Having an insurance claim denied can be a stressful and overwhelming experience. However, it’s important to remain calm and strategic about the steps you take next.

The role of your general insurance broker or adviser becomes crucial in this situation. Their expertise can significantly increase your chances of having your claim reconsidered or successfully appealed.

Here are five essential tips on what to do if your insurance claim has been denied and why it’s important to speak with your general insurance broker or adviser:

  1. Understand the Reason for Denial
    The first step after receiving a denial is understanding exactly why your claim was rejected. Carefully review the denial letter provided by your insurance company, which should clearly outline the reasons for their decision. Common reasons include incomplete documentation, policy exclusions, or disputes over coverage specifics. Understanding these details is essential in effectively addressing and contesting the denial.

  2. Contact Your General Insurance Broker or Adviser Immediately
    Consulting with your general insurance broker or adviser early can significantly impact the outcome of your situation. Brokers or advisers are well-versed in insurance policy language and industry standards and can provide clarity on your policy details and your insurer’s obligations. They help interpret complex policy wording and can identify errors or misunderstandings that could have led to the denial. Early intervention can ensure your appeal or complaint is accurately presented, improving the likelihood of a favourable outcome.

  3. Gather Comprehensive Evidence and Documentation
    Documentation is key when contesting an insurance denial. Collect all relevant evidence supporting your claim, including photographs, repair estimates, medical records, or expert assessments. Your general insurance broker or adviser will guide you on precisely what documents are most persuasive and how to present them effectively. Comprehensive and organised documentation strengthens your case significantly when challenging an insurer’s decision.

  4. Formally Appeal the Decision
    Most insurers have formal appeal processes that you should follow carefully. Prepare a detailed and professionally written appeal letter clearly stating why the denial is incorrect based on policy terms and your collected evidence. Your general insurance broker or adviser is invaluable during this process as they can draft or review your appeal, ensuring it addresses the insurer’s concerns effectively. Brokers or advisers often have experience with similar cases, providing strategic insights into how best to structure your argument.

  5. Seek External Review if Needed
    If your appeal is unsuccessful, your general insurance broker or adviser can guide you in escalating the issue to external dispute resolution bodies, such as the Australian Financial Complaints Authority (AFCA). These organisations provide independent reviews of insurance disputes. Your broker or adviser will assist you in navigating this process efficiently, ensuring you meet all necessary procedural requirements and deadlines.

Importance of Speaking with Your General Insurance Broker or Adviser

The involvement of your general insurance broker or adviser throughout the claims denial process is crucial. Brokers or advisers not only provide expert guidance and strategic advice, but they also significantly reduce the stress involved by managing complex negotiations and paperwork. Their professional advocacy ensures your rights are protected, maximising the chances of successfully reversing a denied claim.

In summary, immediate action, clear documentation, and professional guidance from your general insurance broker or adviser are pivotal in effectively responding to a denied insurance claim.

If this article has inspired you to think about your unique situation and, more importantly, what you and your family are going through right now, please get in touch with your advice professional.

This information does not consider any person’s objectives, financial situation, or needs. Before making a decision, you should consider whether it is appropriate in light of your particular objectives, financial situation, or needs.

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Disclaimer: The information contained in this article is general in nature and does not take into account your personal objectives, financial situation or needs. Please consider whether the information is appropriate to your circumstance before acting on it and, where appropriate, seek professional advice.