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# 9 Most Frequently Asked Questions

Be Informed about your rights? Insurance Law/Denied claims

Insurance policies invariably require an insured to provide their full cooperation to an insurance company in respect of any claim including providing all necessary information and documents.  The investigator is the agent of the insurance company so such information and documents should be provided to him or her.  If certain documents (including financial documents) are requested and you are uncertain as to whether they are relevant to the claim, you should withhold them for the time being and asked that a request for same be put in writing.  You should then seek legal advice as to whether such documents should be produced?

Denied Insurance claims

This would depend upon the terms of the policy but usually an insured’s claim is limited to the amount for which the property was insured.  Interest can also be claimed if the insurer unreasonably delays in settling the claim and making payment. 

Most insurers have an internal dispute resolution procedure, and it is always worthwhile requesting a referral to the IDR team.  You can also make a complaint to the Australian Financial Complaints Authority (AFCA) depending upon the type of claim and the amount in issue.  Otherwise, you can seek redress through the court system by commencing proceedings in the District Court, Supreme Court or Federal Court.  Prior to considering the commencement of such proceedings you should seek advice on the prospects of such claim from an experienced insurance lawyer.

Every effort should be made to resolve the issue prior to commencement of legal proceedings which can be expensive and time-consuming.  Proceedings should not be commenced unless you have received the advice of an experienced insurance lawyer because in the event that you fail in such proceedings you may be saddled with a significant costs order.  If your own correspondence with the insurer is not producing results, you may consider retaining an insurance lawyer to correspond on your behalf.

In most cases a reasonable time to process the average insurance claim is said to be about three months.  If an insurer unfairly delays the processing of a claim they may have to pay interest pursuant to section 57 of the Insurance Contracts Act 1984 (ICA).  A polite letter reminding the insurer of its obligations to pay the claim within a reasonable time and referring  it to the provisions of section 57 ICA may result in the expedition of the claims process.

You should provide whatever evidence is available which might include for example: photographs, valuations, statutory declaration or affidavits, evidence of the value of similar items etc.

This would depend upon the terms of the agreement between the claimant, the financial service provider (FSP) and AFCA.   Such agreement has been found to be a tripartite contract.  If you agree to be bound by the AFCA decision, you may be precluded from taking further action.  You should seek the advice from an experienced insurance lawyer and in the meantime, you should not sign any document agreeing to be bound by the AFCA decision prior to obtaining such advice.

You can lodge a complaint regarding the assessor with the insurer’s internal dispute resolution (IDR) team.  It is possible that the insurer may send a second assessor to carry out a further inspection.  If the matter cannot be thereby resolved, you may need to retain your own expert builder, engineer or quantitative surveyor.  You do not have to accept the insurer’s loss assessment.  You can challenge the assessment either through the insurer’s IDR procedure, AFCA or through the court system however you will need evidence to prove that the insurer’s assessment is erroneous.

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