Get legal advice on an insurance claim

We advise policyholders on their rights under their insurance policy, and advise on the options available to challenge a decision.

Insurance policies are interpreted by insurers in ways that are designed to limit their liability, and policyholders who accept the insurer’s assessment of a claim without independent legal advice often accept less than they are entitled to. The policy terms used to deny or reduce a claim are frequently ambiguous, applied inconsistently with the insurer’s obligations under the law, or rely on exclusions that do not apply in the circumstances. We advise policyholders on what their policy entitles them to and the options available if the insurer’s position does not reflect that entitlement.

What are a policyholder's rights when an insurance claim is denied or underpaid?

When an insurer denies, reduces, or delays a claim, the policyholder has the right to understand the basis for that decision and to challenge it if the decision does not correctly apply the terms of the policy or the obligations imposed on the insurer by law.

The obligations of an insurer under an insurance contract in Australia are governed by the Insurance Contracts Act 1984 (Cth), which imposes duties of utmost good faith on both parties to the contract and requires the insurer to act honestly and fairly in handling claims. An insurer that relies on an exclusion that does not clearly apply, fails to investigate a claim properly, or interprets ambiguous policy terms against the policyholder may be acting in breach of those obligations.

We advise policyholders on the strength of their claim, the basis for the insurer’s decision, and the options available, including internal dispute resolution, AFCA complaint, or litigation.

Can an insurer rely on an exclusion to deny my claim?

An insurer can rely on an exclusion clause to deny a claim, but the exclusion must clearly apply to the circumstances of the claim and must have been disclosed to the policyholder in accordance with the requirements of the Insurance Contracts Act 1984 (Cth). Where an exclusion clause is ambiguous, the law may require it to be construed against the insurer rather than against the policyholder. We review the terms of the policy and the circumstances of the claim to assess whether the exclusion the insurer is relying on clearly applies and whether the insurer’s decision is legally supportable.

What is the duty of utmost good faith and how does it affect my claim?

The duty of utmost good faith under the Insurance Contracts Act 1984 (Cth) requires both the insurer and the policyholder to act honestly and with regard for the interests of the other party throughout the insurance relationship, including in the handling of claims. An insurer that denies a claim without proper investigation, relies on exclusions that do not clearly apply, or delays payment without reasonable cause may be acting in breach of this duty, which can give rise to additional remedies beyond the claim amount itself. We advise on whether the insurer’s conduct in handling your claim raises concerns about compliance with this duty and what the consequences of a breach might be.

What is AFCA and can it help with my insurance dispute?

The Australian Financial Complaints Authority (AFCA) is an external dispute resolution scheme that handles complaints against financial service providers, including insurers, and can make binding determinations in favour of complainants in appropriate cases without the need for court proceedings. AFCA is generally faster and less costly than litigation and is accessible to most individual and small business policyholders. We advise on whether AFCA is the appropriate forum for your dispute, assist in preparing and submitting the complaint, and advise on the strengths and limitations of the AFCA process in the circumstances.

How long do I have to dispute an insurer's decision?

The time limits for disputing an insurer’s decision depend on the type of dispute and the forum in which it is being pursued. Complaints to AFCA must generally be made within certain time limits after the insurer’s final decision on the claim, while court proceedings for breach of contract or breach of the duty of utmost good faith under the Insurance Contracts Act 1984 (Cth) are subject to limitation periods that vary by state. We advise on the applicable time limits in the circumstances and the steps that need to be taken promptly to preserve the right to challenge the insurer’s decision.

Insurer's decision assessed against the policy terms and the law before a response is made.

Policy terms interpreted with legal advice so that the full entitlement is understood.

Options identified and pursued in the most appropriate forum for the circumstances.

An insurer's decision to deny or reduce a claim is a legal position that can often be challenged.

Policyholders who accept an insurer’s denial or underpayment without independent legal advice regularly accept less than they are entitled to. The policy terms the insurer is relying on may not clearly apply, the insurer’s conduct in handling the claim may not comply with the law, and the options available to challenge the decision are frequently more accessible than policyholders expect.

Insurance policies are interpreted by insurers in ways that limit their liability. Independent legal advice shows you what you are actually entitled to.

Your insurer has denied, reduced, or delayed your claim, and the basis they have given relies on policy terms that you do not fully understand. The insurer’s position may be correct, or it may not be, but without independent legal advice on the terms of the policy and the obligations the insurer is subject to, you cannot know whether accepting the decision is the right response or whether challenging it would be worthwhile. Independent legal advice on an insurance claim dispute tells you where you stand before you decide what to do.

We will review the terms of the policy and the insurer's decision and advise on whether the decision correctly applies the policy and the insurer's legal obligations.
We will advise on the full entitlement available under the policy in the circumstances of the claim.
We will identify the most appropriate forum for challenging the insurer's decision, whether through internal dispute resolution, AFCA, or litigation.
We will manage the dispute process and advise on the likely outcomes and the costs and risks associated with each option.

You have made a claim under an insurance policy and the insurer has denied it, reduced it, or is delaying payment, but the policy terms that the insurer is relying on are not as clear as the insurer's position suggests.

Insurance policies are interpreted by insurers in ways that favour the insurer, and policyholders who accept the insurer’s assessment of a claim without independent legal advice often accept less than they are entitled to. The policy terms that are used to deny or reduce a claim are frequently ambiguous, subject to obligations that were not clearly explained at the time the policy was taken out, or applied in ways that do not reflect the legal principles that govern insurance contracts. Independent legal advice changes what the policyholder understands about their entitlements before they decide whether to accept or challenge the insurer’s position.

What's included in your insurance claim legal advice service

Insurance policy review and entitlement assessment.
Insurer decision analysis and challenge advice.
Internal dispute resolution and AFCA complaint management.
Duty of utmost good faith breach advice.
Litigation advice and representation where required.

What goes wrong when policyholders accept an insurer's decision without independent legal advice?

Policyholders who accept an insurer’s denial or reduction of a claim without seeking independent legal advice regularly discover later that the basis for the insurer’s decision was not as sound as the insurer presented it. The exclusion relied on may not have clearly applied in the circumstances, the insurer may have failed to investigate the claim adequately, or the policy terms may have supported a larger payment than the insurer offered. By the time this is discovered, the time limits for disputing the decision may have expired.

Here is how we help you understand your entitlements under your insurance policy and challenge an insurer's decision.

We review the terms of the policy and the insurer’s decision and advise on whether the insurer’s position is legally supportable and what the policy entitles you to in the circumstances. We advise on the options available for challenging the decision, including AFCA complaint and litigation, and manage the process in the forum that is most appropriate for the circumstances. We advise on the time limits that apply to ensure that the right to challenge the decision is not lost.

Three steps to understanding your rights and challenging an insurer's decision.

Policy reviewed, entitlement assessed, decision challenged where warranted.

Review the policy and decision.

We review the terms of the policy and the insurer's decision and advise on whether the decision correctly applies the policy and the insurer's legal obligations.

Assess the options.

We advise on the options available for challenging the insurer's decision and the most appropriate forum given the nature of the dispute and the amount in issue.

Manage the dispute.

We manage the dispute process in the appropriate forum and advise on the likely outcomes, the costs involved, and the time limits that apply.

Lawyers experienced in insurance disputes, policy interpretation, and AFCA complaints across Australia.

Policyholders who have had a claim denied often feel that they are in an unequal position relative to the insurer, who has lawyers and claims assessors familiar with the policy terms and the disputes process. We advise policyholders on insurance disputes with the understanding that access to independent legal advice changes that balance and allows the policyholder to make an informed decision about how to respond.

We understand you want to know the cost, before we get started.

We will map out our process, from beginning to end, so you know what the journey will look like before you get started.

We will provide you with a clear and detailed Work Proposal covering each step along the way.

Our fair fees are all-inclusive. No hidden costs for telephone calls, emails, photocopying, couriers, or coffee.

Our great lawyer guarantee

We want to be part of your team over the long term. We achieve this by adhering to these core principles:

Take the time

We listen carefully to understand what you want to achieve. Then we thoroughly explain our advice and step you through the documents. You can be sure you know the full consequences.

Share our knowledge

We will pass on as much knowledge as we can, so you can make your own informed decisions. We want to make you truly independent.

Stick to our knitting

We only do what we're good at. You can be confident that we know what we're doing and don't pass on the cost of our learning.

Work as one team

Someone will always be available to answer your questions, or point you in the right direction. You will also benefit from a range of perspectives and experience.

Fair pricing

For advice and documents, we provide a fixed or capped quote so you don't take price risk. If you're in a dispute, we map out the process and costs so you know what to expect.

It's your show

We're not in this for our egos. We're in it for a front row seat to witness your success.

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