Making an insurance claim 101

Insurance cover should provide you with the financial peace of mind should the worst happen to you.

During a time of disaster, such as the bushfires that have ravaged significant areas around Australia, it can be difficult to comprehend what to do next. You know you need to make an insurance claim, but working out where to start seems overwhelming.

What paperwork do you need? What evidence must you provide? What steps are involved in making a claim? Who can you call if your insurer is playing tough?

This is our 101 guide to making an insurance claim.

Step 1: Find your policy

You may be entitled to make an insurance claim on a number of different policies for different reasons. The first step is figuring out what policies you have, and with which insurers.

You may have lost your physical copy of your insurance policy, so we recommend trying the following, especially if you're not sure who your insurer is:

• searching through your emails, using terms including “enquiry”, “PDS/Product Disclosure Statement”, “Policy Schedule”, “Quote”, and “Certificate”. These are pretty common terms in most insurance policy emails
• checking your phone records, especially if you recently changed your policy or insurer
• checking your bank records to see which premiums are being paid
• talking to your friends and/or family – did you use the same insurer to get a family discount? Did you take a recommendation from a friend?

If none of these work, you can try contacting the Insurance Council of Australia (ICA). ICA have a dedicated insurance hotline which you can call on 1800 734 621.

If you don’t have your policy documents but you know who you insurer is, give them a call. They should be able to pull up your policy by you providing your details and passing a few security questions.

Once you’ve made contact, ask for two very important documents:

1. Policy Schedule / Certificate of Insurance – this will tell you how much you’re insured for, and

2. Policy Document / Product Disclosure Statement – this may well be available on the insurer’s website.

Step two: Find out what you’re entitled to

Now that you’ve got your insurer identified and the policy documents in front of you, it’s time to work out what you’re entitled to.

Read the fine print on all of your documents. If you’ve lost everything, it’s worth trying to make an insurance claim on all available policies.

This may include:

• home and contents insurance
• landlords insurance
• car insurance
• farming insurance
• accident and trauma insurance
• business expenses insurance

If you’ve been injured or sick and cannot work, you can also look into making a claim on your income protection insurance under your superannuation.

Make a list of your assets that have been damaged or lost and identify which policy will cover that asset. Use bank statements to check which policies are being paid regularly. Cross-check the policies to understand the insurance amounts.

Some insurance policies contain exclusion clauses which are often difficult to interpret, and are sometimes misinterpreted, even by insurers. It’s important to know whether an exclusion clause might apply before you lodge your insurance claim – so read your PDS thoroughly and don't just rely on an insurer to tell you what you're entitled to. If you're still unsure, seek legal advice. 

Step three: Prepare yourself for the claim

You should make an insurance claim as soon as possible after the event, but you need to be prepared before you do so.

Collect as much evidence as possible to prove your loss, or at least list all possessions you believe have been damaged or destroyed. We suggest:

• taking photos of the damage immediately
• reviewing your phone or emails for any receipts for purchases you may have made with big retailers. Stores like Good Guys, JB Hi-Fi, Harvey Norman, Bunnings often use e-receipts
• gathering photos you may have on your phone or in albums that shows the condition of certain things before they were destroyed (this can include your home, furniture, appliances, jewellery, etc.)
• locating similar items in catalogues that you consider best matches your lost/damaged item

This can be tough when your house has been hit by disaster, so ask your insurer what evidence they might need.

Step four: Submit your claim

Ask the insurer to send the insurance claim forms to you for completion.

Sometimes when you make initial contact with your insurer, they will start the insurance claim process with you over the phone. This may be more typical for home and contents insurance claims.

If you are in urgent financial need, your insurer may be able to assist by fast-tracking assessment or providing advance payments. Each insurer should have procedures for this purpose.

After you’ve submitted your claim, your insurer will make an assessment. This may take some time, but there is a guide to reasonable timelines under the General Insurance Code of Practice that insurers abide by. We recommend keeping a diary of contact with your insurer.

Generally speaking, the insurer has ten business days once you’ve submitted your claim to decide on three options: accept your claim, deny your claim, or ask for more information.

If the insurer decides they need more information, they must tell you what information they require and give you an estimate of how long this additional process will take. This can take between 4 to 12 months and they must keep you informed of your insurance claim’s progress every 20 business days. It is in your best interests to work quickly and efficiently to provide the insurer with any additional information they need.

If your insurance claim is taking too long, or you believe your insurer is stalling unnecessarily, lodge a complaint. Your insurer will have 45 days to respond to your complaint or resolve it. If you still feel like you’re not getting anywhere, you can contact the Australian Financial Complaints Authority and lodge a complaint with them. It’s free to do so.

If you get to this stage, we strongly recommend seeking out legal advice.

Common traps to avoid

We help everyday Australians with insurance claims on a daily basis, and we know there are easy traps to fall into. Being aware is the best defence. 

• There have been reports of “insurance middlemen” utilising bullying tactics for the purpose of obtaining fast settlements. We recommend not using the services of Claims Management Companies and to think carefully before signing up to binding agreements or releases where fees or commissions are involved.
• Agreed value vs market value: sometimes the insurer will disputes the amount they are willing to pay to replace or repair an insured item. It’s important to remember that if the policy doesn’t explicitly talk about valuation and you think your insurer has undervalued the replacement or repair, you should get your own quote by your preferred expert.

It is always recommended to seek legal advice on your rights to claim, especially if you want to avoid having your losses undervalued or falling into a dispute with the insurer as to what is covered and what is excluded. Insurance is there to protect you.