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Claim disputes

For many years Maurice Blackburn has tackled insurers, big and small, to ensure hard working Australians receive the benefits they are entitled to. Our clients put their trust in us, as Australia’s largest insurance claims legal department, to negotiate and dispute insurance claims from illness to injury and unforeseen occurrences such as business insurance and home insurance.

It can come as a shock when your insurer uses the fine print to knock back your insurance claim. People pay premiums in good faith and want their claims accepted promptly. However insurers often unreasonably delay and decline claims, causing stress and hardship to genuine claimants. Our insurance claim dispute lawyers are experts in insurance law and will fight hard to get you the compensation you deserve.

You can contact the Maurice Blackburn team If you would like to be supported in the claim process. Taking on a well-resourced insurance company can be daunting. But, with an expert insurance lawyer by your side, it doesn’t have to be. We will listen to you and take care of every step of the claim dispute process to ensure you get everything you’re entitled to.

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Areas we focus on
Rejected claims

Reasons for a rejected claim

1 of 5
They say you haven’t provided enough evidence to support your claim

Most insurance policies require you to submit evidence to prove your entitlement under the policy.  This can be confusing and difficult, especially when expert evidence is needed.

2 of 5
They say you have failed to disclose important information

As an insurance policyholder, you must disclose relevant information when you renew or take out a new policy.
If your insurer can show that you failed to provide accurate or complete details, they may use that as grounds to reject your insurance claim.

3 of 5
They say you have not complied with a condition or an exclusion clause applies

Insurance policy fine print is often difficult to understand.  It’s important to check your policy to find out what conditions and exclusion clauses may affect your claim before you lodge.

4 of 5
They say you have acted dishonestly or fraudulently

If your insurer believes you acted dishonestly or recklessly, they could reject your claim.
Fraud can have serious legal implications so it’s important to seek legal advice immediately if you are accused of fraud.

5 of 5
They say your policy has been cancelled

If the insured event did not occur whilst your policy was in force then the insurer may reject your claim.  This may be due to the insurer cancelling your cover.
Policies are often cancelled when premiums are not paid in time or if the policy is not renewed at its anniversary.

How to dispute
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How to dispute an insurance claim denial

1 of 4
Read up on your policy

To maximise your chance of success, before we contact your insurer we read through your product disclosure statement (PDS) to understand exactly what you’re covered for. We then articulate we believe there is a claim and what the outcome should be.

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Make your dispute

We will contact your insurer and let them know you want to dispute their decision on your claim.

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Request an internal review

You do not have to accept your insurer’s resolution if it doesn’t resolve your problem. We can follow your insurer’s internal dispute resolution process where they should allocate a person who has the decision-making authority to review your dispute.

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Lodge an external dispute with the AFCA

If your insurer can’t resolve your dispute in house, we can lodge a dispute with the Australian Financial Complaints Authority (AFCA).

Why us

Why Maurice Blackburn?

Maurice Blackburn's superannuation and insurance claims lawyers are experts, especially at taking on large insurance companies. But, while we have successfully fought numerous superannuation insurance cases, your situation will still be unique. Your Maurice Blackburn superannuation team will take the time to listen so we can fully understand how you are feeling and how your injury or illness has affected you.

You will also have our support and guidance through every step of your claim process. We can offer you tailored advice on whether you have a valid claim and help assess the details of your claim so that you understand, and receive, your full superannuation benefits when you need them the most.

We offer 'no win, no fee'*

We offer 'no win, no fee'* arrangements for insurance dispute cases. This means that you don’t have to pay for our legal services if your insurance dispute is unsuccessful.

Dedicated lawyers across Australia

We employ insurance specialists in Melbourne, Sydney, Brisbane, Perth, Adelaide, Darwin and a number of other towns and cities throughout regional Australia.

FAQs

Frequently Asked Questions

Most insurance policies require a claim be lodged as soon as possible after the insured event. Whilst it’s best to lodge a claim straight away, there are legal protections that may allow claims to be successful years after ceasing work, so it’s important to get advice about your rights. 

Remember, the sooner your claim is lodged, the sooner your fund or insurer can assess it and come to a decision that, if successful, will help relieve some of your financial burdens.

In general, to dispute an insurer’s decision you might need:

  • Evidence and supporting documents
    Things like reports, assessments, photos, receipts, correspondence, bank and other financial statements that provide background to your dispute.
  • Claim outcome details
    Have a clear description of the outcome you want ready. Relevant calculations that show financial loss or compensation will be helpful.
  • A timeline of events
    This will help everyone involved to understand what happened when in relation to your dispute.

Depending on the type of insurance you are claiming, you may have to lodge:

  • A claim form
  • A list of lost or damaged items
  • Medical or other expert reports
  • Employer statements
  • Details of lost items
  • Tax documents

Insurance claims vary depending on their complexity and the type of claim. Travel, business, motor vehicle and home insurance can take one - three months on average. Income protection, trauma & sickness and accident claims take two - three months. TPD claims usually take six - 12 months.

There is a possibility you may need to see the insurers doctor, depending on your claim and your policy. We can find out for you.

Most likely, but you might still be entitled to partial disability payments if you return part time.

Yes. You can lodge an internal dispute and the insurer has 45 days to provide a response. If the complaint is to a super fund, they have 90 days.

Yes. You can appeal to the Australian Financial Complaints Authority (AFCA). You may also be able to pursue your claim through a court.  Important time limits apply which the trustee/insurer won’t warn you about, so you should get early advice about your rights.

If you want to appeal a decision, contact your local Maurice Blackburn expert lawyer to increase your chances of overturning the decision.

This will depend on the type of insurance policy you have and what value you and your insurer agreed on for what you are insuring.

An insurance claim lawyer can help you:

  • Find out if you have a valid claim
  • Understand the fine print in your policy
  • Lodge a dispute
  • Fight to get you the result you deserve
  • Represent you in court if necessary
  • Minimise the amount of stress you go through

It depends on the type of insurance policy you have. Some types of policies may have time limits like, ‘as soon as possible following damage’, to lodge a claim.

It doesn’t cost you anything to know where you stand

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