Accredited specialists representing individuals navigating complex insurance claims and disputes across Australia.
What we can help you with.
We act for people across the full range of insurance claims and disputes, including:
- Total and Permanent Disability (TPD) claims
- Superannuation claims
- Income protection claims
- Trauma and critical illness claims
- Life insurance claims
- Denied insurance claims
- Delayed or underpaid insurance claims
- Insurance disputes and appeals
Free initial consultation
You speak directly with an experienced insurance lawyer who reviews your policy and explains whether the insurer may have wrongly denied, delayed, or reduced your claim.
We lodge your claim
We assess the terms of your insurance policy, notify the insurer of your claim or dispute, and formally commence the process to protect your position from the outset.
Support throughout your claim
We manage medical and financial evidence, handle insurer communications, and progress the claim or dispute at every stage - while you focus on recovery.
Resolution and entitlement
When your claim is ready to resolve, we negotiate firmly to ensure the insurer meets its contractual obligations. If necessary, we commence proceedings to protect your entitlement.
With office locations in Brisbane, Logan, Ipswich, Gold Coast, Sunshine Coast and Toowoomba, you can easily meet with us in person. We also provide phone or online consultations, and can even come to you if needed.
Who can make an insurance claim?
- Policyholders
- Superannuation fund members with insurance held inside super
- Injured or ill claimants unable to work
- Beneficiaries of life insurance policies
- People whose insurance claim has been denied or reduced
- Executors or families of deceased policyholders
Eligibility depends on the specific circumstances. A short discussion with an insurance lawyer is usually enough to confirm where you stand.
Fewer than 5% of Queensland personal injury lawyers hold Queensland Law Society Accredited Specialist status, which recognises the highest level of industry expertise, experience, and ethical standards.
We don't add extra percentages or "success fees" to your settlement. No additional percentage comes out of your final compensation.
We cover all your evidence costs upfront, including medical reports, so you’re not out of pocket while your case is ongoing.
We actively guide you through each stage of the process, explain what to expect and when, and provide practical support through the personal and financial challenges that can follow injury or illness.
Beyond "No Win No Fee"
Most Queensland injury firms advertise "No Win No Fee". What matters is how that actually works in practice - and where the financial risk really sits during your claim.
At Gain Lawyers, we take No Win No Fee literally. You don't pay anything upfront and nothing while your claim is ongoing. We cover the cost of medical reports and other expert evidence as the case progresses, so you're not out of pocket while focusing on your recovery.
If your claim succeeds, you pay our professional fees from the settlement. We don't charge uplift or "success" fees - many firms add up to 25% on top of their costs, but we believe compensation for injury should go to you.
If your claim is unsuccessful, you don't pay our legal fees or the evidence costs we've incurred. We write those costs off entirely.
Jeremy Roche, Director At Gain
How insurance compensation claims work in Australia
Insurance claims arise where a person seeks payment under an insurance policy they hold, rather than through a statutory compensation scheme or negligence-based personal injury law. Insurance claims in Australia are contract claims, governed by the wording of the policy and the law of insurance contracts, and they involve fundamentally different questions from those that arise in motor vehicle, workers' compensation, or medical negligence matters.
The central question in any insurance claim is whether the claimant's circumstances meet the definitions, conditions, and exclusions set out in the policy, and whether the insurer (or where the policy is held inside superannuation, the trustee) has properly applied those terms to the available evidence.
The legal framework: contract law and the Insurance Contracts Act
Insurance claims are governed primarily by the Insurance Contracts Act 1984 (Cth), which sets out the rights and obligations of insurers and policyholders, alongside the general law of contract and the broader regulatory framework that applies to financial services providers under the Corporations Act 2001 (Cth). The Insurance Contracts Act imposes a duty of utmost good faith on both the insurer and the insured, and breaches of that duty by the insurer can support a claim for damages and adjustments to the way the policy is interpreted.
The Act also regulates several issues that commonly arise in disputed claims, including the duty of disclosure when the policy was taken out and the consequences of any non-disclosure or misrepresentation, the insurer's right to rely on policy exclusions, and the standards an insurer must meet when handling and assessing claims. Claim outcomes commonly turn on how these statutory duties intersect with the specific wording of the policy, and policy interpretation in Australia is increasingly informed by the principle that ambiguous policy terms should be construed in favour of the insured.
Insurance held inside superannuation
A significant proportion of life, TPD, and income protection insurance in Australia is held inside superannuation, with cover provided as a default benefit through the member's superannuation fund. Insurance held inside superannuation is subject to a different decision-making and review framework from insurance held directly with an insurer.
For an insurance claim made through a superannuation fund, the trustee of the fund is the formal decision-maker, even though the trustee usually relies on the insurer's recommendation. The trustee owes duties to the member under the Superannuation Industry (Supervision) Act 1993 (Cth), including the duty to act in the best interests of the beneficiary and the duty to consider each claim properly rather than merely accepting the insurer's view. Where a trustee accepts an insurer's denial without properly engaging with the merits of the claim, the trustee's decision can itself be challenged, separately from any challenge to the insurer's underlying recommendation.
A practical consequence is that disputes about insurance held inside superannuation often involve two layers of decision-making (the insurer's recommendation and the trustee's adoption of it), and the most effective challenge is usually directed at both rather than only one. The release of insurance benefits inside superannuation also interacts with the conditions of release under superannuation law, which can affect when and how the claimant can access the money once the claim is paid.
Common types of insurance claims and disputes
The insurance claims most often disputed in personal injury and incapacity contexts involve policies that pay benefits where illness, injury, or death prevents normal earning capacity. Total and permanent disability (TPD) policies pay a lump sum where the insured is permanently unable to work, with the precise definition varying significantly between policies. "Own occupation" definitions ask whether the claimant can return to their pre-disability occupation, while "any occupation" definitions ask whether the claimant could undertake any reasonably suitable occupation, and the difference materially affects who qualifies. Income protection policies pay ongoing benefits where the insured is unable to work due to illness or injury, typically with waiting periods, benefit periods, and partial disability provisions that need to be navigated carefully. Life insurance policies pay lump sums on the death of the insured, with disputes commonly arising around disclosure, suicide exclusions, and beneficiary disputes. Trauma or critical illness policies pay on diagnosis of a specified condition, with disputes commonly turning on whether the claimant's diagnosis meets the precise medical definition in the policy.
Across all these policy types, the most common ground for an insurer to deny a claim is that the claimant does not meet the policy definition of the insured event. Insurer interpretations frequently apply the policy more narrowly than the claimant expected, and disputes often turn on whether medical and functional evidence supports the definition properly construed. Other common grounds for denial include alleged non-disclosure when the policy was taken out, application of pre-existing condition exclusions, and disagreements about ongoing eligibility for income protection benefits as the medical position develops.
Reviews, AFCA, and time limits
Where an insurer or trustee denies, delays, or reduces a claim, several review and complaint pathways are available. The first step is generally an internal review by the insurer or trustee, which is required under the Insurance Contracts Act 1984 (Cth) and SIS Act regulatory frameworks and which provides an opportunity for the decision to be reconsidered with additional evidence or argument. If the internal review does not resolve the matter, the claimant can lodge a complaint with the Australian Financial Complaints Authority (AFCA), the external dispute resolution body for financial services and insurance complaints. AFCA is free for consumers, can review both insurer and trustee decisions, and can make determinations that are binding on the financial services provider up to specified monetary limits.
Court proceedings remain available where AFCA jurisdiction is exceeded or where the claimant prefers to litigate, but most insurance disputes resolve through internal review or AFCA without court proceedings. Time limits operate at multiple levels. AFCA complaints generally must be lodged within 2 years of the insurer's final internal review response, or within 6 years of when the claimant first became aware (or should reasonably have become aware) of the loss. Court proceedings to enforce a contract claim are subject to a 6-year limitation period under state limitation legislation, and the date the cause of action accrues can itself be a complex question depending on when the policy required the claim to be made and when the insurer's obligation to pay arose. Policy terms can also impose their own notification deadlines that operate independently of statutory limitation periods, which is why early review of the policy is important even where no immediate dispute has arisen.
3 things to know about insurance claims in QLD
“I was out of my depth making a claim, but Jeremy made me feel at ease the whole way through. I was so confident in him right from the start and he did a fantastic job. He genuinely cared about me.”
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Insurance lawyer FAQs (QLD)
The insurer says I don’t meet the policy definition - is that the end of it?
No - an insurer’s decision is not automatically final. TPD claims are assessed by applying the policy definition to the available medical and vocational evidence. Disputes often arise because definitions are interpreted narrowly, particularly around work capacity and permanence.
A refusal does not always mean there is no entitlement - it may mean the wording and evidence need to be properly reassessed.
My TPD claim has been delayed for months - does that mean it will be rejected?
Not necessarily. TPD claims often involve repeated requests for medical reports, employment history, or specialist opinions. Delay commonly reflects ongoing assessment rather than a decision already made. The issue is whether the insurer is handling the claim reasonably - not simply how long it has taken.
My TPD claim was denied - can that decision be challenged?
Yes - TPD decisions can be reviewed. A denial reflects the insurer’s position at that point in time. Where definitions are applied too narrowly, or evidence has not been fully considered, outcomes can change. Many TPD disputes resolve differently once the policy wording and supporting material are reassessed properly.
I don’t understand my TPD insurance policy - does that affect my claim?
No - most people do not fully understand the technical wording of their TPD cover. TPD policies contain defined terms, exclusions, and work capacity thresholds that are often complex. Your entitlement depends on how those terms apply to your circumstances - not on whether you personally drafted or interpreted the contract.
What if I feel too overwhelmed to deal with the insurer?
You are not required to negotiate with the insurer yourself. TPD disputes are conducted through structured correspondence and evidence exchange. The process focuses on medical and vocational material, not personal confrontation. You are not expected to argue your case directly.
My TPD insurance is held inside superannuation - does that change things?
That is common and does not prevent you from claiming. Where TPD cover is held through superannuation, both the insurer and the super fund trustee are usually involved in decision-making. This can affect timing and process, but the central question remains whether the policy definition has been met.
Can I challenge a reduced or partial TPD payment?
Yes - benefit calculations can be disputed. Insurers may apply offsets, exclusions, or work capacity assessments when determining payment amounts. Whether those adjustments are correct depends on the policy wording and the supporting evidence.
Will my TPD dispute end up in court?
Probably not. Most TPD disputes resolve through review, negotiation, or external dispute resolution. Court proceedings are generally a last resort used only where a fair outcome cannot be reached through those processes.
Has too much time passed to challenge a TPD decision?
Time limits can apply, but delay does not automatically extinguish rights. Limitation periods may arise from contract law, policy terms, or superannuation rules depending on how the cover is structured. The effect of delay depends on the specific circumstances.
I’m worried about legal fees - how does that work?
Initial advice is free, and you pay nothing upfront or while the claim is ongoing. If your TPD claim succeeds, our professional fees are paid from the outcome. We do not charge uplift or “success” fees, and we cover the cost of medical and vocational evidence as the matter progresses. If a claim is unsuccessful, we write off our legal fees and evidence costs entirely.
If I contact Gain Lawyers, am I committing to a dispute?
No - the initial consultation is free and often useful in its own right. In many cases, we can give an early indication about whether the insurer’s position appears consistent with the policy wording and what options may exist. The first conversation is about clarity and direction, not obligation.