You have the right to a written explanation of the denial, the right to escalate through the insurer's Internal Dispute Resolution (IDR) process, and if that fails, to lodge a free complaint with the Australian Financial Complaints Authority (AFCA). Most rejections relate to non-disclosure, policy exclusions, or claims outside the policy period — but insurers must act in good faith under the Insurance Contracts Act 1984.
What it depends on
The full answer depends on your specific circumstances. Here’s what matters.
Why the claim was rejected
The most common reasons for rejection are non-disclosure (you didn't tell them something material when you applied), policy exclusions (the specific event isn't covered), and late notification (you didn't report the claim within the required timeframe). Your insurer must provide the specific reason in writing — a generic "claim denied" is not acceptable under the General Insurance Code of Practice.
Your duty of disclosure
Under the Insurance Contracts Act 1984, you must disclose matters you know, or could reasonably be expected to know, that would be relevant to the insurer's decision. But the law was reformed in 2021 — for consumer contracts, insurers can now only refuse claims for non-disclosure if they asked a specific question and you answered it incorrectly or incompletely. They can't rely on a general "tell us everything" clause.
The Internal Dispute Resolution timeline
Your insurer must acknowledge your complaint within one business day and provide a final response within 30 calendar days (for most complaints). If they exceed this timeframe, you can escalate directly to AFCA without waiting for their response.
AFCA's jurisdiction
AFCA can consider complaints about general insurance claims up to $1,085,000 (as of 2024–25, indexed annually). The service is free to consumers. AFCA's decisions are binding on the insurer but not on you — if you disagree with AFCA's decision, you can still pursue legal action.
The last 10%
What a qualified professional can add
The answer above covers the general position. Here’s where professional judgement — applied to YOUR specific situation — makes the difference.
- Reviewing your policy wording to identify whether the rejection is legally justified or challengeable
- Preparing a formal IDR submission that addresses the insurer's specific grounds for refusal with supporting evidence
- Navigating the AFCA process — including what evidence strengthens your case and what common mistakes weaken it
- Assessing whether your current coverage actually matches your risk profile and recommending adjustments
Questions to ask before you engage one
If you decide to engage a professional, these questions help you evaluate whether they’re right for your situation.
Can you show me the specific policy clause the rejection is based on — not just the general category?
How do you handle disputes with insurers when a client's claim is rejected — can you share a de-identified example?
Do you receive commissions from the insurers you recommend, and how does that affect which products you suggest?
What is your process for reviewing whether my existing coverage still matches my circumstances?
If I need to escalate to AFCA, will you support me through that process, and is there an additional fee?
Your next step
Start by requesting a written explanation from your insurer — they're legally required to provide one. Read the specific policy clause cited in the rejection and compare it to your claim circumstances. If you believe the rejection is wrong, lodge an IDR complaint in writing. Explore our Insurance domain for more on understanding your coverage.
General Advice Warning
The information on this page is general in nature and does not take into account your personal objectives, financial situation or needs. It is provided by Global Mutual Funds Pty Ltd (ABN 20 090 555 436, AFSL 222640) and should not be relied upon as a substitute for professional advice. Consider whether the information is appropriate before acting on it. Read our Financial Services Guide.