Disputing a business insurance claim: from complaint to AFCA

Most business insurance claims are paid without a fight. But after a disaster, when assessors are stretched and policies are being read closely, disputes are more common: a claim denied under an exclusion, an offer that won’t cover the repair, or a decision that never seems to come.

You have rights, and a free, independent path to use them. This page lays out the steps.

What timeframes should your insurer be meeting?

Most general insurers subscribe to the General Insurance Code of Practice (current version updated in October 2023; a redraft has been consulted on in 2026). Its claims-handling commitments include:

Stage	Commitment
After you lodge	Tell you what information they need within 10 business days
During the claim	Update you at least every 20 business days
Once they have everything	Decide within 10 business days
Overall	Generally decide within four months

Check whether your policy is covered — some business policies fall partly outside the Code. Our page on delayed claims covers what to do if these timeframes slip.

How do you make a complaint to your insurer?

1. Ask for reasons in writing. If a claim is denied or reduced, ask for the specific policy clauses and evidence relied on.
2. Lodge a formal complaint. Use the insurer’s complaints or internal dispute resolution process — the details are usually in the product disclosure statement or on its website. Say clearly that it is a complaint.
3. State what you want. Payment of the claim, a reassessment, a second assessor, a decision by a date.
4. Attach your evidence. Photos, reports, quotes, your claim diary.
5. Keep a copy of everything and note every call.

When should you go to AFCA?

If the insurer’s response doesn’t resolve the problem, or it doesn’t respond within its required timeframe, you can take the complaint to the Australian Financial Complaints Authority. AFCA provides consumers and small businesses with fair, free and independent dispute resolution for financial complaints.

• Phone: 1800 931 678
• Online: afca.org.au

business.gov.au’s disaster guidance also points businesses to AFCA for insurance complaints after an emergency.

What makes a strong complaint?

Include	Why
A one-page timeline	Shows the history at a glance
The policy schedule and wording	The exact clauses in dispute
Photos and video from before the clean-up	Evidence of damage and cause
Independent reports or quotes	Counter an assessor’s view with facts
Your claim diary	Proves delays and promises made
The outcome you’re seeking	Makes it easier to resolve

Our guide to documenting damage for an insurance claim covers what to capture in the first days — the best time to build your evidence.

How do you keep the business going during a dispute?

Disputes take time, and your costs don’t pause for them. Practical steps:

• ask whether the insurer will pay the undisputed part of the claim now
• talk to your landlord, bank and suppliers about temporary relief
• call the ATO before any due date you’ll miss
• get free financial counselling from the Small Business Debt Helpline (1800 413 828)
• consider funding that doesn’t depend on the dispute’s outcome

If you need a bridge, a short enquiry gets a real person looking at it — with no credit check at enquiry stage.

What funding works while a claim is disputed?

Lenders will want repayment that stands on its own, rather than relying on winning the dispute:

• Property-secured loan — first or second mortgage or caveat loan over residential or commercial property, from $20,000 to $5,000,000. See property-secured emergency funding.
• Unsecured cash-flow funding — typically $5,000 to $500,000 if you’re still trading and bank statements support it.
• Covering a shortfall permanently — see the underinsurance gap.

If the dispute later succeeds, the recovered amount can reduce or clear the loan.

Illustrative example only: a small manufacturer’s claim for storm damage to machinery is reduced because the assessor says the damage was wear and tear. The owner gets an independent engineer’s report, complains to the insurer, then to AFCA. While the dispute runs, a second mortgage funds the repairs so contracts are kept; the later settlement pays most of it back.

What happens once AFCA has your complaint?

AFCA is designed to be used without a lawyer. Broadly, once you lodge a complaint:

1. AFCA checks it’s within its rules, and refers it back to the insurer if the insurer hasn’t yet had the chance to resolve it through its internal process.
2. If it’s still unresolved, AFCA works with both sides to try to reach agreement.
3. If agreement isn’t possible, AFCA can assess the complaint and make a decision.

Throughout, keep your evidence organised and respond to requests promptly. Keep your claim diary going — it often becomes the backbone of your case. Ask AFCA on 1800 931 678 about the steps and timeframes that apply to your complaint.

Need funding that doesn’t hinge on the dispute?

Standing up for your claim matters, and so does staying open while you do it. Funding that doesn’t hinge on the dispute can help.

Expect a call from a real person who’ll ask about insurance, grants and timing as well as money. We leave your credit file alone while we talk it over; nothing is checked until you decide to proceed. In a crisis you need fewer calls, not more, so your enquiry stays with one team.

Give us straight numbers — how much, what it’s for, which state, and whether property is involved — and the first call can go straight to real options. Begin the 60-second form.