Dealing with insurance claims can be a difficult process, especially when you’re faced with delays. These disruptions can lead to stress, frustration, and financial strain for policyholders. In Australia, insurance claim delays are not uncommon, and being prepared to navigate them is essential for a smooth resolution of your claim. In this blog post, we will provide you with a comprehensive guide to understanding, preventing, and managing insurance claim delays in Australia.
Understanding the causes of insurance claim delays: It’s essential to understand the common causes of insurance claim delays in order to avoid or address them effectively. Some common causes of insurance claim delays include:
• Incomplete or inaccurate documentation: Providing insufficient or incorrect information in your claim can lead to delays as the insurer needs to gather all necessary details before processing or making a decision.
• Complex claims: Claims involving significant damage, unknown causes of damage (i.e.slow water leaks or mould), or claims requiring multiple expert opinions can take longer to assess.
• Natural disaster: Natural disasters or other large-scale events can lead to a high volume of claims, overwhelming insurers and the supply chains that support insurers (i.e. assessors, builders and experts).
• Fraud investigation: If an insurer suspects fraudulent activity, they may take additional time to thoroughly investigate the claim. This is particularly common in certain claim types like fire claims.
• Breakdown in relationship: In some circumstances there can be a breakdown in relationship between the Policyholder and the Insurer. This can make communication between the parties difficult causing delays and increased stress.
Preventing insurance claim delays:
Preventing insurance claim delays requires both the Policyholder and the Insurer to work together to minimise delays. As the Policyholder, taking a proactive approach can help prevent unnecessary delays in processing your claim. Here are some steps you can take:
• Read and understand your policy:
Familiarise yourself with the coverage, exclusions, and requirements of your policy to avoid surprises and delays. If you are unsure of whether your claim falls within your policy, consider seeking professional advice or opinion. If you’re uncertain about coverage, we recommend talking to an expert prior to lodging the claim.
• Provide accurate and complete information:
When submitting your claim, ensure that all necessary documentation is included, and all information provided is accurate.When submitting your claim you need to submit (as much as possible) the information the insurer will require to assess the claim. This could include photographs, videos, description of how the damage has occurred and any receipts or invoices.
• Keep records: Maintain a file with all relevant documentation, such as receipts, invoices, and photos of the damage. This will help expedite the process and facilitate communication with your insurer. We also recommend keeping a claim diary to record all interactions that you have with the insurer and service suppliers. Keeping detailed notes of interactions will ensure that if a dispute was to arise that you have evidence to support your position.
• Follow up in writing: Following up in writing after interactions with your insurer and service suppliers is essential for several reasons. Firstly, it helps to create a clear and accurate record of all communications between you and your insurer, which can be invaluable if any disputes or disagreements arise during the claims process. Written correspondence also ensures that both parties are on the same page regarding important details, such as policy coverage, claim status, and any additional information or documentation required. Additionally, having a written record of your interactions can help you stay organised and keep track of any deadlines, commitments, or progress made during the claims process.
• Respond promptly: If your insurer requests additional information or documentation, provide it as soon as possible to avoid delays.
Managing insurance claim delays: If you’re facing an insurance claim delay, here are some steps you can take to address the issue:
• Communicate with your insurer: Regularly follow up with your insurer to check the status of your claim and address any concerns or questions they may have. If your interaction is over the phone with the insurer, we recommend following up in writing.
• Stay organised: Keep a record of all communication and documentation related to your claim, as this will help you track progress and provide evidence if disputes arise.
• Be polite and professional: We understand that insurance delays can be incredibly stressful and emotionally taxing; however, it’s crucial to continue engaging with your insurer and their service providers in a courteous and professional manner. Displaying aggression or using harsh language may only result in further delays. Keep in mind that insurers are not usually intentionally delaying your claim; strive to comprehend their requests and collaborate with them to achieve a timely resolution. We acknowledge this can be challenging, but maintaining a respectful and cooperative attitude will ultimately be more productive. If you feel like you’re not able to engage in a polite and professional manner, consider appointing a claims representative to act on your behalf.
• Make a complaint: If your claim is taking an unreasonably long time to process, you may consider lodging a complaint with your insurer’s internal dispute resolution (IDR) department. If the issue remains unresolved, you can escalate the matter to the Australian Financial Complaints Authority (AFCA), an independent body that provides free dispute resolution services to consumers. For more information about the complaint resolution process with AFCA, refer to our blog post “Navigating the Complaint Resolution Process with AFCA.”
• Request urgent financial need: If claim delays result in urgent financial need for you and your family, you can request that the insurer prioritise the assessment and payment of your claim. Be prepared to provide evidence to support your request, including bank records and documentation of bills or expenses. It’s recommended to submit requests directly to the insurer and reference Section 64 of the General Insurance Code of Practice for general insurance claims (e.g., home and property claims). By doing so, you can emphasise the urgency of your situation and expedite the resolution of your claim.
• Seek external assistance: If you’re having difficulty understanding or navigating the claims process, consider seeking the help of a qualified insurance professional, such as a claims advocate (see below). There are also free legal assistance available in most states that can be found on Google.
• Consider Claims Hero: As experts in handling complex insurance claims, we’ll efficiently manage your claim on your behalf, leveraging our established processes to overcome delays and ensure a smooth resolution. Our in-depth understanding of insurers’ requirements allows us to work closely with you to present a strong, well-prepared claim that expedites the process. We provide a complimentary initial consultation to assess your situation and discuss how we can help you achieve the best possible outcome. Don’t hesitate to contact us today at 1300 219 469 and take the first step towards resolving your claim.
Navigating insurance claims in Australia can be challenging, particularly when dealing with delays that cause stress and frustration. Understanding the causes of delays, taking proactive measures to prevent them, and managing them effectively are key to a smooth and timely resolution. Maintain open communication with your insurer, stay organised, and respond promptly to requests. Seek external assistance if needed, such as Claims Hero, to ensure your claim is managed professionally. By staying proactive and vigilant, you can overcome claim delays and secure the insurance coverage you need when it matters most.