Insurance Claims Lawyers Melbourne

How we help

How we help with insurance claims

A denied or underpaid claim is rarely as straightforward as the letter makes it sound. Insurers rely on detailed policy wording, exclusions and definitions — and on the fact that most people don't have the time, energy or know-how to push back. Our job is to even that out. We read your policy line by line, work out exactly why the claim was knocked back, and tell you honestly whether the decision can be challenged.

When it can, we act for you through the insurer's own internal dispute resolution process, and — if that doesn't resolve things — through the Australian Financial Complaints Authority (AFCA), the free external ombudsman scheme that can make a determination binding on the insurer. We handle home and contents, total and permanent disability (TPD) and income protection claims, and disputes over how much you've been paid. You won't be talked down to or strung along, and you'll always know where you stand and what the next step is.

Denied claims reviewed Underpayments challenged AFCA complaints handled

Pasha Legal reviewing an insurance claim with a client in Melbourne

What we can help with

When the insurer says no — or not enough

A knock-back is not the end of the road. These are the insurance situations we're asked about most. If yours isn't listed, tell us anyway — most disputes turn on the same handful of issues.

Denied claims

Your claim was refused outright — often citing an exclusion, non-disclosure or a policy definition. We work out whether that reason actually holds up, and challenge it if it doesn't.

Underpaid claims

The claim was accepted, but the payout doesn't come close to your loss. We press for a fair assessment of what you're genuinely owed under the policy.

Home & contents

Disputes over storm, flood, fire, burglary or damage claims — including arguments about wear and tear, maintenance, or how the policy defines an event.

TPD claims

Total and permanent disability claims, often held inside your superannuation. We help when an insurer disputes that you meet the policy's definition of being unable to work.

Income protection

Benefits stopped, reduced or refused while you're unable to work. We deal with disputes over medical evidence, waiting periods and ongoing entitlement.

Disputes & AFCA complaints

We run the insurer's internal dispute resolution process for you and, where needed, lodge and manage a complaint with AFCA — the free external scheme that can bind the insurer.

A quick note on time limits: many policies and the AFCA scheme have deadlines for raising a complaint after a decision is made. The sooner you talk to us, the more options you'll usually have.

How it works

A clear path, from no to fair

No jargon, no pressure, and no surprises on cost. Here's how a typical insurance matter unfolds with us.

Initial consultation

Bring your policy, the insurer's decision letter and any correspondence. We'll read them with you, explain in plain English why the claim was knocked back, and give you an honest view of whether it's worth challenging.

A clear plan & costs

If there's a case to make, we set out the strategy — internal dispute resolution first, then AFCA if needed — along with likely timeframes and clear, upfront fees. You decide whether to go ahead before any work begins.

We act for you

We gather the evidence, write the submissions, and deal with the insurer and AFCA on your behalf — so you can focus on getting on with life while we hold them to the policy you paid for.

Common questions

Insurance claims — your questions, answered

General information about how insurance disputes work in Australia. It isn't advice about your specific claim — for that, please have a chat with us.

My claim was denied. Is that the final decision?

No. A denial is the insurer's first view, not the last word. You have the right to ask the insurer to formally review the decision through its internal dispute resolution (IDR) process, which the insurer must respond to within set timeframes. If you're still unhappy after that, you can take the matter to the Australian Financial Complaints Authority (AFCA), an independent ombudsman scheme that's free to consumers and can make a decision binding on the insurer. Many claims that are knocked back at first are resolved at one of these stages.

What is AFCA, and does it cost anything?

AFCA — the Australian Financial Complaints Authority — is the external dispute resolution scheme that handles complaints about banks, insurers and other financial firms. It's free for consumers to use. Before AFCA will consider a complaint, you generally need to have given the insurer a chance to resolve it through their internal process first. AFCA can review the insurer's decision and, where it finds in your favour, make a determination the insurer is bound to follow. We can prepare and run an AFCA complaint for you, presenting the evidence and arguments in the way that gives it the best chance.

Why do insurers refuse or underpay claims?

Common reasons include a policy exclusion (something the policy says it doesn't cover), an argument that the loss was caused by wear and tear or lack of maintenance rather than a sudden event, or a claim that you didn't disclose something relevant when you took out or renewed the policy. With TPD and income protection, the dispute is often about whether your circumstances meet the policy's precise definition of disability or inability to work. These reasons are not always correct, and the wording of the policy and the medical or factual evidence both matter a great deal — which is exactly what we examine closely.

What's the difference between a TPD and an income protection claim?

A TPD (total and permanent disability) claim is usually a lump-sum benefit paid if illness or injury means you're unlikely to ever work again in a defined way — and it's often held inside your superannuation, sometimes without you realising. Income protection pays an ongoing monthly benefit while you're unable to work because of illness or injury, after a waiting period. The definitions in each policy are what decide whether you qualify, and disputes frequently turn on the medical evidence and on the exact words used. We help with both, including claims you may not know you hold through your super fund.

Is there a time limit to dispute a decision?

Often, yes. The insurer's internal process has its own timeframes, and AFCA generally requires a complaint to be lodged within a set period after the insurer's final decision (there are limited exceptions). Separate legal time limits can also apply if a matter ever needs to go to court. The practical message is simple: don't sit on a denial letter. The earlier you get advice, the more room there is to act and the lower the risk of missing a deadline.

What will it cost to have you look at my claim?

Your first consultation is confidential. We'll review your policy and the insurer's decision and tell you honestly whether you have grounds to challenge it — without obligation. If there's a case worth pursuing, we'll explain the likely steps, timeframes and our fees clearly and upfront, so you can make an informed decision before any work starts. If we don't think a challenge is worthwhile, we'll tell you that too.