How to Challenge Unfair Insurance Disputes & Rejections

Insurance Disputes

How can I challenge my insurance claim rejection if I feel it was unfair?

The information on this website is general in nature and does not take into account your objectives, financial situation, or needs. Consider seeking personal advice from a licensed adviser before acting on any information.

Just because your insurer has rejected your claim, does not necessarily mean that your case is closed. If you think that you have been unfairly treated, here are some ways to get the insurer decision overturned.

What to do

Inform the insurance company as soon as you can following the event. It is sometimes a good idea to write the details of the event as soon as you can, and then use that as a reference to make the written claim.
Be consistent. Remember, it will be awkward if you want to change your story later on.
Keep all documents that are relevant to the claim.
Make sure the staff of the insurance company can get in touch with you.

If the claim is rejected?

Insuring your most valuable asset

While many people would consider their home or their car to be their most valuable asset, it's your ability to earn an income that is most important in shaping your financial future. Statistically, two thirds of working Australians will suffer an injury or illness that will sideline them for 90 days or more. The majority of these people would not be able to pay their mortgage or meet car finance and other loan commitments without adequate income insurance.

... compare rates & options ...

There are circumstances where you may in fact have the legal right to be reimbursed for your loss even though the insurer refused to pay the claim. Although you can sometimes make this judgement yourself, it is sometimes a good idea to get legal advice. See our fact sheets on "Disputes".

Check the policy

If the claim is rejected ask your insurer to identify specifically the clause of the contract on which they rely. If you do not have a current policy make sure they supply one.

What caused the loss?

If the insurer claims that you caused the loss, and this is in breach of the policy, make sure that this is so.

For instance, if you were smoking in bed at the time of a fire, and a fire caused this way is a breach of your policy, you may not in fact be in breach if the fire was caused by an electrical fault. In this case the fact that you were smoking in bed would be coincidental and not the cause of the fire.

Pre-existing conditions

The policy may stipulate that a known pre-existing situation or condition is not covered. For instance, if you have disability insurance but at the time you signed the policy you had a tumor. However, under the law it would be crucial whether you actually knew you had this condition. If you were unaware of it you should still be covered.

Ignorance of the terms

Under the law the insurer has a legal obligation to inform you about the restrictions in the insurance policy. This must be done before you sign the application and the policy is issued. This means (in part) that:

you must be given a copy of the policy; and
the wording of the policy must be clear and unambiguous.

If these pre-conditions were not met it may be possible to retain your coverage for your loss. Again, it may be necessary to obtain legal advice.

Is it worth the claim?

Many types of insurance contracts will have an excess. This is common in a car insurance contract, or similarly you may lose part of the no-claims bonus. Some companies now reward rating one drivers with a lifetime rating one guarantee. At times you will have to decide whether the amount of the claim is worth the long term loss that results from the effect on rating or no-claims bonuses, especially after taking into account the amount of the excess.

Published: Sunday, 1st Aug 2021
Author: Paige Estritori

Business Insurance Articles

Understanding Business Insurance: How to Safeguard Your Australian Small Business

Welcome to the elucidative journey through the realm of business insurance and the pivotal role it plays for small businesses in Australia. In the ever-evolving business landscape, having a solid safety net is not merely an option, but a necessity to thrive amidst unforeseen challenges. - read more

The Importance of Adequate Insurance Coverage for Your Small Business

For small businesses, navigating the intricacies of sustainability is a critical task that can be made more manageable through the prudent use of business insurance. Understandably, many small business owners prioritize immediate operational concerns over seemingly discrete matters like insurance. However, as we will explore, insurance is not a mere formality—it's a vital backbone to enduring success. - read more

Must-Have Insurance Policies for Australian SMEs in 2025

In today's rapidly evolving business environment, insurance has become an essential component for the survival and success of small to medium enterprises (SMEs). As businesses navigate through uncertainties, unexpected events can pose significant threats. Insurance not only provides a safety net but also conveys a sense of stability and trust to partners and customers. - read more

Financing Your Business: The Role of Loans and Insurances

Starting a new business is an exciting journey filled with opportunities and challenges. One of the most critical aspects to ensure your venture's success is adequate financing. Whether you're launching a small local shop or a larger enterprise, having a solid financial foundation is essential. - read more

Key Factors to Consider When Comparing Business Insurance Options

Business insurance is a vital aspect of safeguarding your company's interests and mitigating potential risks. Whether you are a small startup or a well-established organization, having appropriate insurance coverage is essential for protecting your assets, finances, and reputation. - read more

Insurance News

Australian Insurers Achieve Significant Profit Growth Amid Rising Premiums

03 Jan 2026: Paige Estritori

Australia's insurance industry has reported an after-tax profit of $6.1 billion for 2024, a substantial increase from the five-year average of $2 billion, according to KPMG's annual review. This surge is attributed to premium hikes and a year with fewer significant weather events. - read more

Rising Insurance Risk Pressures Challenge Australian Businesses

03 Jan 2026: Paige Estritori

Australian businesses are confronting heightened insurance risk pressures stemming from increased litigation, technological advancements, supply chain disruptions, catastrophic events, and geopolitical tensions. A recent report from Gallagher underscores the importance of risk insights and awareness for organizations preparing for insurance renewals. - read more

IAG's Strategic Moves Propel Profit Forecast Upward

26 Dec 2025: Paige Estritori

Insurance Australia Group (IAG) has recently announced an optimistic upgrade to its financial guidance for the fiscal year 2026, projecting a 10% increase in gross written premium (GWP) and an insurance profit ranging between $1.55 billion and $1.75 billion. This positive outlook is largely attributed to strategic acquisitions and a focus on digital transformation. - read more

Australian Insurers Face Challenges in Emerging Risk Preparedness

26 Dec 2025: Paige Estritori

Recent findings from PwC's Insurance Banana Skins Survey indicate that Australian insurers are trailing behind their global counterparts in terms of preparedness for emerging risks, particularly in areas such as cyber threats and artificial intelligence (AI). - read more

Australian Insurers Falling Behind in Cyber and AI Risk Readiness

18 Dec 2025: Paige Estritori

In an era where digital threats are escalating, Australian insurers are reportedly less prepared to manage risks associated with cyber threats and artificial intelligence (AI) compared to their global counterparts. This insight emerges from the latest PwC Insurance Banana Skins Survey, which assesses the industry's readiness to tackle emerging challenges. - read more

Click for more Insurance News

Knowledgebase

Loss Ratio:
The ratio of claims paid by an insurer to the premiums earned, used as a measure of profitability.