Insurance Claims

Understanding the Legal Process for Insurance Claims in Australia

Navigating the world of insurance claims in Australia can be a complex journey. Whether you are dealing with a denied claim or an underpayment, understanding the process is crucial. This guide offers an easy-to-understand overview of how insurance claims occur and highlights when it might be time to engage a lawyer.

The Insurance Claims Process Simplified

When an unexpected event occurs, the first step is to file an insurance claim. This involves notifying your insurer about the incident and providing them with all necessary documentation. The insurer will then assess the claim to determine its validity based on the terms of your insurance policy.
However, issues can arise. Sometimes, claims are denied, delayed, or not fully-covered, leading to insurance policy disputes. Reasons for these disputes often include disagreements over policy interpretations, exclusions, or the extent of coverage.

Legal Proceedings in Insurance Claim Disputes

If you find yourself in an insurance claim dispute, there are several steps you can take:

1. Internal Dispute Resolution: Begin by lodging a complaint with your insurer. They are required to handle disputes through their internal processes.
2. External Dispute Resolution: If unsatisfied with the outcome, you can escalate the issue to the Australian Financial Complaints Authority (AFCA), an independent body that handles financial disputes
3. Legal Action: When resolutions are not achieved through these channels, initiating legal proceedings might be necessary. This generally involves preparing a case to present in court, where a judge will determine the outcome.

Why Engage an Insurance Claim Lawyer?

Insurance law is complex, and navigating it without professional help can be challenging. Here is when an insurance lawyer becomes invaluable:

• Expertise in Insurance Issues: They understand the nuances of insurance policies and can identify where insurers may be acting unfairly.
• Negotiation Skills: An experienced lawyer can negotiate on your behalf to achieve a fair settlement.
• Representation in Court: If your case proceeds to litigation, an insurance claim lawyer will advocate for your rights and work towards the outcome you deserve.

Conclusion

Facing an insurance claim dispute can be overwhelming, but you do not have to go through it alone. Professional guidance can make a significant difference to your case.
In a recent case, we took a matter over from another lawyer who had advised our client that a claim should not be lodged with the Insurer as the matter happened too long ago. A claim was lodged on our advice and after negotiating with the Insurer on our client`s behalf, the claim was ultimately accepted and it saved our client thousands of dollars.