaint. Minor issues may be resolved by phone, while more complex disputes may require the assistance of a compensation lawyer.

Understanding Your Insurance Policy

Insurance claims may relate to damage to your vehicle, home, or contents. Before taking action, it’s essential to read and fully understand your insurance policy to ensure your concerns align with what your insurer agreed to cover.

The Complaint Process

Under Australian law, insurance companies must provide two complaint pathways:

• Internal dispute resolution (within the insurer)
• Independent external dispute resolution

Insurers must keep you informed of the progress of your complaint, usually within 10 business days. A decision is generally provided within 15 business days after review.

Common Reasons for Claim Rejections

Insurance claims may be rejected or reduced for reasons such as:

• Insufficient or incorrect information
• Policy coverage exclusions
• Under-insurance
• Failure to meet policy conditions
• Policy cancellation or missed payments
• Lack of property maintenance

Common Types of Disputes

Disputes often arise from property flooding or damage to vehicles involved in motor vehicle accidents.
These matters frequently involve lengthy negotiations with insurers.

Resolution Options

If internal complaints do not resolve the issue, insurers must inform you of external dispute resolution options. These services are free, independent, and administered by bodies such as the Financial Ombudsman Service.