Legal Guide

What You Should Know About the Insurance Process

Having insurance nowadays seems like a must -- many believe it to be a worthy investment and it gives you a sense of security for any uncertain circumstances that may happen in the future.

Insurance policies depend on your needs and certainly one size doesn’t fit all. Insurance companies have tailored policies that they know will benefit their client in the long run, depending on what they think will happen in the years to come.

Two Kids of Insurance Policies

Generally insurance policies are divided into two categories: personal and business. Under these two, there are subcategories that will cater to each individual’s needs.

Personal Insurance

  • Life Insurance
  • Accident and Critical Illness Insurance
  • Home and Content Insurance
  • Income Protection Insurance
  • Tenant Insurance
  • Landlord Insurance
  • Lender’s Mortgage Insurance
  • Travel Insurance
  • Motor Vehicle Insurance

Business Insurance

  • Public Liability
  • Professional Indemnity
  • Management Liability
  • Farm Insurance
  • Cyber Insurance
  • Key Person Insurance
  • Business Interruptions

How to claim your insurance

Claiming your insurance is easy and there are usually 5 stages for this process:

First stage: the incident

These are events that are insurable -- usually natural disasters or accidents. For example, your house is insured and it gets flooded; this is the incident. Anything that happens to your home, even if it’s as simple as a broken window, is an insurable event.

Second stage: claiming process

If you want to claim insurance, the first step is to contact the insurance company. Before you do this, make sure that you have collected all the relevant information you need.

Be sure to be cool, calm, and collected when you talk to an agent. Only tell them details that are relevant or related to the incident. Avoid statements which can be used against you.

If you can afford it, talk to a lawyer first before calling the insurance company. They will be able to give you professional advice. If a lawyer is out of the question, just make sure to remember that your call will be recorded. Any statements made during the call may affect your claims.

After contacting the company, they’ll be able to study which claims they should approve or deny. They may also start investigating if your claims are true or false.

Third stage: internal review process

The insurance company is required by law to have your case reviewed by another employee, other than the person who handled your case. This is so they can study it especially when your claim has been denied.

Most of the time insurance companies don’t change their initial decision.

Fourth stage: external review process

Sometimes clients might not be happy with the decision of the insurance company. They can seek the help and advice of the Australian Financial Complaints Authority. Negotiations will take place and most likely a compromised agreement between the company and client will be the result.

If the AFCA decided that the company should cover your insurance, they must comply. If the AFCA decides that the company doesn’t need to to cover you, you are not bound by this decision. You may go to court. 

Fifth stage: the court process

In this stage you will bring to court your claims because the insurance company has failed to compensate you and they are bound by contract to do so. In other words, they have breached the contract and you can file a case against them. A civil litigation lawyer is one who is knowledgeable about such processes and will be able to help you make insurance claims seamlessly.

Insurance companies are supposed to help you in times of need and the money you have invested in a plan should go towards any untoward incident that may happen to you.

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