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Most rejections can be challenged successfully. Here is what to do in the next 48 hours.
If your insurance claim has been rejected, you have rights — and most rejections can be challenged successfully. Get the rejection in writing, identify whether it is a legitimate policy exclusion (rarely disputable), a factual dispute (usually disputable with evidence), or a procedural failure (almost always disputable). Do not start repairs. Gather evidence: IICRC-certified independent assessment, BOM data, neighbour statements. Escalate to AFCA — free, independent, and binding on your insurer.
Insurers must provide written reasons under the ICA General Insurance Code of Practice. If rejected by phone, email immediately: "Following our conversation on [date], please send written confirmation of the rejection and grounds within 24 hours." The letter must contain your policy number, claim number, clear rejection statement, grounds for rejection, reference to the policy clause applied, your right to escalate to AFCA, and AFCA contact details.
There are three types. Type 1 — Legitimate Policy Exclusion: the policy genuinely doesn't cover the damage (rarely disputable, unless your insurer misled you). Type 2 — Factual Dispute: the insurer claims pre-existing damage, wear and tear, late notification, or failure to mitigate — all disputable with new evidence. Type 3 — Procedural Failure: the insurer missed deadlines, provided insufficient reasons, or gave misleading information — almost always disputable.
Starting repairs before the claim is settled gives your insurer grounds to deny or reduce your claim. They may argue you used unapproved contractors, destroyed evidence, or inflated costs. Make emergency repairs only (e.g., tarp a roof) and document all temporary repairs with photos and receipts. Wait for AFCA resolution before major repairs.
The single most important piece of evidence is an IICRC-certified independent assessment, requested within 48 hours. Also gather: new photos and video of damage, Bureau of Meteorology weather data (bom.gov.au), signed written statements from neighbours who experienced the same event, before-and-after comparison photos, receipts and bank statements for damaged contents, and all correspondence with your insurer.
Do not handle a rejected claim alone. Your insurer rejected you once — they will not easily reverse without external pressure. NRPG will review your rejection letter within 48 hours and advise whether the rejection is disputable. If disputable, NRPG will recommend next steps, gather evidence, send a formal reconsideration letter to the insurer, and prepare your AFCA submission if needed. Fee is 15–25% of the recovered amount only, waived if denied.
Get an IICRC assessment specifically addressing whether damage is consistent with a sudden incident or pre-existing gradual deterioration. Provide before-and-after photos, BOM weather data, and neighbour testimony. In AFCA: your insurer bears the burden of proving pre-existence.
Provide maintenance records. Get an IICRC assessment confirming the damage is consistent with a sudden event, not gradual failure. Distinguish: a fallen tree puncturing a roof is sudden (covered); a roof slowly leaking for 5 years is gradual (not covered).
Provide timestamped evidence of your notification (email, portal, certified mail). If slightly late, argue the delay did not prejudice your insurer — they could still inspect fully. If they accepted the claim without immediately raising late notification, argue they waived the timeframe.
Document all emergency measures you took (photos, receipts, contractor call logs, timeline). Your duty to mitigate is reasonable, not absolute. Your insurer must prove you acted unreasonably, not just that you didn't prevent all further damage.
Document the claim lodgement date, the 4-month ICA Code deadline, and when (or if) the insurer responded. Request detailed written reasons if not provided. AFCA can order compensation for Code breaches (typically $500–$2,000 for delays), separate from the claim amount.
AFCA (Australian Financial Complaints Authority) is an independent, government-backed dispute resolution service. Free for consumers. Binding on your insurer. Not part of your insurance company.
Your insurer cannot make false statements about coverage, hide exclusions, or imply coverage that doesn't exist. If they misled you about what was covered when you bought the policy, you have a claim.
Your insurer cannot take advantage of your distress or vulnerability to pressure you into accepting a low settlement. If your home is destroyed and they pressure you while you're displaced, that is unconscionable conduct.
Terms in your insurance policy that create significant imbalance, are not reasonably expected, and cause you detriment are void. Your insurer cannot rely on a void term to deny your claim.
There is no formal appeal process within the insurance company. Once rejected, escalate to AFCA. Do not delay — escalate within weeks, not months, as evidence degrades over time.
Yes, completely free. AFCA is funded by the insurance industry, not consumers. You pay no fee to lodge, investigate, or obtain a determination.
No. It is illegal for your insurer to penalise, discriminate against, or threaten you for lodging an AFCA complaint.
If your insurer refuses to comply with AFCA's determination, you can take legal action in court, report to ASIC, or report to the ACCC. Most insurers comply because non-compliance damages their reputation.
No, not required. AFCA is designed for consumers without lawyers. NRPG is an alternative — NRPG advocates on your behalf without requiring a lawyer.
An independent IICRC-certified assessment is your strongest evidence. It is objective, credible, and contradicts your insurer's assessment, creating leverage in dispute resolution.
Minimum: IICRC assessment, photos, BOM data (if weather-related), written correspondence, and original claim docs. Additional strength: neighbour testimony, building inspection, maintenance proof, and receipts.
NRPG takes a percentage of the recovered amount (typically 15–25%), with no upfront fees. If the claim is denied, NRPG's fee is waived. You approve the fee before work begins.
Submit your rejection letter. NRPG will review within 48 hours and advise whether the rejection is disputable. No upfront fees. Fee is 15–25% of recovered amount only, waived if denial stands.
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