Was your car insurance claim refused? How we challenged the insurer’s decision

A case involving forensic evidence, an AFCA complaint and third-party court proceedings.

Having a car insurance claim refused after an accident can be stressful, particularly when an insurer questions the honesty of the claim.

In this matter, our client said she lost consciousness after experiencing fatigue and collided with parked vehicles. The insurer disputed her account and refused cover.

The dispute required more than an internal review. It involved competing expert reports, a complaint to the Australian Financial Complaints Authority (AFCA) and third-party court proceedings.

Why was the car insurance claim refused?

The insurer’s decision relied heavily on forensic accident reconstruction evidence and interview material. It alleged that the accident had not occurred as described and that the claim involved dishonest, incorrect or incomplete information. Its concerns extended to suggestions that the collision had been staged or involved collusion with third parties.

Our client disputed those allegations. The case we advanced was that the crash data and physical evidence remained capable of supporting an accidental collision consistent with fatigue or loss of consciousness. We argued that the insurer’s more serious allegations went beyond what the evidence could establish.

The challenges: Expert evidence and parallel proceedings

The insurer’s allegations of dishonesty made the assumptions underlying its expert report particularly important.

The competing expert evidence raised questions about the interpretation of vehicle inputs, the impact and damage analysis, and whether the physical scene supported the insurer’s theory. A central issue was whether a driver’s intention could reliably be inferred from vehicle data alone.

The AFCA complaint required us to address both the refusal of cover and the evidentiary basis for the allegations.

The matter became more complex when third parties commenced court proceedings while the complaint was still underway. Those proceedings concerned liability to third parties, while the AFCA complaint concerned insurance cover. Both processes had to be coordinated to protect our client’s position.

Our strategy: Test the evidence and coordinate the response

We began with a detailed comparison of the expert reports. We distinguished what the crash data actually demonstrated from conclusions that depended on assumptions or inference.

The client’s expert case challenged the insurer’s reading of the vehicle data, disputed aspects of the impact and damage analysis, and rejected the suggestion that the scene established a staged collision. This allowed us to present a coherent explanation consistent with our client’s account.

We then prepared and pursued an AFCA complaint supported by the expert material, targeted research into AFCA’s framework and relevant published determinations. Our submissions focused on three issues:

• whether the loss was covered by the policy;

• whether the insurer’s forensic conclusions were justified; and

• whether the evidence supported allegations of staging, collusion and dishonesty.

We argued that those serious allegations required persuasive supporting evidence and had not been established by the contested material.

Alongside the complaint, we managed the third-party court proceedings. Coordinating both processes helped protect the client’s position in the litigation while the dispute over cover remained unresolved.

The outcome: The insurer took over the third-party proceedings

The matter resolved on confidential terms. The insurer agreed to treat the claim as a normal claim and took over the handling of the third-party court proceedings.

Our client therefore no longer had to manage the defence of those proceedings personally. The resolution addressed the refusal of cover and secured the insurer’s involvement in the related litigation.

This case shows the value of testing the assumptions behind expert evidence and coordinating an insurance dispute with any related court proceedings.

If your car insurance claim has been refused, Trio Partners Pty Ltd assists with disputed insurance claims, AFCA complaints and related litigation. Early advice can help you understand the refusal, assess the evidence and plan your response.