# Insurance claim declined? Prepare for a legal review

Canonical: https://findlawfirms.com.au/guides/insurance-claim-dispute

Updated: 2026-09-20

General Australian consumer preparation information. Not advice about an individual matter. Examples are illustrative. Read source scopes before applying jurisdiction-specific information.

> Start with the actual decision and the policy version. An argument about cover is different from a disagreement about the amount paid.

A declined claim can leave you with a long email chain and several different explanations. Before asking a lawyer to take over, identify which decision you need reviewed and what has happened since. A short, accurate file helps an adviser separate questions about cover, evidence, valuation and the complaint process. This guide is an enquiry preparation method, not an assessment of whether your policy should respond.

## Build a decision timeline

List the incident, claim submission, requests for information and each decision in date order. Copy the date you received a decision separately from the date printed on it. Include any review or response date stated in correspondence. Ask the adviser to check which time limits apply instead of estimating them from a general guide. If more than one insurer or policy is involved, keep their references separate.

## Keep the policy and evidence together

Gather the policy schedule, wording supplied for the relevant period, claim form, decision letter and supporting material already provided. Preserve reports in their original form. Create a list of photographs, invoices or assessments that exist without deciding that every item proves the claim. Highlight what the insurer says is missing and whether you have responded. Avoid commissioning an expensive new report before asking what question it needs to answer.

- Policy schedule and wording for the relevant period
- Claim reference and decision letters
- Reports, photographs and invoices already supplied
- Complaint correspondence and outstanding information requests

## Choose the first legal output

Ask whether the proposed engagement is an opinion on cover, help preparing a complaint, negotiation or representation. Request an explanation of the documents included in the initial review and the form of the advice. If expert input might be needed, ask who selects and instructs the expert and who pays. A fee for reading a refusal letter may not include reviewing the policy or arranging another assessment.

## Use the official complaint route deliberately

AFCA provides information about complaints involving financial services, including insurance. Check its current guidance about raising a complaint with the financial firm and whether AFCA can consider the issue. Keep evidence of the complaint and response. Ask the lawyer how any complaint process interacts with other possible steps; do not assume that contacting a complaint body pauses every time limit or replaces advice about proceedings.

## Illustrative example: disagreement over repairs

An owner has an accepted storm claim but disputes the proposed repair scope. Instead of describing the file as a completely rejected claim, the owner separates accepted damage, disputed items and the reports relied on. The requested legal output is an explanation of the dispute and possible next steps. This invented example shows how precise instructions can prevent a quote for the wrong task; it does not establish entitlement to additional payment.

## Record the decision after the review

Ask what information could change the advice and who is responsible for obtaining it. Record the next proposed step, estimated cost and decision point before authorising further work. If a settlement is proposed, request advice about the complete written terms rather than the payment figure alone. Retain the insurer and complaint references so later correspondence can be matched to the right file.

## Does a declined claim mean I must go to court?

No. Ask about the insurer’s complaint process, AFCA’s current jurisdiction and whether legal advice is useful for your issue. The available route depends on the claim and stage.

## Should I pay for a second expert report immediately?

First ask what evidence is missing, what question a report would address and who would bear its cost. A second report is not automatically necessary or reimbursable.

## Official sources and scope

- [AFCA — financial complaints](https://www.afca.org.au/) — Official starting point for insurance complaint pathways and current eligibility; the preparation workflow and example are original. Checked 2026-09-20.

## Related guides

- https://findlawfirms.com.au/guides/comparing-legal-fees

- https://findlawfirms.com.au/guides/organising-documents-for-a-lawyer

- https://findlawfirms.com.au/guides/superannuation-insurance-enquiry

Editorial approach: https://findlawfirms.com.au/editorial-policy