How to make a home insurance claim, and what not to say to the assessor

Overview

This page focuses on how to make a claim within home insurance. Claims rarely turn on one sentence. They usually turn on the sequence of events, the available evidence, the wording, the insurer's expert reports and whether the policyholder can clearly link the loss to an insured event. The goal here is to make that process easier to understand and to show the points where claims often become delayed, reduced or disputed.

What matters most in Home Insurance

The first thing to understand in home insurance is what problem the policy is supposed to solve. For owner occupiers and people protecting the building itself, the common pressure points are sum insured accuracy, storm, flood and fire differences, temporary accommodation benefits, underinsurance and repair scope disputes. Those issues affect pricing, the level of evidence the insurer will ask for and whether a dispute later becomes an argument about causation, value, disclosure or the wording itself. A good decision usually starts with identifying the event you most need protection for, then checking the limit, excess, waiting period if relevant, optional benefits and the exclusions that are most likely to apply in your real world circumstances.

Typical cover and common limits

Policyholders often assume cover is broader than it is. In practice, home insurance commonly addresses insured damage to the home building, storm, fire, escape of liquid and other insured events and temporary accommodation and debris removal on some policies. That does not mean every policy covers every version of those events. The schedule, PDS and endorsements still control the outcome. Sub limits, excess, waiting periods, depreciation, item category limits, professional service definitions, policy periods and notification conditions can all change the end result. The safest approach is to read the core grant of cover and then actively read the exclusions, conditions and claims section, rather than relying on marketing summaries alone.

Documents and evidence that usually decide outcomes

When a claim or complaint becomes difficult, the quality of the evidence usually matters more than the volume of material. For home insurance, the documents that most often matter are address and policy details, photos and emergency mitigation records, repair quotes, inventory of damage and emergency service or builder reports if available. If the issue is a purchase or renewal rather than a claim, the critical evidence may instead be proposal answers, declarations, prior insurer history, valuations, invoices, reports, occupational or business information and correspondence confirming what was disclosed or requested. Keeping those records in one place makes it far easier to respond quickly and accurately when the insurer asks questions.

What not to say to the home insurance assessor

On most storm, water and fire claims the insurer sends an assessor before it decides anything. The assessor works for the insurer, or is a loss adjuster appointed by the insurer. They are not there to advocate for you. Their job is to confirm two things: what caused the damage and how far it extends. The report they write usually decides whether the claim is accepted, what repairs are in scope and what is paid. That is why what you say during the visit matters, and why a casual remark can end up as the reason a claim is declined or cut down.

Things that hurt a claim when said casually

• Guessing at the cause. "The roof has probably leaked for years", "the gutters were likely blocked", "that tree was already half dead". A guess gets written down as your account of events and can turn a storm claim into a maintenance claim.
• Volunteering that maintenance had been put off. You must answer honestly if asked, but you do not need to offer a list of jobs you never got to.
• Agreeing with a cause you are not sure about. If the assessor suggests wear and tear, rising water or a long term leak, it is fine to say you do not know and that you would like to see the report before commenting.
• Saying you would be fine with a cash settlement. Once you have said it, the conversation shifts from repairing your home to a figure, and that figure is usually based on the insurer's rates, not a builder's quote.
• Signing anything on the day. A scope of works, a release or a settlement acceptance can wait until you have read it and compared it with your own evidence.
• Playing it down. "It is not too bad" or "we can live with that" gets recorded as the extent of the damage.

What to do instead

• Describe what you saw and when. Facts, dates and times, not theories about why it happened.
• Walk the assessor to every bit of damage, including what is not obvious: the ceiling cavity, under carpet and floating floors, behind cabinets and skirting, fences, sheds, retaining walls, outdoor items and damaged contents.
• Have your own photos and a dated list of damage ready and hand over a copy, so there is a record that does not depend on what the assessor chose to photograph.
• Ask for a copy of the assessor's report and any scope of works. If the insurer relies on a report to decline or reduce the claim, you are entitled to ask for it.
• Take your own notes of who attended, what they looked at and what they said, and confirm anything important by email afterwards.

Why home claims get knocked back after the visit

Two reasons account for most declines after an assessor's report. The first is the maintenance, wear and tear exclusion. Home policies cover sudden damage from an insured event, not gradual deterioration. If the report says rusted roof sheeting, perished sealant or a long term leak let the water in, the insurer may decline the lot or pay only for the "resultant" damage and not the roof itself. The second is storm versus flood. Storm damage from wind, hail and rain, including stormwater runoff, is covered on standard policies. Flood, meaning water escaping from a river, creek, lake, dam or similar, is often an optional extra or excluded. Insurers use hydrology reports to decide which one it was, and that report can be challenged if the facts on the ground say otherwise. See storm claims and flood claims for the detail.

Your own builder's quote, and when a loss assessor for you is worth it

Get your own licensed builder to quote the repairs, especially if the insurer's scope looks thin or you are being pushed towards cash. If the insurer is refusing to repair and offering a cash settlement instead, you do not have to accept it on the spot. Ask in writing how the figure was calculated and whether it includes GST, builder's margin, make safe work, removal of debris and any temporary accommodation you are entitled to, then compare it line by line with your builder's quote. On a large or complex claim, such as a fire, major water damage or a possible total loss, an independent loss assessor who works for you rather than the insurer can prepare the scope, handle the back and forth and negotiate the settlement. They charge a fee, often a percentage of the settlement, so weigh that against the size of the gap between what the insurer is offering and what the repairs actually cost.

What happens after the visit

The insurer should tell you its decision in writing, and the General Insurance Code of Practice sets timeframes for that, including a general expectation that a claim is decided within four months of lodgement unless it is unusually complex or part of a declared catastrophe. If the decision, scope or payout comes back short, ask for the written reasons, the assessor's report and the policy wording relied on, then put your builder's quote and photos against it. If that does not resolve it, use the insurer's internal dispute resolution process and then AFCA. Our pages on denied home claims, home claim underpayment and claim timeframes cover each path. If an assessor is booked or the report has already gone against you, use the form on this page and we will match you with a claims adviser or independent assessor who deals with home claims.

Claims, complaints and dispute handling

A strong insurance file is chronological, specific and evidence backed. That means recording the date of the event, the date you notified the insurer, every request for information, every document provided and every reason the insurer gave for its position. In Australia, insurance complaints generally start with the insurer's internal dispute resolution process. If the matter is not resolved, AFCA may be available for eligible complaints. If the insurer has rejected all or part of a home insurance claim, For denied home insurance claims, Moneysmart says the insurer must explain in writing what part of the claim was not accepted, why, your right to ask for copies of reports relied on, and how to complain. If you ask for those reports, the insurer must send them within 10 business days. Even outside home insurance, asking for the reasoning, the relied on policy wording and any expert reports often clarifies whether the issue is genuinely about cover, evidence, valuation or process.

Price, excess and value for money

Premium is important, but premium on its own is a weak comparison tool. Moneysmart notes that a higher excess can reduce premium, but it also means a larger out of pocket amount if you claim. A low premium can also reflect tighter exclusions, lower limits, stricter optional benefit settings or a narrower claim pathway. The better way to compare value is to line up the event you most care about, the excess you could actually fund tomorrow, the payout basis and the key exclusions most likely to arise in your situation.

How to use this page effectively

Use this page to narrow the issue before you act. Identify whether your problem is selection, renewal, claim lodgement, claim delay, denial, underpayment, complaint handling or comparison. Once you know that, gather the relevant policy wording and supporting documents, keep your timeline straight and move to the more specific sub pages linked below. That usually produces a faster and cleaner result than trying to solve every insurance question at once.