How the insurance claims process works

It’s easy to assume all types of insurance fundamentally do the same thing: provide a financial safety net that can help to step in if something goes wrong. But not all types of cover work the same way.

Insurance can sometimes feel like one of those things you set and forget — you pay your premiums, hope you’ll never need to make a claim, and then one day something unexpected happens and suddenly you’re wondering: how do I make a claim on my insurance policy?

In this guide, we’ll walk you through the insurance claims process, explain what happens behind the scenes, and flag the common reasons claims may get declined (to help you avoid them).

Whether it’s for life insurance, home & contents insurance, health insurance, or any other type of insurance policy — think of this as your friendly guide to the insurance claims process.

What is an insurance claim?

First things first, what is an insurance claim?

In a nutshell, an insurance claim is when you ask your insurer to step in and cover something your policy includes. Maybe your car’s been dinged, your roof’s sprung a leak, or you’ve had an unexpected health cost — this is where an insurance claim comes in.

There are also a few key players in the process to get across now:

• You (the policyowner): Typically, the one making the claim. You’ll provide details, documents, and follow the procedure for the insurance claim.
• The insurer (your insurance provider): They’ll check if your policy covers the event, assess your claim, and decide on a benefit payout.
• Other parties: This can include repairers, doctors, assessors, or even other drivers (in car accidents, for example).

And it’s not just about your insurer’s rules. There are broader frameworks designed to protect you. In Australia, insurance claims are regulated under the Insurance Contracts Act 1984 and overseen by ASIC (the Australian Securities and Investments Commission) and APRA (Australian Prudential Regulation Authority). These regulators make sure insurers treat customers fairly, provide clear processes, and handle insurance claims in line with the law.

Understanding the insurance claims process

The insurance claims process will vary, depending on your type of insurance cover (car, home, pet, life), but the general steps are pretty similar. Let’s take a look at the typical journey step-by-step.

What to do immediately after an incident

So, something has happened. What’s the first move?

• Stay safe first: Whether it’s an accident, storm damage, or illness, prioritise your own well-being and that of others before worrying about paperwork.
• Jot down details: Dates, times, witnesses. The fresher the memory, the better — so once you’ve ensured everyone is safe, do this as soon as manageable.
• Gather evidence: Photos, receipts, medical reports, death certificates, police reports, footage from a nearby camera — anything that proves what happened.

Think of yourself as a detective gathering clues. The more information you’ve got, the smoother your insurance claim is likely to go.

Contacting your insurance provider

It’s important to let your insurer know what’s happened as early as you can. You can usually do this online, over the phone, or via an app, depending on your insurance provider and/or type of cover.

Thankfully, you don’t need to know every detail right away. Flagging the incident early means your insurer can open a file, explain the next steps, and tell you exactly what documents they’ll need.

Lodging a formal claim

Once you’ve spoken with your insurance provider and gathered all the relevant info, it’s time to make a formal claim.

This is the “official paperwork” part — although these days, most claims are made digitally. For this part, you’ll fill in a claim form and submit all your supporting documents.

Rest assured, there’s no need for fancy words or copywriting skills. When filling out a formal claim, focus on being clear, accurate, and thorough.

Be sure to double-check that:

• Names, dates, and policy numbers are correct
• Attachments (photos, reports, receipts) are included
• You’ve answered all the required questions
• You’ve provided all the required information and documents
• Your claim contains as much relevant detail as possible

For more tips on life insurance claims, specifically, check out this article.

Initial claims assessment and investigations

Once you’ve submitted (aka “lodged”) your claim form, your insurer will receive and review your information. Heads up, they may:

• Ask for additional documents
• Send out an assessor (e.g., to inspect property damage)
• Contact third parties (e.g., doctors, witnesses)

There’s no need to worry if they ask more questions; it’s all part of the procedure for insurance claims. The goal on their end is to confirm the claim is valid and covered under your policy.

For tips on making a car insurance claim after an accident, take a read here.

Settlement and benefit payments

If everything checks out, your insurer will approve your claim. Depending on the policy, this could mean:

• Paying you directly
• Covering repair costs
• Paying service providers (like hospitals or tradies) on your behalf

This is the part everyone looks forward to — when the safety net you’ve been paying for actually catches you in your time of need.

Common reasons for claims being rejected

No one wants to hear that their claim has been denied, but it happens. To help you avoid disappointment, let’s take a look at some of the common reasons:

• Cover exclusions: If your policy doesn’t cover the event (say, flood damage under some home insurance policies), your claim won’t be approved. Be sure to read the relevant product documents for all exclusions on your policy.
• Insufficient documentation: Missing receipts, vague descriptions, or no proof of ownership can sink a claim. Be sure to gather as much proof as possible.
• Non-disclosure: If you didn’t disclose something important when taking out the policy (like a pre-existing medical condition), it could affect your claim later
• Fraudulent red flags: Inflated repair costs, dodgy receipts, or inconsistencies can trigger deeper investigations. Make sure you’re being honest and transparent.

It’s a good idea to read your policy’s Product Disclosure Statement (PDS) or Policy Booklet. It’s not the most exciting or light read, but knowing what’s included (and excluded) can save you nasty surprises.

How long does an insurance claim take?

So, how long can insurance claims take? The short answer: it depends.

Some straightforward claims can be settled in a matter of days. Others (like complex health or life insurance claims) might stretch out over months.

Factors that affect timing include:

• Having all the right documents upfront
• Whether extra medical reports or assessments are needed
• If your bank details or listed beneficiaries are incomplete
• Disputes or the need for specialist investigations

The best way to speed things up is to be organised, accurate, and responsive to your insurer's requests.

Compare your insurance options with Choosi

Making an insurance claim might sound intimidating, but once you know the steps, it’s much more straightforward.

By understanding the insurance claims process, being proactive with your paperwork, and knowing the common pitfalls, you’ll be better prepared if and when you need to claim. Compare insurance products from our Approved Product List today and choose cover that’s clear, reliable, and ready to step in when life happens. Having the right insurance isn’t just about peace of mind — it’s about knowing you can claim with confidence.