Your insurance company might refuse to pay you for your claim if:
Your insurance company should provide you with its decision in writing. Ask for a written decision if you are told that your claim has been refused over the telephone.
If you are not happy with your insurance company's decision you can challenge the decision. You have a number of options:
Any complaint about your claim should first be made to your insurance company's Internal Dispute Resolution (IDR) department. The complaint should be made in writing.
You can contact your insurance company for the contact details of their IDR department and what details to put in your written complaint.
If you are not happy with the decision of your insurance company's IDR department, or you can't find their details, you can lodge the dispute with the Financial Ombudsman Service (FOS). Instructions about how to lodge a dispute can be found on the FOS website.
There are time limits for lodging a dispute with FOS. Make sure that you do it within three months of the date the insurance company's IDR department rejected your claim.
For more information on the dispute handling process go to the FOS website.
If you are not satisfied with the outcome of either an internal review by your insurance company or a determination of FOS, you can make an application to have the dispute decided by the Consumer and Commercial Division of the NSW Civil and AdministrativeTribunal (NCAT) within 3 years.
Claims are usually limited to $40,000.00 (as at July 2014). For more information on making an application to NCAT, go to the NCAT website.
You may also be able to make a claim against your insurance company for breach of contract. If the amount of your claim is less than $10,000.00, you would make this claim in the Small Claims Division of the Local Court. If the amount of your claim is more than $10,000.00 but less than $100,000.00, you would make this claim in the General Division of the Local Court. You should get legal advice before making a claim for breach of contract.
Before making a claim against an insurance company to NCATor the Local Court you should get legal advice. The Insurance Law Service provides legal advice, call 1300 663 464 or go to the Insurance Law Service website.
Financial Ombudsman Service Before you lodge a dispute
Financial Ombudsman Service Dispute handling process in detail
Insurance Law Service