Insurance in Australia
General insurance in Australia is worth around $100 billion in 2024, according to industry research firm IBISWorld. The big players include:
- INSURANCE Australia Group (IAG) – NRMA Insurance, CGU, Swann Insurance, WFI and more.
- Suncorp Group Limited – Suncorp insurance, AAMI, GIO, Bingle, APIA, Shannons, terri scheer, VERO, Essentials and more.
- Auto & General Insurance Company Ltd – Budget Direct and more.
- QBE Insurance Group Limited
- Hollard Insurance – Real Insurance, Guardian and more.
- Youi Insurance
- Allianz
Royal Automobile Club of Queensland (RACQ)In addition to the above list, there are many small insurance companies as well.
Gibbs Wright Lawyers have experience with all of the large insurance companies and many of the smaller insurance companies in disputing a rejected claim. If you have an insurance dispute, Gibbs Wright Lawyers are here to help.
Types of insurance
Personal insurance
- home and contents insurance;
- comprehensive and third party motor vehicle insurance;
- travel insurance;
- lender’s mortgage insurance;
- landlord insurance;
- tenant insurance;
- income protection insurance;
- personal injury and illness insurance;
- life insurance;
- and more.
Business/professional insurance
- public liability;
- product liability;
- professional indemnity;
- management liability;
- farm insurance;
- cyber insurance;
- key person insurance;
- business interruptions;
- and more
Common reasons claims are rejected
The three most common reasons that insurers give for rejecting claims are:
Non-disclosure
You as the insured have a duty to disclose relevant information when you take out an insurance policy or when you renew the insurance policy. If you did not provide comprehensive or accurate information at the requisite time, then your insurer may be entitled to reject your claim.
Fraud
If your insurer believes that you have acted or engaged fraudulently in some way, they may cite fraud as the reason for cancelling your claim.
Exclusion clauses
Your insurer may claim that due to certain clauses in your policy, your loss, damage or injury will not be covered under a particular provision.
There are obvious exclusions to different types of insurance policies (e.g. motor vehicle insurance policies) that are often overlooked:
- the age and/or experience of the driver – some insurance policies only cover drivers that are over a certain age (e.g. drivers over 25 years);
- if you have an accident and you are under the influence of drugs or alcohol;
- if you have an accident and you are charged with certain offences; and
- if you fail to disclose certain information before taking out an insurance policy (e.g. you fail to disclose your traffic record), insurers may attempt to deny liability on the basis that they would not have covered you if you had disclosed this information prior to taking out the policy.
The insurance process
The insurance process for general insurance matters can generally be broken down into five distinct stages:
- Stage 1 – the incident
- Stage 2 – the claims process
- Stage 3 – the internal review process
- Stage 4 – the external review process
- Stage 5 – the court process
Stage 1 – the incident
The incident relates to the insurable event. If you have home and contents insurance for example, an insurable event may be when your house floods, is damaged by fire, or a window is broken. In some cases, you may be obligated to take certain steps to ensure you are entitled to claim for insurance, including mitigating (reducing) your loss.
Stage 2 – the claims process
The claim process relates to the first main step in recovering insurance relating to the insurable event. This primarily involves two main areas:
- new claims; and
- existing claims where the problem has not been fixed properly by the insurance company (e.g. defects in the repair work).
We will primarily discuss the process of new claims in this article, even though protections exist for defective repairs.
The claims process is your first contact with your insurance company. Many times, people make their claim over the phone.
Before you make a claim, it is important that you:
- are calm;
- have a short chronology of events that have occurred;
- ensure that you exclude any irrelevant information; and
- only provide information that is directly relevant to your claim.
You should also review your product disclosure statement to learn about what rights you have and exclusions you have.
Almost all insurance companies will record each interaction you have with them, and they may use this against you. If you have said something that may be harmful, you should contact a lawyer to help you correct the record, or ideally, obtain a lawyer before contacting your insurance company (unless immediate or urgent reporting is required).
The initial claims process is the first step for your insurance company to determine what claims could be denied.
If there is any prospect of the insurance company being able to deny your claim, an insurance company may start an investigation to support the decision to deny you, or simply deny you without conducting an investigation.
You may or may not know about the investigation, but it is usually evident through an extended delay of processing your claim. If an external investigator is appointed, the insurance company will usually let you know. These investigators are often highly trained (for example, ex-police detectives) and have the goal of finding reasons to deny your insurance claim.
Stage 3 – the internal review process
It is a requirement by law that all insurance companies have an internal review process. An internal review process is usually only necessary if you are unsatisfied with the outcome of Stage 2 – usually, when your claim has been denied.
The internal review process is handled by an employee from the same insurance company. In larger companies such as Suncorp and AIG, this person is usually in a completely separate building to the original person handling your claim.
The internal review process is often beneficial and sometimes necessary before continuing to Stages 4 and 5.
Stage 4 – the external review process
Previously, the Financial Ombudsman Service (FOS) dealt with the external review process, but it is now handled by the Australian Financial Complaints Authority (AFCA). AFCA is available to most individuals and many small businesses (fewer than 100 employees) for things such as general insurance products and life insurance. AFCA does not have jurisdiction to assess every matter.
The insurance company is usually bound by the decision of AFCA. That is to say, if AFCA say the insurance company needs to fix your car, the insurance company must fix your car.
You are not bound by a decision made by AFCA. This includes if AFCA says the insurance company does not need to cover you. If you do not accept the position of AFCA, you can continue to Stage 5.
Stage 5 – the court process
The court process is the last step in the process. The court process is usually similar to any other breach of contract claim in the courts. Additionally, the Insurance Contracts Act 1984 (Cth) provides some rights and responsibilities of both the policyholder and the insurer. In essence, you have a contract with your insurance company, and you will be arguing that they have breached that contract by failing to indemnify you for your loss.
Should I get a lawyer?
People engage us at different stages throughout the insurance process. Some of our clients engage us shortly after the incident occurs, when an investigator is appointed, or when they are first denied insurance.
Gibbs Wright insurance lawyers will usually accept clients at any stage through the insurance process and can assist you by negotiating with your insurer, assisting or representing you through AFCA and representing you in court.
