Insurance claims process

Introduction

Filing an insurance claim can be stressful, especially when you’re already dealing with damage to your home, car, business or belongings.

Many Australians feel confused about what happens after they contact their insurer. By understanding the four main stages of an insurance claim, lodgement, assessment, liability, and settlement, you can protect your rights and make sure you get a fair outcome.

1. Lodgement of Your Insurance Claim

The first stage of any insurance claim is lodgement. This means you notify your insurer that a loss has occurred and provide the basic details.

When lodging an insurance claim, you’ll usually need to give:

Information about the event (for example, the storm, flood, fire, theft, or accident) and loss or damage you’ve suffered.
Supporting evidence such as receipts, photos, videos or reports.

Once your insurance claim is lodged, the insurer must confirm within 10 business days whether more information is required and provide you with an estimated timeframe.

2. Assessment of Your Insurance Claim

The insurance claim assessment stage is where the insurer gathers evidence about what happened, how the damage occurred, what loss you’ve suffered, and how extensive it is. This may involve:

Sending experts to prepare reports assessing the cause of damage,
Preparing a scope of works (a detailed repair list),
Obtaining quotes to estimate the cost of repairs or replacements.

This stage is crucial because the evidence collected here will determine the insurer’s liability decision and/or settlement offer.

3. Liability Decision on Your Insurance Claim

The liability stage of an insurance claim is when the insurer decides whether to accept or decline the claim.

Outcomes can include:

Full acceptance: The insurer agrees to cover the claimed loss.
Partial acceptance: Only part of the insurance claim is approved.
Decline: The insurer refuses the claim.

If your insurance claim is declined, the insurer must give you written reasons, explain how the policy terms apply, and provide copies of reports relied upon. You then have the right to challenge the insurance claim decision through the insurer’s complaints process or escalate to the Australian Financial Complaints Authority (AFCA).

4. Settlement of Your Insurance Claim

If your insurer accepts liability, the settlement stage of your insurance claim begins. This is when the insurer delivers on the policy promise.

Settlement options for an insurance claim include:

Repairs organised by the insurer, using their preferred suppliers.
Replacement of lost or damaged items.
Cash settlement, where you receive money to arrange your own repairs or replacements.

Many disputes occur at this stage because insurers may undervalue repairs, overlook parts of the damage, or miss additional benefits in the policy.

If the settlement offer does not reflect the true value of your insurance claim, you can dispute it through the insurer’s internal complaints process, and if necessary, through AFCA.

Conclusion

Making an insurance claim involves four key stages — lodgement, assessment, liability, and settlement. At each stage, there are risks of delays, unfair decisions, or low offers. By knowing what to expect and holding your insurer accountable, you can improve your chances of achieving a fair outcome.

If your insurance claim has been delayed, declined, or underpaid, remember that you don’t have to accept it. You have the right to complain, provide stronger evidence, and escalate the matter if necessary. For expert help during this phase, reach out for our team for a free initial discussion about your claim.

Having issues?

We commonly see these issues during a storm or flood claim:

Assessment disputes – disagreements over the cause of damage, incomplete scopes of work, or reliance on poor-quality expert reports.
Liability decisions – partial or full claim denials based on exclusions (e.g., wear and tear, maintenance, defects) that may not be applied fairly.
Settlement shortfalls – insurers offering low cash settlements, missing policy benefits, or excluding parts of the damage from repair scopes.
Unreasonable delays – long periods of inaction, poor communication, or lack of updates, leaving claimants uncertain about their insurance claim outcome.

confused? over it? Want a second opinion?

If you are exhausted with the claims process or want the support of an expert claim advocate in your corner, submit an enquiry and we’ll review your claim, for free, and help you move forwards with confidence.

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