You bought the policy, you took the trip, something went wrong, you came home and lodged the claim. Six weeks of “we’re still assessing” later, you get a denial. The reasons are vague: “pre-existing condition”, “not covered under section X”, “you didn’t follow the claims process correctly”. You’re out anywhere from a few hundred to tens of thousands of dollars.
The legal framework
Travel insurance is governed by the Insurance Contracts Act 1984 (Cth) and the General Insurance Code of Practice. The ASIC Regulatory Guide 271 (internal dispute resolution) requires insurers to handle complaints within 30 days. The Design and Distribution Obligations (Treasury Laws Amendment 2019) mean insurers can’t sell you a product that doesn’t match your circumstances and then deny on those circumstances.
Common denial reasons and how they fail
- “Pre-existing medical condition.” Section 47 of the ICA limits how insurers can apply medical exclusions — they often overreach. If you weren’t asked, or if the condition wasn’t symptomatic in the look-back period, the denial may be invalid.
- “You didn’t get medical certification within X hours.” Section 54 of the ICA limits these procedural defences unless the insurer was actually prejudiced.
- “Cancellation reason isn’t a covered event.” PDS wording is often broader than the assessor admits. Quote it back.
- “Lost item wasn’t in your control.” Most policies cover items in the care of an airline or hotel — not just on your person.
- “You didn’t lodge a police report within 24 hours.” Procedural; section 54 again.
Ready to put it in writing?
Answer 3 quick questions to check you have the details your document needs, and see your next step.
1. Who is this about?
2. How much is at stake?
3. Do you have it in writing?
Your result is ready. Where should we send it?
What the document does
A Letter of Demand quotes the policy, the precise denial reason, the legal or contractual reason it’s wrong, the dollar amount, and the deadline. A formal demand citing the ICA and AFCA jurisdiction routes your file to the disputes team, where the decision often changes.
What Claim Done delivers
Wizard takes about ten minutes. Flat $97 fee. Our Programmatic Algorithms draft the letter citing the Insurance Contracts Act, the Code of Practice, and the AFCA jurisdiction. Draft in your dashboard in about five minutes, for you to read and approve.
What to expect after sending
Most travel insurers respond within 21–30 days. Common outcomes: full reversal, partial settlement, or a request for additional medical evidence. If denied again, lodge with AFCA — completely free for you, binding on the insurer up to $1,263,000 (AFCA’s limit since 1 January 2024) per claim,
What happens when you put it in writing — properly
Same problem. What a prepared case looks like.