Denied / Declined claims Life Insurance
If your claim is denied, the insurer must give you access to an internal and an external dispute resolution process. The insurer's complaint and response letter can be used to find out the reasons why your claim has been refused. You need to address these reasons if you want to take your complaint to AFCA.

We see claims for TPD and IP denied by insurers and super funds because they believe:

• You still have a work capacity
• You need further treatment
• You have not reached ‘maximum medical improvement’
• You can do ‘light duties’
• You can work in other jobs

If your claim has been declined, contact AMS Consulting Australia – Insurance Advocate and speak to Andrea Lewis who will advise you if the claim should be contested.
AMS Consulting Australia – Insurance Advocate has seen many cases where the insurer tries to:

Cancel a policy:
1. on the basis of a very minor previous illness or injury
2. where an insurance agent was told about an illness or injury, but chose not to put it on the application form
3. where an insurance agent did not explain the application form
4. where the person did not understand the application form
5. on the basis of a medical condition the person did not even know about
If an insurer tries to cancel your policy, you should get an expert opinion immediately.

Pre – existing condition
Some policies say that you cannot claim for a pre-existing condition. The rules about pre-existing conditions can be complex, and often a pre-existing condition is not a reason for a claim to be rejected. You should get expert advice on whether a pre-existing condition is a problem for your claim.

How can AMS Consulting Australia – Insurance Advocate help you.
Once a claim is declined we can:
• advise you on whether you have a good case
• lodge a dispute with the insurer against your policy being cancelled, or against your claim being rejected
• lodge a complaint with external parties.