- Claim Guide
4 Moments When Claims Get Stuck (and What to Do Next)
- Claims process
Summary
- Insurance claims in Australia most commonly get stuck at four stages: waiting for a decision, waiting for a settlement offer after acceptance, evaluating an offer, or challenging a decline or underpayment.
- Under the General Insurance Code of Practice, insurers must make a decision within 10 business days of receiving all required information, and within four months of lodgement.
- At each stage, policyholders are entitled to ask for a clear explanation of what the insurer needs, what they are waiting on, and when a decision will be made.
- If a claim is declined or underpaid, policyholders can challenge the outcome through the insurer’s internal dispute resolution (IDR) process.
- If IDR does not resolve the issue, policyholders can escalate to the Australian Financial Complaints Authority (AFCA) at no cost.
- Independent claim advocates, such as Claimboost, can assist with disputed or underpaid claims on a no-win, no-fee basis.
Introduction: Why Is My Insurance Claim Taking So Long?
If your insurance claim feels like it has completely stalled — no updates, no decision, no clear explanation — you are not alone. Delayed, disputed, and underpaid insurance claims are among the most common consumer frustrations in Australia.
The problem is rarely that your claim is hopeless. More often, it’s that you don’t know which stage you’re stuck in or what you’re supposed to do next. Insurers are permitted to take time to assess your claim, but “reasonable time” has limits — and silence is not an explanation.
At Claimboost, we work with everyday Australians, families and small businesses whose claims have been denied, delayed or underpaid. We’ve seen the same four sticking points come up again and again. Here’s what they are, and exactly what to do at each one.
How Long Should an Insurance Claim Take in Australia?
Under the General Insurance Code of Practice, Australian insurers are expected to:
Acknowledge your claim promptly after lodgement
Make a decision within 10 business days of receiving all the information they need
Proactively keep you informed if there are delays — including the reason why and a revised timeframe
In most cases, make a final decision within four months of lodgement
If your insurer has gone quiet or missed these timeframes without a valid explanation, you have grounds to push back — and this guide will show you exactly how.
Stage 1: No Decision Has Been Made Yet
What this looks like: You lodged your claim weeks or months ago. You’ve had little communication, no decision, and you’re not sure what the insurer is still waiting on.
Why Claims Get Stuck Here
Insurers often request information in stages rather than all at once. Every new request buys them more time, and without proactive follow-up, claims can sit unprocessed for months. Many policyholders don’t realise they’re entitled to clear, specific answers about what the insurer needs and when.
What You Need to Know
- Exactly what evidence or information the insurer still needs from you
- What date they expect to have everything required to make a decision
- When you can expect a final decision once that information is provided
What to Do
Call or email your insurer and ask:
“Can you confirm exactly what information or evidence you still need from me to make a decision on my claim?”
“Once you have that, what is the expected timeframe for a decision?”
Write down the name of the person you spoke to, the date, and what they said. If the insurer cannot give you a clear answer, or if four months have passed since you lodged your claim, this may be grounds to escalate — starting with a formal complaint.
Stage 2: Your Claim Is Accepted, But Nothing Happened
What this looks like: You’ve been told your claim is accepted, but weeks or months have gone by with no repair plan, no scope of works, and no settlement offer. Nobody is telling you what comes next.
Why Claims Get Stuck Here
After accepting a claim, insurers typically need to obtain builder assessments, specialist reports, or quotes before making an offer. This is legitimate — but it’s often done without any explanation to the policyholder, who is left waiting with no idea of what’s happening or how long it will take.
What You Need to Know
- Which parts of your damage the insurer has formally accepted under your policy
- What the insurer is currently doing — are they waiting on a builder scope, a specialist report, or quotes?
- When you should expect a repair plan or cash settlement offer
What to Do
Contact your insurer and ask:
“Can you confirm in writing what damage has been accepted under my claim?”
“What reports, quotes or assessments are you waiting on before making a settlement offer, and when do you expect to receive them?”
If they can’t answer clearly, request a written update on the current status and expected next steps. If you’re past the four-month mark, you may have grounds to lodge a formal complaint.
Stage 3: You've Received an Offer, But Not Sure What to Do
What this looks like: Your insurer has made a repair or cash settlement offer. You’re not sure whether it’s fair, you feel pressured to accept quickly, or you don’t fully understand what the offer covers.
Why This Stage Is Critical
Accepting an inadequate offer can leave you out of pocket for damage your policy should cover — and once you’ve accepted, it can be very difficult to revisit. This is one of the most important moments in the entire claims process, and it’s exactly where many people settle for less than they’re entitled to.
You are not required to accept any offer immediately. You have the right to review the documents the insurer relied on, seek independent advice, and take the time you need to make an informed decision.
What You Need to Know
- For repair offers: what damage was assessed, what works are included in the scope, and whether everything affected has been captured
- For cash settlement offers: how the figure was calculated, what it covers, and whether it reflects genuine current repair costs in your area
- Whether a qualified local builder or tradesperson could realistically complete the work for the amount being offered
What to Do
Before accepting anything, ask:
“Can you provide me with the full scope of works and any reports or assessments you used to prepare this offer?”
Then get those documents in front of one or two local builders or trades for an independent assessment. If their quotes significantly exceed the offer, you have strong grounds to challenge it.
Don’t feel rushed. An insurer cannot pressure you into accepting an offer on the spot. Take the time you need.
Stage 4: Your Claim Has Been Declined or Underpaid
What this looks like: Your insurer has declined your claim outright, or the settlement offered doesn’t come close to covering your actual loss. You don’t know if you can challenge it or where to start.
Why This Is Not the End of the Road
Most policyholders accept a declined claim or low settlement without realising they have real options. Insurers make mistakes. Assessors miss damage. Policy exclusions are sometimes applied incorrectly or overly broadly. A decision in the insurer’s favour is not always fair — and it is not always final.
What You Need to Know
- The specific reason the insurer declined your claim or limited the settlement amount
- The exact evidence — reports, assessments, photos — the insurer relied on to reach their decision
- Whether there is additional evidence, an independent report, or a policy argument that could change the outcome
What to Do
Step 1 — Get the reasoning in writing. Ask the insurer to explain their decision in writing and provide copies of all reports and assessments they relied on. This is your right under the General Insurance Code of Practice.
Step 2 — Review the decision carefully. Does the exclusion they’re relying on actually apply to your circumstances? Is the scope of damage accurate? Was the assessment done by a qualified person using current information?
Step 3 — Build your counter-evidence. Independent builder reports, specialist assessments, photographs, and expert opinions can all support a challenge to the insurer’s position.
Step 4 — Lodge a formal complaint. Begin with the insurer’s internal dispute resolution (IDR) process. If they don’t resolve it to your satisfaction within 30 calendar days, escalate to the Australian Financial Complaints Authority (AFCA) — free of charge for consumers. AFCA has the power to overturn insurer decisions and award compensation.
Step 5 — Get expert support. If you’re facing a complex dispute or don’t know where to start, a claim advocate like Claimboost can review your claim, prepare the evidence and arguments needed, and manage the dispute on your behalf — with no fee unless we achieve a better outcome for you.
What Can You Do If Your Insurance Claim Is Disputed in Australia?
If you believe your insurer has treated you unfairly, you have several formal options:
- Internal Dispute Resolution (IDR): Every Australian insurer is required to have a free internal complaints process. Lodge a complaint in writing and request a formal review of the decision.
- Australian Financial Complaints Authority (AFCA): If IDR does not resolve your complaint within 30 days, or the outcome is unsatisfactory, you can escalate to AFCA at no cost. AFCA is an independent body that can award binding decisions against insurers.
- Claim advocates: Independent advocates like Claimboost specialise in preparing the evidence, strategies, and arguments needed to dispute insurer decisions and work on a no-win, no-fee basis.
Frequently Asked Questions
How long can an insurer take to process a claim in Australia?
Insurers are generally expected to make a decision within 10 business days of receiving all the information they need, and within four months of lodgement in most cases. If your insurer has exceeded these timeframes without a clear explanation, you may have grounds to escalate.
Can I dispute an insurance claim decision in Australia?
Yes. You can lodge a formal complaint through the insurer’s internal dispute resolution process, and if that doesn’t resolve the issue, escalate to AFCA. You can also engage an independent claim advocate to help prepare your case.
What is AFCA and can they help with insurance claims?
The Australian Financial Complaints Authority (AFCA) is a free, independent dispute resolution service. They can review insurer decisions and make binding awards requiring the insurer to pay claims, change outcomes, or compensate you for losses caused by poor claims handling.
What does a claim advocate do?
A claim advocate helps policyholders who have had claims denied, delayed, or underpaid. They review your policy, gather evidence, prepare arguments, and manage the dispute process on your behalf. Claimboost operates on a no-win, no-fee basis — meaning you only pay if we secure you a better outcome.
Can an insurer decline a claim without a valid reason?
Insurers must provide a clear, written explanation for any claim decision, including declines. If you believe the reason given doesn’t hold up against the terms of your policy or the evidence available, this can be challenged through IDR or AFCA.
Conclusion: Clarity Creates Momentum
Not knowing what happens next usually means one of two things: your insurer hasn’t clearly told you what stage your claim is in, or you haven’t been given enough information to understand what they’re waiting on.
At every stage, the most powerful thing you can do is ask clear, specific questions, and know what you’re entitled to. If you need support, Claimboost is here to help you understand your rights, build your case, and pursue the outcome you deserve.
Claimboost helps everyday Australians, families and small businesses stand up for their rights when insurance claims are denied, delayed or underpaid. You only pay us when we get you a better outcome.