Letter to Complain about Insurer's Rejection or Delay of Claim - Word & PDF Template Form Pro · AU-law

PRIVATE & CONFIDENTIAL

________
________
Email: ________
Telephone: ________

________

________
________

Attention: ________

Re: Internal Dispute Resolution — Rejection of Insurance Claim
Policy Number: ________
Claim Reference Number: ________
Policyholder: ________

Dear Sir/Madam,

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1. The Claim

On ________ I submitted a claim under the Policy. The claim is made in relation to the following item(s):

________

(hereafter the "item(s)")

The total amount claimed in respect of the item(s) is ________.

2. The Insured Event

The item(s) were stolen on ________ in the following circumstances:

________

The theft was reported to ________ on ________ and was allocated report/event reference number ________.

3. Your Decision

By correspondence dated ________ you rejected my claim under the Policy on the following basis:

________

4. Grounds of Dispute

I respectfully dispute your decision to reject my claim for the following reasons:

________

In support of my position I note that:

1. the loss falls squarely within the cover provided by the Policy and no applicable exclusion operates to defeat my claim;
2. I have at all times complied with my duty to take reasonable care not to make a misrepresentation and with my duty of utmost good faith as required by sections 13 and 21 of the Insurance Contracts Act 1984 (Cth);
3. where you seek to rely upon any non-disclosure, misrepresentation or breach of condition, you are required to establish the matters set out in the relevant provisions of the Insurance Contracts Act 1984 (Cth), including the remedies available under sections 28, 54 and 56 of that Act; and
4. I have provided all evidence, information and documentation reasonably requested of me in respect of the claim.

5. Unreasonable Delay

Notwithstanding that I have submitted all required evidence and have cooperated fully with your enquiries, it has now been ________ since I first lodged my claim. This delay is unreasonable, is inconsistent with the timeframes prescribed under the General Insurance Code of Practice, and it appears that we have now reached a deadlock. I have done all that I can to progress my claim, however it has not been dealt with adequately or in a timely manner.

6. Request and Notice

My claim is duly covered by the Policy and I therefore request that you reconsider your decision and settle my claim in full as a matter of urgency. I require that this letter be treated as a formal internal dispute resolution complaint and that the matter be escalated to your internal dispute resolution team.

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Please direct all future correspondence in relation to this matter to me at the address set out above.

Yours faithfully,

________
________

Enclosures: ________