Preparing a complaint about an insurance claim decision
Short answer
If you disagree with an insurer's claim decision, ask for its written reasons and the policy clause it relied on. Identify the finding, repair item or claim-handling action you dispute, match each point to the relevant evidence, and state what you want the insurer to reconsider.
Identify the decision you're challenging
Are you disputing whether the event was covered, an exclusion, missing repair work, the settlement amount or delays and communication? Separate the issues so the insurer can answer each one.
Gather four records
Your actual policy schedule, relevant Product Disclosure Statement edition and supplementary terms.
A short timeline of the event, your claim, inspections, decisions, requests and responses.
The insurer's decision letter, relevant clauses, expert reports and itemised repair scope.
Dated photos, tests, professional reports, receipts or quotes that address the disputed facts.
Decide what you're asking for
Specify the outcome: an explanation, reconsideration of cover, inclusion of particular repairs, a corrected settlement amount or a response to claim-handling problems. Explain why the attached evidence supports that request.
Complain to the insurer first
ASIC Moneysmart advises making a clear written complaint and keeping a copy. For many insurance complaints, firms generally have up to 30 calendar days to provide an internal dispute-resolution response, although exceptions and other categories apply. Check the current requirements for the issue you're raising.
You could start: “I'm making a formal complaint about the decision dated [date]. I disagree with [specific finding] because [document and date]. Please reconsider [specific outcome] and explain the policy provision and reasons in writing.”
If you need help from AFCA
The Australian Financial Complaints Authority (AFCA) is a free external dispute-resolution service for eligible insurance complaints. It usually encourages you to raise the complaint with the insurer first and may refer the matter back to the firm for a response. If you remain dissatisfied, check AFCA's current eligibility and time limits and how to lodge a complaint.
For water-damage disputes, see Home insurance water leaks: the failed part versus resulting damage. For cash offers, see Insurance excesses and cash settlements: what to check before agreeing. To understand published decisions, see What published AFCA insurance decisions can tell you.
If a gas, electrical, water or structural hazard needs immediate attention, seek appropriate qualified help rather than waiting for the complaint process.
Your next step
Open the policy checklist
Record questions against your own policy and its edition.
Open the policy checklist