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If something bad happens to you and you have an insurance policy, you can make a claim to receive a payment from your insurer. It is an insurers business to pay claims that satisfy the terms and conditions of the policy and are deemed genuine based on the evidence provided.
If your claim is accepted, you will receive an amount of money or in the case of some insurance, replacement or repair of your belongings from the insurer – this is known as a ‘benefit’ or ‘payout’.
The maximum the insurer will pay you is the amount of money, or ‘sum insured’ in your insurance contract. Depending on your policy you may receive this either all at once (lump sum) or as a regular stream of payments (income stream).
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| Here are some steps that may be relevant for you in making a claim: |
- Contacting the police. If the claim involves theft or a serious car accident or any crime, you should call the police as soon as possible. If a police report is made, make sure you write down the police report number.
- Before you contact your insurer you should dig out your policy document to make sure you’ve got the appropriate cover for the loss or damage.
- Contacting your insurer as soon as possible. Some insurers allow some claims to be made over the telephone without having to fill out a form. This means your insurer can start processing your claim straight away. Whereas, other insurers may need you to complete a claim form – your insurer will send you a form or may direct you to a form that can be downloaded off their website.
- Keeping a written record of the incident. It is often easy to forget what happened, particularly the small details which may prove important later, so it is best to keep a record. You should also keep any supporting evidence, such as contact details of an accident witness or receipts of your belongings. You may also want to take photos for your records.
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WHAT TO DO WHEN A CLAIM HAS BEEN REJECTED ?
An insurer can reject your claim if you haven't told the insurer everything it needs to know or if the policy doesn't cover what you expected.
If your insurer rejects your claim and you’re unhappy with this decision, you can do something about it. You have the right to request that your insurer review your case.
All insurers are required to have an internal dispute resolution scheme to listen to your complaint.
If your insurer has reviewed your claim and you’re still unhappy with their decision, you can either take your claim to an approved external dispute resolution scheme (or independent complaints scheme) or go to court to resolve the issue.
All insurers are also required to be a member of an external dispute resolution scheme. There are four approved external dispute resolution schemes that are available free to help consumers resolve their complaint against insurance companies, brokers or advisers.
- The Insurance Ombudsman Service assists in resolving disputes between consumers and participating insurance companies. It deals with complaints relating to claims under most insurance policies – including home and contents, car and travel.
For more information visit www.insuranceombudsman.com.au or phone 1300 780 808.
- The Financial Industry Complaints Service (FICS) was set up to resolve complaints between consumers and providers of financial services, including life insurers, fund managers and financial advisers.
For more information visit www.fics.asn.au or phone 1300 780 808.
- Insurance Brokers Disputes Limited can help you if you have a problem with your insurance broker or other financial service provider (other than insurance companies).
For more information visit www.ibdltd.com.au or phone 1300 780 808.
- The Private Health Insurance Ombudsman deals with complaints against health funds, hospitals and doctors about private health insurance arrangements.
For more information visit www.phio.org.au or phone 1800 640 695.
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ASIC’s FIDO website has more information about external dispute resolution, in particular see the free publication You can Complain at www.fido.asic.gov.au
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