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

The Importance of Cyber Security: Protecting Your Small Business

Cyber security refers to the practices and technologies designed to protect computers, networks, programs, and data from unauthorized access, attacks, or damage. It's a crucial aspect of modern business operations, and understanding its importance is vital for all businesses, especially small ones. - read more

Navigating Cyber Threats: Essential Cyber Insurance for Your Start-up

Starting a new business venture is an exciting endeavor, but amid the myriad decisions start-up founders face, one must not overlook the importance of insurance. In today's digital-first world, the potential for cyber threats is a reality that can no longer be ignored by businesses of any size or sector, especially start-ups aiming to secure their future. - read more

Assessing the Insurance needs of your Australian Labour Hire firm

As a labour hire firm, it is important to assess your insurance needs to protect your business from the risks it faces. Assessing your insurance needs involves identifying potential risks specific to your industry and taking steps to mitigate them. With the right coverage, you can protect your employees, clients, and business assets from unforeseeable circumstances, which could otherwise result in costly lawsuits or accidents. - 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

10 Common Insurance Terms Every Business Owner Should Know

As a business owner, understanding the ins and outs of insurance can feel like navigating a maze. The terminology alone can be daunting, yet it's crucial to grasp these concepts to make informed decisions about protecting your enterprise. - read more

Insurance News

IAG's Strategic Expansion: 90% Acquisition of RACQ Insurance

24 Mar 2026: Paige Estritori

Insurance Australia Group (IAG) has announced the acquisition of a 90% stake in RACQ Insurance for $855 million. This strategic move is expected to bolster IAG's gross written premiums by approximately $1.3 billion, reinforcing its position in the Australian insurance market. - read more

Suncorp's Impressive 89% Profit Increase in H1 2025

24 Mar 2026: Paige Estritori

Suncorp Group has reported a remarkable 89% increase in net profit for the first half of 2025, with earnings per share reaching A$86.56. This substantial growth reflects the company's strong performance in the Australian insurance sector. - read more

Gallagher Bassett's Mobile Case Managers Enhance NSW Workers' Compensation

24 Mar 2026: Paige Estritori

Gallagher Bassett has introduced mobile case managers in New South Wales, aiming to enhance workers' compensation services by providing on-site support to injured workers. This initiative builds upon a successful model implemented in South Australia over the past decade. - read more

Australian Insurers Face Challenges in Cyber and AI Risk Readiness

08 Mar 2026: Paige Estritori

Recent findings from the PwC Insurance Banana Skins Survey have raised concerns about the preparedness of Australian insurers in managing emerging risks, particularly those associated with cyber threats and artificial intelligence (AI). The survey, which gathered insights from 698 insurance executives across 42 territories, including 37 from Australia, indicates that Australian insurers scored 6.6% lower on the Preparedness Index compared to their global counterparts. - read more

Rising Insurance Premiums Pose Challenges for Australian Businesses

08 Mar 2026: Paige Estritori

Businesses across New South Wales are grappling with substantial increases in insurance premiums, prompting calls for urgent reforms to alleviate financial pressures. According to Business NSW's latest Business Conditions Survey, nearly 80% of businesses have experienced double-digit hikes in insurance costs over the past year, with one in three reporting increases of 30% or more. These surges significantly outpace the annual inflation rate of 2.5%, placing an undue burden on the business community. - read more

Click for more Insurance News

Knowledgebase

Beneficiary:
The person or entity designated to receive the death benefit from a life insurance policy.