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Unhappy with an insurance claim decision? Dispute it properly.

Claim denied, settled for less than the repairs cost, or stuck in assessment limbo — dissatisfaction with a claim is not the end of the road. Insurers change decisions when the dispute attacks their stated reasons with evidence. Here is the path. (New to insurer complaints generally? Start with the insurance complaints guide.)

The five steps that get claim decisions changed

Get the decision — and its reasons — in writing

Under the 2020 General Insurance Code of Practice, an insurer that denies your claim or does not pay it in full must tell you in writing which aspects it does not accept and why, and must tell you that you can ask for the information about you it relied on and for copies of any service suppliers' or external experts' reports it relied on. Ask for all of it — the Code says you get it within 10 business days. A decision you cannot examine is a decision you cannot be expected to accept.

Request an internal review, in writing

Every insurer must run internal dispute resolution, and ASIC's Regulatory Guide 271 requires a response to most complaints no later than 30 calendar days after it is received. Quote the claim number, the policy number and the dates — of the event, the lodgement, each assessment — and ask for a complaint reference. This written trail is what an ombudsman later reads, so make it the version of record.

Attack the reasons, not the outcome

'I am dissatisfied' invites a form letter; 'your assessor's scope omits the water damage in photos 4–7' requires an answer. Take each stated reason and put your evidence against it: your own itemised repair quotes against their scope of works, your photos against their report, the policy wording against the exclusion they claim. If the offer is cash, make them show the settlement covers what repairing actually costs.

Say what outcome you want, with a deadline

The claim accepted, the settlement raised to the quoted amount, the repairs re-scoped, or a decision at all if you have been left waiting. Ask for the response within their published timeframe and say plainly that you will take the dispute further when it lapses. Delay is itself a complaint — handling and settling a claim has been a licensed financial service since 1 January 2022, and an AFS licensee must do all things necessary to ensure its financial services are provided efficiently, honestly and fairly.

Escalate to AFCA — free, and mind the clock

The Australian Financial Complaints Authority (afca.org.au, 1800 931 678) reviews claim denials, settlement amounts, delays and claim handling, and is free for consumers. AFCA says a complaint generally must reach it within two years of the insurer's final internal dispute resolution response, and within six years of when you first became aware of the loss, whichever comes first — so never sit on a final decision letter. If you accept AFCA's determination, the insurer is required to comply with it.

What actually changes a claim decision

Insurers do not reverse decisions because a customer is upset; they reverse them when the file no longer supports the reason they gave. That is why the order of the steps matters. You cannot argue with an assessment you have not read, and the Code entitles you to read it — so the request for the reports comes before the argument, not after.

Once you have them, the dispute is a comparison exercise. Scope of works against your own itemised quotes. Their photographs against yours. The exclusion clause they relied on against the actual wording in your policy schedule and product disclosure statement. Each mismatch is one line in your internal-review request, and each line has to be answered individually rather than absorbed into a general refusal.

Keep the dates as tightly as the substance: the date of loss, the date you lodged, the date of every assessment and inspection, the date of the decision letter. Those dates set both the insurer's 30-day internal review clock and the two-year window for the ombudsman, and they are the first thing anyone reviewing the matter will look for.

Or let Trumis build the dispute in one conversation

Tell Trumis what happened in your own words — any language, even screenshots of the assessment and your quotes. It drafts the dispute the insurer's own internal review process needs, with the particulars, your confirmed circumstances and your evidence attached, and addresses it to their internal-review team. The response clock is tracked too, so you know exactly when to escalate. Free — no account, encrypted intake records retained for up to 24 months.

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Common questions

Can I dispute a cash settlement that will not cover the repairs?

Yes. Get your own itemised repair quotes and put them against the insurer's scope of works line by line. A settlement built on an assessment that misses damage, prices repairs below real quotes, or quietly swaps repair for cash is disputable — and quote-versus-scope comparisons are exactly the kind of evidence an internal review and then AFCA can weigh.

What if the insurer is just slow — no decision at all?

Delay is itself a complaint. From 1 January 2022 an insurer needs an AFS licence to handle and settle claims, and a licensee must do all things necessary to ensure its financial services are provided efficiently, honestly and fairly. Ask in writing where your claim sits against the insurer's published timeframes; silence past their own deadline is grounds to escalate.

Am I entitled to the reports the insurer relied on?

Under the 2020 General Insurance Code of Practice, an insurer that denies a claim or does not pay it in full must tell you in writing which aspects it does not accept, the reasons for the decision, and that you have the right to ask for the information about you it relied on and for copies of any service suppliers' or external experts' reports it relied on. If you ask, the Code says you get them within 10 business days. Ask in writing.

How long do I have to take a claim dispute to AFCA?

AFCA says a complaint generally must be lodged within two years of the firm's final internal dispute resolution response, and within six years after you first became aware — or should reasonably have become aware — that you suffered the loss, whichever comes first. Do not sit on a final decision letter: note its date and lodge well inside the window. AFCA is free for consumers.

Reviewed 28 July 2026. Check your insurer's current process, the General Insurance Code of Practice and AFCA's official guidance before escalating. General information only.