1. Know What You’re Entitled To

This is the foundation of any successful claim and is where trusting your insurer to offer everything can fall short. 

Knowing what you’re entitled to means understanding:

• Your Product Disclosure Statement (PDS) – your policy sets out what is covered, what is excluded, and how your insurer can settle your claim. If you don’t know what your policy promises, it’s hard to challenge an outcome that falls short of it.
• How the law limits unfair insurer conduct – insurers are not free to do whatever they want. The law places limits on unfair conduct and how discretion can be exercised. These legal principles exist to prevent outcomes that are technically convenient for insurers but unreasonable for customers.
• How AFCA approaches claims disputes – AFCA does not just apply policy wording in isolation. It looks at what is fair and reasonable in the circumstances. Understanding AFCA’s approach can create real leverage when an insurer is taking a narrow or rigid position.
• The subject matter of your claim – for example, with property claims, this means knowing what “good” looks like in practice.
  • What does a proper assessment involve?
  • What should a fair scope of works include?
  • What are common items insurers miss or under-allow for?
    
    

If you don’t know what a fair outcome looks like, it is very hard to push for one. Many people accept poor outcomes simply because they do not realise they are being short-changed. 

2. Know How to Prove It

Knowing you are entitled to something is one thing. Proving it is another.

Insurance claims are evidence driven. By the time a claim is delayed, reduced, or declined, insurers often have:

• Technically drafted decisions
• A weight of expert evidence
• A team who is convinced of their position and is unwilling to change their mind
  
  

For most customers, the evidence appears stacked against them.

This is where the art of proving your case matters: 

• You need to know what bad evidence looks like – not all reports are strong, complete, or fair. Some assessments are superficial. Some scopes of works are incomplete. Some opinions rely on assumptions rather than proper investigation. When you can identify gaps, inconsistencies, and poor methodology, the insurer’s position becomes less convincing.
• You need compelling and persuasive evidence of your own – challenging insurer evidence without strong counter-evidence rarely works. The goal is not to argue emotionally, but to put forward better quality, more persuasive evidence that directly addresses the insurer’s conclusions.
  
  

Frustrated claimants get frustrating outcomes. But those who can explain their frustration with evidence, facts and purpose, often get the result they deserve. 

3. Know the Strategy to Get It

This is the piece most people underestimate.

We regularly speak to clients who:

• Know their PDS inside out and understand the legal principles and AFCA rules that apply
• Have strong evidence to support their position
  
  

Yet their insurer still will not move. This is where strategy matters.

Insurance claims are not decided in a vacuum. Insurers operate under internal pressures, performance targets, cost controls, and risk frameworks. Claims teams are influenced by what is easy to approve, what is risky to escalate, and what is likely to be challenged. 

Unless you understand:

• What the insurer is likely thinking
• What pressures their claims team is under
• Where their real risk points are
• When to escalate effectively, not out of frustration
  
  

.. you can still be stuck, even with a strong case. 

Without strategy, you remain at the mercy of a process that may not be designed to properly engage with well-reasoned customer arguments. Knowing when to push, when to reframe issues, when to escalate, and how to create leverage can be the difference between being ignored and being taken seriously.