If you’re holding a declined decision and wondering where to turn, you still have options. You can ask your insurer for a detailed written explanation of the decision and then take the matter through their internal dispute resolution process. If that doesn’t resolve things, you can escalate to the Australian Financial Complaints Authority. These steps exist to give you a fair go, no matter the type of general insurance.
Even though InsurerHub isn’t an insurer or underwriter, we can help you understand how the claims journey works and what levers you can pull when things don’t go to plan.
How the claims process works in Australia
When you lodge a claim, your insurer generally follows a standard path: they acknowledge receipt, appoint a claims handler, and start gathering the facts. That means you’ll typically need a completed claim form, photos or repair quotes if relevant, and any police or incident report numbers. The insurer then assesses your policy’s coverage, checks any exclusions, and decides whether to accept, partially accept, or decline the claim.
Because every policy is different, the exact steps and timelines can vary. The only binding terms are in your product disclosure statement (PDS). InsurerHub is here to give you the general picture, not to interpret a specific policy.
When a claim is declined
A decline doesn’t have to be the end of the road. By law, your insurer must give you reasons in writing if you ask. Once you have those reasons you can begin the dispute process.
Step 1: internal dispute resolution
Every general insurer must have a free internal dispute resolution (IDR) process. You don’t need a lawyer to use it. Put your complaint in writing—whether by email or a letter—and include your policy number, the claim reference, and exactly why you believe the decline was wrong. The insurer is required to respond within set timeframes and to explain their final decision clearly.
Step 2: Australian Financial Complaints Authority (AFCA)
If IDR doesn’t settle things, you can take your complaint to AFCA. This is a free, independent external dispute resolution scheme that covers general insurance. AFCA will look at both sides and can make binding decisions on the insurer. There are time limits on when you can lodge, so don’t let it sit.
Where InsurerHub fits in
InsurerHub helps you learn the rules of the road for general insurance. We’re not an insurer or underwriter, and we never promise premiums, cover, or claims outcomes. If you’d like to talk through your situation, you can submit a general insurance enquiry through our website and we’ll respond within one business day.
Quick guide to getting started
- Read your PDS – it’s the master document for what you’re entitled to.
- Ask for written reasons – you can’t challenge a decline properly without them.
- Use the insurer’s IDR process – it’s free and designed for this situation.
- Know your backup – AFCA is there when IDR isn’t enough.
Understanding your rights doesn’t guarantee a different outcome, but it does mean you won’t be left in the dark.