You can choose to pay Decline to provide you with detailed advice on your claim's strengths and weaknesses. This service is on an hourly rate basis. We can also give you an honest assessment of why we think there is a good chance the insurer won't accept your claim. If you can take steps to pursue your claim further, we'll provide you with information about this. Go here for details about the hourly fee option.
If we have accepted your declined claim we will work to set service standards. If we have requested information from you or some other organisation we will provide 3-daily follow-ups until the information is supplied.
Detailed claim submissions can take up to 10 days to formulate.
The clock starts three days before the date we formally advise you that your application for our assistance has been accepted. You will then need to sign our Contract for Services. These extra three days allow for the time we have spent collecting and thoroughly investigating relevant information. Remember - you still only pay if we are successful. We won't be able to start the next steps until the Contract for Services has been signed.
Here's a draft copy of our Contract for Services.
Yes. Send us the details of an older claim, and we'll see if we can help.
Very old claims can be a challenge as some participants may not remember the details, and records could have been destroyed. However, most claims have already been declined for 1 - 3 years before we get involved.
We can't do the impossible, but there are many areas of the life/trauma/disability sales process where insurers, advisers and applicants can make mistakes. Often, these mistakes are completely innocent but have far-reaching consequences for the claimant. The error could have been while reviewing the insured person's medical records or in the wording of the insurer's questions. The mistake could have been made following the complex compliance requirements demanded of insurers and advisers. There are many and varied areas where things can fall down, leaving the claimant disadvantaged.
A lawyer can usually offer help from an insurance law perspective, but unless they fully understand every element of the process, they will usually stop after one or two lawyers' letters that don't move the needle on your claim.
Bryan Tucker from Declined has worked exclusively in the insurance industry for 37 years. There isn't much he doesn't know about the industry, so he has advantages that your lawyer doesn't. If he's invested weeks of his time into your case, he will only get paid if he is successful, so there is far more on the line than for your lawyer - who gets paid win or lose.
Not all advisers are experienced in claim advocacy. In a few cases, the adviser may be partially responsible for the difficulty you are having with the claim. They're unlikely to tell you this.
A senior technical adviser from a major insurance company told us that our last case would be a waste of our time. The lawyer had tried for two years, and the technical adviser was confident about the claim decision.
The insurer paid the claim within ten days of receiving one submission from Bryan Tucker.
Sometimes a policy was started and increased one or more times. Although the insurer might apply a blanket decline, the law applies very differently to older applications for cover. It could be that we can get your original application paid but not the increase that occurred more recently.
You have the final decision about whether you will accept the offer made by the insurer. However, we reserve the right to charge you a fee for our services if we feel you are declining an offer unreasonably. Any dispute about this will be resolved in the Small Claims Tribunal or some other court of competent jurisdiction.
Yes. In most cases, the insurer will be required to pay you interest for the delay in payment of the claim. Our fee is also a percentage of any interest payments we negotiate on your behalf.
There is no GST on the claim payment for life insurance claims, so we can charge you a fee without adding GST.
There is GST payable for any part of the claim that is Trauma or Disability cover. We will charge our fee plus GST on the Trauma or Disability part of your claim.
For very large or very small claims, Decline will negotiate the fee we will charge.
If a claim is substantial, we will be able to negotiate a reduced fee. A substantial claim would be over $800,000.
If the claim is tiny, a percentage fee may not be enough to cover the time and expertise invested. In this case, we may charge a higher percentage or elect to offer you the service at an hourly rate (payable whether we are successful or not). A small claim would be under $100,000.
The amount paid by the insurer determines the size of the claim for fee purposes. Not the amount of the original claim.
If Decline has decided not to accept your application, we have serious doubts that we could be successful. A larger percentage of nothing is still nothing.
If we decline your application, you may want to pay us to provide you with a report summarising the strengths and weaknesses of your case. We’ll tell you every conceivable avenue you could try.
When Decline agrees to take a case, our insurance advocate invests many hours into researching, assessing complex information and preparing detailed submissions. We also hire external expertise when and if we feel this is warranted. Our success fee may appear high as a dollar amount of the claim, but that fee also has to cover the costs we have incurred for any cases that weren't successful.
The clock starts three days before the date we formally advise you that your application has been accepted and you have signed our contract for services. These extra three days allow for the time we have spent collecting and thoroughly investigating relevant information. Remember - you still only pay if we are successful. We won't be able to start the next steps until the contract for services has been signed.
Decline needs you and every living person that is a party to the policy to be available to answer questions and provide extra documents as required. Sometimes you may be asked to attend meetings (in person or over Zoom) to discuss your claim.
By being prompt and helpful, you shorten the time it takes to get your claim resolved. A faster turnaround time means a lower fee.
Decline may withdraw its offer to help you if you or other policy owners or insured persons are not cooperating effectively. If you stop cooperating after Decline has invested time into your case, we reserve the right to charge you a fee for our work.
You and every other insured or policy owner need to sign:
- The contract for services
- A blanket authority to release information - including application forms and medical records for the insured
If the insured is deceased, a certified copy of the 'Letters of Administration' will need to be provided by the person or organisation looking after the estate.
Decline needs you to be completely honest about every matter about your insurance policy. We are not bound to pass any information on to your insurer, so you can tell us everything freely.
Knowing where the weaknesses are in your case is essential to getting a successful outcome. You might incorrectly assume that a mistake you made is partly responsible for the failure to get the claim paid. The best submissions deal with every element - the good, the bad and the ugly. Raising an issue with the insurer and then soundly dealing with it in a submission is far better than not raising it and being blindsided later.
Decline may withdraw its offer to help if you are not completely honest about every aspect of your claim.
The Ombudsman service is a valuable last resort, but the policy wording commonly drives its decisions. Funding for the Ombudsman comes from the insurance companies and participating insurance advisers. Those insurance companies and advisers choose which Ombudsman they will appoint for future dispute resolution. In Decline's opinion, this creates an awkward tension between the Ombudsman and insurers that is not in the best interests of policyholders. Suppose an Ombudsman is consistently finding against an insurer. In that case, the insurer can move to a different Ombudsman, removing a significant funding source for that Ombudsman.
Review some of the case studies on the Insurance & Financial Services website here. Scroll to the end of each case study and count how many complaints were upheld (found in favour of the client/complainant).
In some extreme circumstances, we may resort to a complaint to the Ombudsman. This is only when we feel the case is very strong and backed up by insurance law.
In most cases, Decline will find upheld decisions by an Ombudsman that have similarities to your situation and present these as part of a submission to the insurer. This is a very effective way of pressuring the insurer. Few Ombudsman decisions go against the insurers, so they may not want to risk the brand damage that comes with an adverse decision.
This can make our work harder as it will tend to embolden the insurer to hold their position. Once the Ombudsman has made a final decision, it's difficult or almost impossible to appeal this decision. This may leave the courts as the only remaining avenue if a submission to the insurer doesn't work.
Having said that, no one will investigate your case as Decline will, and there is always the possibility that new information will come to light. It won't cost you anything to send the information to Decline to get an opinion.