Three key takeaways
- Identify the exact reason and policy clause behind the rejection.
- Clarify genuine factual issues with documented evidence.
- Keep track of appeal and dispute deadlines; outcomes are not guaranteed.
Get the insurer’s written reasons, identify the policy clause and evidence behind the decision, and check whether there is a factual issue to clarify. An appeal should address the reasons for rejection; approval cannot be promised.
Explore the review framework
A practical starting point
Get the insurer’s written reasons, identify the policy clause and evidence behind the decision, and check whether there is a factual issue to clarify. An appeal should address the reasons for rejection; approval cannot be promised.
- Understand
Get the written decision and supporting reasons.
- Clarify
Organise the timeline and any factual corrections.
- Review
Submit a focused appeal and check dispute options.
Choose the next step that fits your own circumstances.
General education. Your circumstances, documents and applicable terms determine what applies.
Understand the decision before disputing it
Request the written decision and relevant policy wording. Ask whether the issue involves an exclusion, disclosure, benefit definition, timing, missing information or the treatment claimed. Separate a document request from a final rejection.
Build a clear record
Keep the schedule, application answers, bills, claim forms and correspondence together. Write a dated timeline of symptoms, consultations, investigations, diagnosis and treatment where relevant. Mark what is documented and what needs clarification.
Ask for factual clarification where needed
A medical note may use a description that needs context. If dates or wording appear inaccurate or ambiguous, ask the treating clinician to clarify the facts supported by their records. Do not ask anyone to change an accurate record merely to support a claim.
For example, the onset of a symptom and the date of a diagnosis may be different. Whether that distinction affects the claim depends on the questions asked, policy terms and evidence. Clarification is not a guarantee of a different decision.
Send a focused appeal
State the decision you are questioning, the specific factual or contractual point, the supporting documents and the review you are requesting. Ask for acknowledgement and the expected response process. Keep a copy and record deadlines. Your adviser may help organise the documents; the insurer assesses the claim.
If the issue remains unresolved
Use the insurer’s complaints process and request its final written reply. FIDReC provides a dispute-resolution route for eligible complaints. Its guidance says to approach it within six months of receiving the financial institution’s final reply; check the current eligibility and time-limit rules directly.
This guide does not assess the merits of an individual claim or promise an appeal outcome. For a dispute requiring legal advice, consult a qualified lawyer.
What to prepare for a review
- Written rejection and relevant policy wording
- Claim forms, bills and correspondence
- A dated factual timeline
- Supporting records provided through a secure channel
Keep sensitive documents secure. Use the contact form to share your priorities, then agree how to provide any records needed for the review.
Sources & further reading
- MOH — Integrated Shield Plan claims and disputes
- FIDReC — Consumer’s Guide to Life Insurance Disputes
- MoneySense — Resolving a dispute
These sources provide general background. The review questions and checklists are educational commentary. Check the current official guidance and your own documents before acting. This guide is not a personal financial or legal recommendation.
Have a question about your own plans?
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