What Evidence Do You Need to Dispute a Denied Insurance Claim?

To dispute a denied insurance claim in Australia, you need your denial letter, your Product Disclosure Statement (PDS), the assessor's report (request it under the Code of Practice), any photos, videos, or receipts documenting the damage, independent expert reports or quotes, and a written timeline of events. The stronger your evidence package, the more likely your insurer or AFCA will reverse the denial.

Key takeaways

• Essential documents: your denial letter, PDS, assessor's report, photos/videos, independent expert reports, and a written timeline.
• You are entitled to the assessor's report under the Code of Practice. Request it in writing.
• Independent quotes and expert opinions carry significant weight, especially when they contradict the insurer's assessment.
• The stronger and more organised your evidence package, the more likely IDR or AFCA will overturn the denial.

When an insurer denies your claim, the decision can feel final. But it rarely is. A well-evidenced dispute can overturn a denial, whether through the insurer's internal review process or through the Australian Financial Complaints Authority (AFCA). The key is knowing what evidence to collect and how to present it effectively.

Understanding the standard of proof

Insurance disputes are decided on the balance of probabilities. This means you need to show that your version of events is more likely than not. You do not need to prove your case beyond reasonable doubt, as you would in a criminal matter.

Importantly, when an insurer relies on a policy exclusion to deny your claim, the onus falls on the insurer to prove that exclusion applies. This principle is well established in Australian insurance law and is recognised by AFCA in its decision-making. Section 54 of the Insurance Contracts Act 1984 also limits an insurer's ability to refuse a claim based on technical breaches that did not contribute to the loss.

In practical terms, your job is to present enough evidence to support your claim. The insurer must then prove any exclusion it relies on actually applies to your situation.

Photographs and video

Photographic evidence is one of the most powerful tools in a dispute. If you have photos or video of your property before the damage occurred, these are invaluable. They establish the pre-loss condition and make it much harder for an insurer to argue the damage was pre-existing.

After an incident, document everything thoroughly before any clean-up or temporary repairs. Take wide-angle shots to show the overall scene, then close-ups of specific damage. Use your phone's timestamp feature and, if possible, enable location tagging. Video walkthroughs can capture details that static photos miss, particularly for water damage or structural issues.

If you did not take photos before the loss, do not worry. Real estate listing photos, council inspection images, or even social media posts showing your property in good condition can serve the same purpose.

Independent expert reports

Your insurer will typically rely on reports from assessors they have appointed. These assessors work for the insurer, not for you. Obtaining your own independent expert report can provide a crucial counterpoint.

Depending on your claim, consider engaging a licensed building inspector, structural engineer, hydrologist for flood-related disputes, meteorologist, or arborist. An independent expert can challenge the insurer's findings on causation, scope of damage, or repair methodology.

Under the General Insurance Code of Practice, insurers must give you access to the reports they relied on when making their decision. Review these carefully. An independent expert can identify errors, unsupported assumptions, or conclusions that do not align with industry standards.

Tradesperson quotes and repair estimates

Obtain at least two or three quotes from licensed tradespeople for the repair work. Each quote should include a detailed scope of works, not just a lump sum figure. Detailed quotes help demonstrate the true cost of reinstatement and can counter lowball estimates from the insurer's preferred repairers.

Ask the tradespeople to note whether, in their professional opinion, the damage is consistent with the event you are claiming for. A roofer who confirms that tile damage is consistent with hail impact, for example, provides useful supporting evidence.

Bureau of Meteorology and weather data

For weather-related claims, Bureau of Meteorology (BOM) records are essential. BOM provides historical weather data including rainfall totals, wind speeds, hail reports, and storm tracking information for specific locations and dates.

This data is publicly available and carries significant weight with AFCA. If your insurer argues that a storm was not severe enough to cause the damage, BOM records can prove otherwise. You can also obtain SES call-out data and council emergency declarations to corroborate the severity of an event.

Council and government records

Local council records can support your dispute in several ways. Building approval records show that your property was constructed or renovated to code. Compliance certificates demonstrate that work met regulatory standards. Flood mapping and planning records can be relevant if your insurer disputes whether your property was affected by a defined flood event.

If your property was in a declared disaster zone, government disaster declarations and associated records provide strong supporting evidence.

Witness statements

Neighbours, family members, and tradespeople who are familiar with your property can provide witness statements. A neighbour who saw the storm damage occur, or a plumber who serviced your property regularly and can confirm it was well maintained, adds credibility to your claim.

Witness statements should be written, dated, and signed. They should include the witness's full name, address, and their relationship to you or your property. Focus on facts rather than opinions.

Maintenance receipts and inspection reports

One of the most common reasons insurers deny claims is the maintenance exclusion. Insurers may argue that damage resulted from gradual deterioration, wear and tear, or lack of maintenance rather than a sudden insured event.

To counter this, gather receipts for regular maintenance: gutter cleaning, roof inspections, plumbing services, pest treatments, and similar upkeep. Professional inspection reports, particularly pre-purchase building inspections or annual maintenance inspections, can demonstrate that your property was in sound condition before the event.

If your insurer argues that you failed to maintain your property, these records shift the balance of evidence back in your favour.

Policy renewal history

Your policy renewal history can be more useful than you might expect. It shows continuous coverage, which undermines any suggestion that you only insured the property when you anticipated a claim. It also records any changes to your sum insured, excess, or policy terms over time.

Review your renewal notices carefully. Under Section 37 of the Insurance Contracts Act, an insurer has a duty to clearly inform you of any changes to your policy terms at renewal. If the insurer changed an exclusion or condition without clearly notifying you, this may be grounds to argue the change should not apply to your claim.

What AFCA considers persuasive

AFCA weighs evidence based on its reliability and relevance. In general, AFCA gives more weight to the following types of evidence:

• Documentary evidence over verbal accounts
• Independent expert opinions over insurer-appointed assessor reports
• Contemporaneous records created at or near the time of the event, rather than accounts prepared later
• Official records such as BOM data, council records, and government declarations

AFCA also expects insurers to act consistently with the General Insurance Code of Practice and to handle claims in a fair, transparent, and timely manner. If your insurer failed to investigate your claim properly, did not provide reasons for the denial, or did not give you access to the reports it relied on, these procedural failures can strengthen your dispute.

How The Fair Claims Co can help

Gathering and organising evidence for an insurance dispute takes time, and knowing how to present it effectively takes experience. The Fair Claims Co prepares professional dispute documents and AFCA submissions for Australian consumers. We review your policy, assess the evidence, and build a clear, well-structured case on your behalf. If your claim has been denied and you believe the decision is wrong, get in touch to find out how we can help.