Australia's dispute process for insurance is genuinely structured — a denial is a starting point for a defined process, not a dead end.
Read the decision and identify the exact reason
Insurers must explain why a claim was denied — locate the specific policy wording cited, not just the general category of reason. Compare that wording directly against your own copy of the policy.
Check the wording against your actual facts
Exclusions and conditions are sometimes applied more broadly than they're actually worded, or based on incomplete information. Identify any factual gap between what the insurer's decision assumes and what you can actually evidence.
Gather evidence the insurer may not have had
An independent assessor's report, additional photos, or documentation contradicting the stated reason for denial can all support a formal review request — submit these clearly, referencing exactly which part of the decision they address.
Use internal dispute resolution (IDR) first
Every insurer has an internal dispute resolution process. Under the General Insurance Code of Practice, insurers generally aim to resolve complaints within 30 calendar days, with a maximum of 45 calendar days under the regulatory standard — if they can't meet that, they must tell you why and explain your right to escalate.
Escalate to AFCA if IDR doesn't resolve it
If you're not satisfied with the insurer's internal decision, the Australian Financial Complaints Authority (AFCA) provides free, independent external dispute resolution. AFCA can mediate, and if that doesn't resolve things, issue a determination that's binding on the insurer (though not on you) — meaning you can still pursue other options if you disagree with AFCA's outcome.
Sources
Related Kibbo Tools
- Insurance Claim Denial Review Checklist — work through the denial systematically before responding.
- Insurance Denial & Coverage Dispute Generator — draft your formal dispute for internal review or AFCA.