How to Make an Insurance Claim in Australia 2026 — Step by Step

Quick Answer: To make an insurance claim in Australia, notify your insurer as soon as possible, document everything with photos and receipts, and keep records of all communications. Insurers must acknowledge claims within 10 days and decide within 10 business days for straightforward claims. If denied, complain to AFCA — free dispute resolution.

Making an insurance claim should be straightforward — but for many Australians it is a stressful and confusing process. Understanding your rights, the correct process for each insurance type, and what to do when things go wrong can mean the difference between a successful claim and an out-of-pocket financial loss. Australia has strong consumer protections for insurance claimants through ASIC, APRA, and the Australian Financial Complaints Authority (AFCA) — knowing how to use them is essential.

Why This Matters for Australians in 2026

The Insurance Council of Australia reported record claim volumes following Ex-Tropical Cyclone Alfred in early 2026, with over $1.5 billion in claims lodged. In high-pressure, high-volume situations, insurers can make errors, delays can occur, and legitimate claims can be disputed. From December 2026, new AI transparency obligations require insurers to explain algorithm-based claim decisions — giving policyholders more power to challenge automated assessments. Knowing your rights before you need them is invaluable.

Your Legal Rights as an Insurance Claimant

The Insurance Contracts Act 1984 is the primary legislation governing insurance in Australia. Key rights include:

Insurer must act in utmost good faith — they cannot act in ways that are unreasonable or designed to avoid a valid claim
Right to reasons for denial — if your claim is denied, the insurer must provide written reasons
Right to internal dispute resolution — the insurer must have a free internal complaints process
Right to external dispute resolution — via AFCA if internal resolution fails
Right to information — you can access your claim file and all documents relied upon in the decision
AI transparency (from December 2026) — insurers must explain how algorithms contributed to claim decisions

Claim Timeframes — What Insurers Must Do

Step	Timeframe Required
Acknowledge receipt of claim	Within 10 business days
Request further information	Promptly — must not delay unreasonably
Make decision on straightforward claims	Within 10 business days of receiving all information
Notify of delays	Must inform you if decision will take longer, and why
Pay accepted claim	Promptly after acceptance
Provide reasons for denial	In writing, within the decision timeframe

If an insurer is not meeting these timeframes, document the delay and raise it in a formal complaint — first internally, then to AFCA.

Claim Process by Insurance Type

Insurance Type	Notify Deadline	Key Documents	Expected Timeline
Car (accident)	24–48 hours	Photos, police report (if applicable), other driver details	5–15 business days
Car (theft)	Immediately	Police report number, vehicle details	10–20 business days
Home (storm/flood/fire)	As soon as possible	Photos/video before repairs, receipts, police report if vandalism	10–30+ business days (longer after major events)
Private health (hospital)	Before admission (elective); within 2 years	Hospital invoice, Medicare statement	5–10 business days
Life insurance (death)	As soon as practical	Death certificate, completed claim form, policy documents	20–40 business days
Life insurance (TPD)	As soon as practical	Medical evidence, completed claim forms, financial records	60–120+ business days (complex)
Income protection	After waiting period	Medical certificates, financial records, completed forms	10–20 business days initial; monthly ongoing
Travel (medical)	As soon as possible	Medical reports, receipts, boarding passes	10–15 business days
Travel (cancellation)	Within 21–30 days of incident	Medical certificate, airline cancellation confirmation, receipts	10–15 business days

How to Make a Car Insurance Claim — Step by Step

At the scene: Stop, check for injuries, call 000 if needed. Do not admit fault.
Exchange details: Name, address, phone, registration, insurer, licence number from all parties.
Document: Photograph all vehicles, damage, road conditions, tyre marks, traffic signals.
Police report: Required if anyone is injured, if the other driver refuses to exchange details, or if they leave the scene. Get the report number.
Notify your insurer: Call the claims line or lodge online within 24–48 hours (check your PDS — some require immediate notification).
Provide information: Your insurer will ask for the details, photos, and police report number.
Vehicle assessment: Your insurer arranges inspection — either at an approved repairer or an assessor visits.
Repair or settlement: Approved repairer completes work, or a cash settlement is offered for write-offs.

How to Make a Home Insurance Claim — Step by Step

Ensure safety first: If your home has been damaged by fire or structural failure, ensure everyone is safe before anything else.
Prevent further damage: Take reasonable steps to prevent additional damage (e.g., cover a broken window, turn off water at the mains for a burst pipe). Keep receipts for emergency repairs.
Document everything: Photograph and video all damage before any repairs or clean-up. This is critical — insurers often deny claims where there is no evidence of the damage in its original state.
List damaged items: Make a detailed inventory of damaged or destroyed contents with approximate values and purchase dates.
Notify your insurer: Call the claims line or lodge online as soon as practical.
Assessor visit: Your insurer may appoint a loss assessor to inspect the damage. Be present if possible.
Obtain repair quotes: Your insurer may arrange this or ask you to obtain quotes.
Settlement: Insurer approves repairs through preferred repairer network, or agrees a cash settlement.

Important: Do not dispose of damaged items before the assessor visits — they are evidence.

How to Make a Health Insurance Claim

In-hospital claims (hospital cover):

For planned admissions, contact your fund for pre-approval
The hospital typically lodges the Medicare and fund claim on your behalf
You pay any gap or excess at discharge
Receive the Explanation of Benefits statement from your fund

Extras claims (dental, optical, physio, etc.):

Most extras are claimed on the spot using your health fund card at the provider
Your provider swipes the card, the fund pays their portion, you pay the gap
For providers not using HICAPS (the electronic claims system), submit a paper or online claim with the original receipt

How to Make a Life Insurance Claim

Life insurance claims — particularly for death and TPD — are more complex than general insurance claims. Consider using a financial adviser or claims specialist to manage the process.

Death claim:

Obtain a certified copy of the death certificate
Contact the insurer’s claims team (or your financial adviser)
Complete the insurer’s claim forms
Provide supporting documents: medical records, attending physician statement
Confirm beneficiary details and banking information for payout
For super-linked policies, the super fund trustee must also be notified

TPD claim: TPD claims require substantial medical evidence that your disability is permanent and total. Medical reports, specialist assessments, and employment records are all typically required. These claims often take 60–120+ days. A financial adviser can manage this process on your behalf.

What to Do If Your Claim Is Rejected

Step 1 — Request Written Reasons

If your claim is denied, request the specific written reasons in detail. The insurer is legally required to provide these. Reasons might include: exclusion clause, non-disclosure, policy lapse, or the claimed event not being covered.

Step 2 — Review the PDS and Reasons Carefully

Compare the denial reason against your policy wording. Exclusions must be clearly expressed in the PDS to be enforceable. If the denial relies on an exclusion you were not clearly informed about, this may be contestable.

Step 3 — Lodge an Internal Dispute (IDR)

Every insurer must have an Internal Dispute Resolution (IDR) process. Lodge a formal written complaint with the insurer’s complaints team — not just the claims team. The insurer must respond within 30 calendar days.

Step 4 — Lodge a Complaint with AFCA

If the internal dispute is not resolved to your satisfaction within 30 days, lodge a complaint with the Australian Financial Complaints Authority (AFCA):

Phone: 1800 931 678
Website: afca.org.au
Cost: Free for consumers
AFCA can order insurers to pay claims, change decisions, and award compensation
AFCA decisions are binding on insurers (up to monetary limits)

AFCA resolves the majority of insurance complaints within 60 days. It is a powerful and free resource — do not hesitate to use it.

Common Reasons Insurance Claims Are Rejected

Reason	How to Avoid
Non-disclosure	Disclose all relevant information at application and renewal
Exclusion clause	Read your PDS before purchasing — know what is excluded
Policy lapsed	Set up direct debit; never let premiums fall behind
Event not covered	Understand your policy before you need it
Claim lodged too late	Notify as soon as possible after the event
Insufficient evidence	Always photograph damage and keep receipts
Pre-existing condition	Declare all health conditions honestly
Fraud	Never exaggerate claims — criminal offence

AI Transparency Obligations — December 2026

From December 2026, ASIC’s new AI transparency rules require insurers to:

Explain how any algorithm or automated system contributed to a claim decision
Provide this explanation in plain language on request
Allow consumers to request human review of algorithm-based decisions

If your claim is assessed or denied by an automated system, you now have the right to know how that system reached its conclusion and to request human review.

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10 Frequently Asked Questions

1. How quickly must an insurer decide on my claim? For straightforward claims, insurers must make a decision within 10 business days of receiving all required information. For complex claims, they must inform you of the delay and provide regular updates. These are minimum standards under the General Insurance Code of Practice.

2. Can an insurer cancel my policy after I make a claim? An insurer can choose not to renew your policy at the next renewal period — but they generally cannot cancel a current policy mid-term solely because you made a claim, unless there is evidence of fraud or material non-disclosure. Check your PDS.

3. What is non-disclosure and why does it matter for claims? Non-disclosure means you failed to provide accurate and complete information when applying for or renewing your policy. If you failed to disclose a relevant fact (e.g., a pre-existing health condition, prior claims history, property modifications), the insurer may reduce or deny your claim — even if the undisclosed fact did not directly cause the claim.

4. What is AFCA and is it really free? AFCA (Australian Financial Complaints Authority) is an independent external dispute resolution service for financial consumers. It is completely free for consumers to use. AFCA can order insurers to pay claims and award compensation up to $1.085 million for general insurance disputes.

5. Do I need a lawyer to dispute an insurance claim? Not usually — AFCA’s process is designed to be accessible without legal representation. For very large or complex disputes (life insurance TPD claims, business interruption claims), a specialist insurance lawyer or claims advocate may add value.

6. My insurer is taking too long to decide my claim. What can I do? First, contact your insurer in writing requesting an update and a decision timeline. If they continue to delay unreasonably, lodge a formal internal complaint. If not resolved within 30 days, lodge a complaint with AFCA. AFCA can address unreasonable delays as well as disputed decisions.

7. The insurer offered me a settlement that seems too low. Can I negotiate? Yes. An insurer’s first offer is not necessarily final. You can negotiate — provide evidence supporting a higher value (quotes, valuations, receipts). If you cannot reach agreement, lodge an internal dispute and then AFCA if needed. You are not obligated to accept a settlement you believe is inadequate.

8. What is a loss assessor and do I need one? A loss assessor is a professional who assesses damage on behalf of an insurer. For large or complex claims (major home damage, business interruption), you may want to engage a public loss assessor (who works for you, not the insurer) to independently assess the damage and advocate for a fair settlement.

9. Will making a claim affect my premium? For car and home insurance, at-fault claims typically result in a premium increase at renewal and loss of no-claims discount. For life and income protection claims, premiums are generally not affected by claim history. Check your policy terms.

10. What is the difference between an insurer’s internal complaints process and AFCA? The internal dispute resolution (IDR) process is run by the insurer itself — a second review of your claim by their complaints team. AFCA is a fully independent external body with no financial connection to the insurer. If IDR does not resolve your complaint, AFCA is your next step and has binding authority over the insurer.

This article is for general information only and does not constitute financial advice. Always read the Product Disclosure Statement (PDS) before purchasing any insurance policy. Consider seeking advice from a licensed financial adviser.