Insurer - dispute resolution 

If you are not happy with a decision made by​ an insurance company you can challenge the decision. 

If your insurance company refuses your claim

You should check your insurance policy to find out what you are covered for. Your insurance company might refuse your claim if: ​

• you did not provide important information to them when you took out the policy (called 'non-disclosure')​
  
• ​your loss is not covered by the policy
• they believe you acted fraudulently
• the insurance policy was cancelled before the accident.
• If your claim has been refused, ask your insurance company to give you a written decision.

If you are not happy with your insurance company's decision you can challenge their decision. You have a number of options:

• ​Internal Dispute Resolution (IDR)
• Australian Financial Complaints Authority (AFCA)
• NSW Civil and Administrative Tribunal (NCAT). ​
  

Internal Dispute Resolution (IDR) 

​You should first make a complaint to your insurance company's Internal Dispute Resolution (IDR) section. The complaint should be made in writing. Most insurers have a complaint form you can lodge online through their website or send by post. Ask your insurance company for the contact details of their IDR department.

If you are not happy with the decision of your insurance company's IDR section, or are having difficulty dealing with the IDR section, you have the option of lodging a dispute with the:

• ​Australian Financial Complaints Authority (AFCA)
• NSW Civil and Administrative Tribunal (NCAT)
• Local Court. 

Australian Financial Complaints Authority (AFCA)

AFCA can consider some disputes about an insurance company where the insurer has refused the claim or delayed the claim.

A determination made by AFCA is final and binding on the insurer if you agree with the decision. If you disagree with the decision, you can apply to the NSW Civil and Administrative Tribunal (NCAT) or start a court case. 

For more information on lodging a dispute, see Make a complaint on the AFCA website. 

There are time limits for lodging a dispute with AFCA. Make sure that you do it within three months of the date the insurance company's IDR department rejected your claim. 

NSW Civil and Administrative Tribunal (NCAT)

If you are not satisfied with the outcome of an internal review by your insurance company, you can make an application to have the dispute decided by NCAT within three years. 

Consumer claims are limited to disputes under $100,000.

For more information on making an application, see Application process on the NCAT website. 

If you want to start a case against an insurance company, you should get legal advice. 

For more interactive assistance, see the MVA Problem Solver on the Financial Rights Legal Centre website.

If you have a dispute with the other party's insurance company

If the other driver was at-fault

If the other driver was at-fault and they (or the owner of the car) made a claim on their insurance policy, the insurer will make a decision and should contact you. If they refuse your claim and the cost of repairing your car is less than $16,300, you may be able to make a claim through AFCA. This is a free service and is cheaper than taking the other driver to court. You should try this option before going to court.

For more information, see Insurance complaints on the AFCA website.

If you want to make a claim through AFCA you must be uninsured. The other party must be insured and have made a claim on their insurance policy. You may still be able to make a claim to AFCA if the other party has not made a claim and they have died or cannot be found. If you are not sure whether the other party has made a claim on their insurance, you should contact AFCA. They will contact the other party's insurance company to see if a claim has been made.

If the dispute is more than $16,300, you will need to decide whether to start a case in court against the other party. If you can't claim against the other driver, in some limited circumstances you may be able to claim against their insurance company. If you are considering this, you should get legal advice.

For more information on starting a court case, see Going to court.

If you were at-fault

If the other party's insurance company believes you were at-fault and makes a claim against you, you may wish to negotiate with the insurer and try and resolve the dispute. If you can't agree, the driver, owner or insurer may decide to start a court case against you. In that case, you will need to decide how to respond.

For more information, see Going to court.

An insurance company can take the place of any person that they insure and do whatever that person can do, such as make a claim in court. This is called the 'right of subrogation'.

It is a good idea to try and resolve disputes without going to court, as court cases take time and cost money and the outcome may be uncertain.​​​