How to Navigate the Insurance Claims Process in Several Easy Steps

Posted on April 16, 2024 | by | Posted in Insurance

Making an insurance claim can seem daunting and overwhelming on the first attempt. Here at Matrix Insurance, we want all our clients to feel comfortable and secure in the process, so we have broken it down and created the following guidelines. The exact nature of some of the following steps depends on the reason for the claim, but most hold true in any circumstance and will facilitate the smooth processing and payment of your claim. 

Gather information 

The more information you have about an insurance claim, the easier things will be. Provided you have the means and it is safe to perform the following actions, it is far better to have too much information than too little.

• Take as many photographs and videos of the scene or related areas as possible. Common sense will dictate this; you must not endanger yourself while documenting unsafe areas or items. 
• Create a list of the items you wish to include in your claim, and try to note where and when they were purchased. If you have receipts for items, attach those to the list. 
• If you were present, write a clear, concise account of the events as you saw them unfold. If emergency officials attended the scene, ask for their badge numbers and a reference number for the incident. List the names of any witnesses or involved parties. 
• If a building has been damaged, document and list any affected structural elements, flooring, or large pieces of furniture if they are safe. 

Making the claim

Your insurance provider should provide clear instructions for making your claim; do not hesitate to contact them if you need clarification. If you have friends or family members familiar with making insurance claims, draft them in to help relieve some of the stress and burden. Work systematically through the instructions and check off each action once completed. 

• If the provider informs you that your inability to provide documentation precludes you from continuing your claim, seek legal assistance. 

Assessment

Your insurance provider may send an assessor to your location. It is critical to be as honest and cooperative as possible, showing them any relevant items and locations and running through the story again if necessary. The assessor may wish to conduct interviews, speak with independent witnesses, and review the reports filed by any attending emergency services.

• Most importantly, only sign documents once you agree and understand the details and repercussions. You may wish to seek legal advice before signing.

Facilitating faster payments

If you are in a dire financial situation, insurers are required to do everything possible to fast-track your claim. The General Insurance Code of Practice implicitly states this, and you should familiarise yourself with its contents and mention it if necessary. An advance payment must be made within five days of your demonstration of financial difficulties. This will be deducted from your final balance. 

• If problems occur or the insurer refuses to adhere to the code, you can request a review or complain to the Australian Financial Complaints Authority (AFCA).

Timeframe and final steps

Your insurance company must inform you of its decision within ten business days of receiving your claim unless it requires more information and assessments.

• If, under normal circumstances, you haven’t received a decision from your insurer within those ten business days, you may wish to write a letter of complaint or request an internal review of the matter.

Rejected claims

If your claim is rejected and you believe it is unfair, ask your insurer to review it internally. If they do not respond within fifteen business days or the matter is unresolved, you can escalate proceedings to a senior level within the company. They then have forty-five calendar days from that point to give you a final assessment of their decision. If your complaint remains unresolved, contact the AFCA and request an independent review. This request must be made within two years of the final decision. 

• If you remain unsatisfied with the result of these investigations, you can pursue the matter in court at your own expense. 

Luckily, most insurance claims never reach the latter stages of these guidelines, so it is acceptable to be aware of your rights and tackle each phase as and when it occurs. 

Contact us

If you want to learn more about Matrix Insurance and our comprehensive range of quality insurance policies, please do not hesitate to contact us. Our trained, knowledgeable staff are standing by to assist in any way they can. Our reputation as a trusted broker means everything to us, and this is built on honesty and professional integrity. We will never try to sell you unnecessary insurance coverage and will always give you open, honest advice on the best course of action in your circumstances.