Letter of further Evidence after Insurer's Rejection of Claim - Word & PDF Template Form

________
________
Email: ________
Phone: ________

________

________
(the "Insurer")
ABN: ________
________
Attention: ________

Dear Sir/Madam,

RE: INTERNAL DISPUTE RESOLUTION REQUEST — REVIEW OF DECLINED INSURANCE CLAIM

Policy Number: ________
Claim Number: ________
Policyholder: ________
Date of Insured Event: ________

§1. Introduction

I refer to your letter dated ________ (the "Decision"), in which you declined my claim under the above policy of insurance (the "Policy"). I write to formally request an internal review of the Decision. This letter constitutes a complaint and a request that the matter be dealt with through your Internal Dispute Resolution (IDR) process in accordance with the General Insurance Code of Practice and the requirements of the Australian Securities and Investments Commission, including ASIC Regulatory Guide 271 (Internal Dispute Resolution).

§2. Basis of the Insurer's Decision

I understand that the claim was declined on the following basis:

________

§3. The Claim

3.1 The claim is made in respect of loss of, or damage to, the following item(s):

________

(together, the "item(s)")

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

§4. Circumstances of the Loss

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

________

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

§5. Grounds for Review

5.1 I respectfully dispute the Decision and request that it be reconsidered for the following reasons:

________

5.2 In particular, I submit that the loss falls squarely within the cover provided by the Policy, that I have complied with all relevant terms, conditions and duties under the Policy, and that the Insurer's reliance on the matters set out in §2 is not supported on the facts or at law.

Lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat duis aute irure dolor in reprehenderit voluptate velit esse cillum dolore eu fugiat nulla pariatur lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad.

§6. Further Evidence

Since receiving the Decision, I have obtained the following further evidence, which is enclosed and which supports my claim:

________

§7. Request

7.1 For the reasons set out above, my claim is duly covered by the Policy and I therefore request that you reconsider your decision and reimburse me in full for my loss in accordance with the terms of the Policy.

Lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat duis aute irure dolor in reprehenderit voluptate velit esse cillum dolore eu fugiat nulla pariatur lorem ipsum dolor sit amet consectetur adipiscing elit sed do.

7.3 Please direct all correspondence in relation to this matter to me at the address and contact details set out above.

§8. Reservation of Rights

8.1 In the event that the Decision is not reversed, or I do not receive a substantive response within the required timeframe, I reserve my right to refer this dispute to the Australian Financial Complaints Authority (AFCA), an external dispute resolution scheme of which the Insurer is a member, and to pursue any other remedy available to me at law.

8.2 Nothing in this letter constitutes a waiver of any of my rights, all of which are expressly reserved.

Enclosures: ________

Yours faithfully,



________
Policyholder