Letter to Request further Information from Insurer - Word & PDF Template Form

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To: ________
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Policyholder name: ________
Policy name/type: ________
Policy number: ________
Claim number: ________
Date of claim: ________

Re: Request for Further Information in Relation to Insurance Claim No. ________

Dear Sir/Madam,

1. I refer to the above-mentioned insurance policy and to my claim made under that policy on ________ (the Claim).

2. I make this request in order to better understand the basis upon which the Claim has been assessed and/or determined, and to enable me to consider my position. This request is made having regard to your obligations of utmost good faith under section 13 of the Insurance Contracts Act 1984 (Cth), your obligations under the General Insurance Code of Practice (or the Life Insurance Code of Practice, as applicable), and my right to access personal information held about me under Australian Privacy Principle 12 of the Privacy Act 1988 (Cth).

3. Accordingly, I hereby request that you provide me with the following documents and information:

(a) a copy of any applicable Product Disclosure Statement and/or policy schedule relevant to the Claim;

(b) a copy of any applicable Certificate of Insurance or Certificate of Currency;

(c) a complete copy of the relevant policy wording, including any endorsements, exclusions and special conditions relied upon;

(d) any reports from external sources or experts which you have taken into consideration in assessing the Claim;

(e) any reports from service suppliers, loss adjusters or assessors which you have taken into account in assessing the Claim;

(f) any transcripts of conversations or interviews in which I have been involved (including conversations or interviews with assessors, investigators, or other personnel acting on your behalf) which you have taken into account in assessing the Claim;

(g) any audio or video recordings involving me (including recordings of conversations or interviews I have had with assessors, investigators, or other personnel acting on your behalf) which you have taken into account in assessing the Claim;

(h) a thorough written explanation of the reasons for the decision in relation to the Claim, including (if the Claim has been declined or reduced) the specific policy terms, conditions or exclusions relied upon and the factual and other matters on which you have relied;

(i) copies of any assessments, file notes, internal recommendations and calculations made in relation to the Claim; and

(j) any other document or information you have relied upon in assessing or determining the Claim.

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5. I confirm that I consent to the release of the requested information to me and, where relevant, to my authorised representative noted below.

6. If you are unable to provide any of the requested documents or information, please advise me in writing of the reasons for that refusal and the relevant provision relied upon.

7. To the extent that any fee is properly payable for providing access in accordance with Australian Privacy Principle 12.8, please advise me of the amount of that fee before incurring it.

8. Please direct your response to me at the address set out above. Should you require any further information from me in order to process this request, or to confirm my identity, please do not hesitate to contact me.

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Thank you for your assistance in this matter.

Yours faithfully,

________

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Authorised representative (if applicable): ________