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In the event that your claim has been declined, you may not agree with the decision.
The next logical step is to refer the decision to the Insurers Internal Disputes Resolution Team (IDR) for review.
If you do not succeed in having the claim decision overturned, you may wish to send the matter to AFCA for adjudication.
Insurance policies often include “grey” areas and not all insurers will err on the side of the Insured.
Give ClaimSmart a call and we will provide an opinion as to whether the insurers decision is correct.
If we believe the decision made is not correct, ClaimSmart will prepare a submission that gives you the best possible chance of success given its vast knowledge of policy wordings, recent determinations and experience with similar scenarios.
Often, the way in which the dispute or complaint is presented can be the difference between the decision being overturned or upheld.
The right terminology, the correct sections of the policy and the right emphasis on particular words in a PDS are all critical for success.