When you make an insurance claim, it’s not just a process; it’s a legal and contractual relationship in action. Your insurer has obligations to treat you fairly. Your duty requires you to deliver truthful and precise information.
The process of understanding both sides helps you to prevent delays and disputes while securing your claims. The entire insurance claim process in NZ becomes far less stressful when you understand your rights and responsibilities before any situation occurs.
Your rights when making an insurance claim
In New Zealand, insurers who belong to the Insurance Council of New Zealand must follow the Fair Insurance Code. The code establishes definite standards that insurers must follow when managing insurance claims in NZ.
The right to fair treatment
When you make an insurance claim, you are entitled to:
- Clear, transparent communication
- Respectful service
- Timely responses
- A fair assessment based on your policy wording
Insurers must explain what information they need and why. They can’t simply decline a claim without referencing the relevant policy terms.
The right to clear explanations
If your claim is
- Approved
- Partially approved
- Declined
Your insurer must explain the decision in plain English and link it to your policy conditions. This applies whether it’s a house insurance claim, motor claim, or personal insurance claim, like life insurance nz or health insurance nz.
The right to privacy
Your personal information, including medical records (for trauma insurance NZ or income protection insurance claims NZ), must be handled confidentially and in line with privacy law.
Insurers may request sensitive documentation, but they must only use it for legitimate claim assessment purposes.
The right to complain
If you believe your claim hasn’t been handled properly:
- Raise the issue with your insurer first.
- Follow their internal complaints process.
- Escalate to their independent dispute resolution scheme if unresolved.
You are not powerless in the insurance claim process, NZ. There is a formal structure in place to protect you.
Your obligations when making a claim
Insurance is built on good faith. That means you must act honestly and reasonably when lodging and managing your claim. Here are your key responsibilities.
Duty of disclosure (before and during the policy)
When you take out insurance, you must disclose relevant information truthfully. This continues during a claim. If you:
- Withhold important facts
- Provide false information
- Exaggerate a loss
Your claim may be declined, and your policy could be cancelled. This applies across all cover types, from mortgage protection insurance nz to motor and house insurance.
Provide accurate and complete information
When making a claim, you must provide:
- The date and time of the incident
- A clear explanation of what happened
- Details of damage or loss
- Supporting documents (receipts, photos, medical reports, Police reference numbers where relevant)
- If you’re claiming under health insurance nz or trauma insurance nz, you may need medical certificates or specialist reports.
The faster and more accurately you provide information, the smoother the insurance claim process in NZ will be.
Take reasonable steps to prevent further loss
If your home is damaged in a storm, you can’t simply leave it exposed to further rain damage if temporary protection is possible. Your policy typically requires you to:
- Take reasonable steps to reduce additional damage
- Avoid putting yourself or others at risk
- Contact your insurer before arranging major repairs
For house insurance claims, emergency works may be covered, but always confirm first.
Pay your excess
Most policies include an excess, your contribution toward the claim. Your excess amount will be stated in your policy documents. It may differ depending on:
- The type of claim
- The cause of loss
- Whether you were at fault (for motor claims)
Failure to pay the required excess can delay settlement.
Cooperate with the assessment process
Your insurer may appoint:
- An assessor or loss adjuster (for property claims)
- A medical assessor (for personal insurance claims)
- A claims case manager
You’re required to cooperate reasonably with this process. That includes:
- Providing requested documents
- Attending assessments if required
- Responding to communications promptly
For example, insurers often assign dedicated claims specialists to guide customers through personal insurance claim in NZ. Cooperation helps them assess your claim efficiently.
Common misunderstandings about claims
“Insurance covers everything.”
It doesn’t. Insurance is designed for sudden and unexpected events, not wear and tear or lack of maintenance. Gradual damage may be limited or excluded depending on your policy. Always review your cover carefully.
“If I’m unsure, I won’t mention it.”
That’s risky. If something may be relevant to your claim, disclose it. Non-disclosure can create bigger issues than the original loss.
“The insurer must accept my repair quote.”
Insurers assess repair scope and cost independently. They may approve repairs, appoint their own repairer, or offer a cash settlement. Their decision must align with the policy terms.
When widespread disasters happen
In large-scale events like floods or earthquakes:
- Insurers may prioritise the most severely affected or vulnerable customers.
- Assessments may take longer due to volume.
- Communication timelines may extend, but insurers must still act fairly and transparently.
Your obligation remains the same: provide clear information and notify of repeat or additional damage if further events occur.
Why understanding both sides matters
Claims disputes often arise from misunderstanding, not bad intent. If you:
- Know what your policy covers
- Understand your excess
- Keep records
- Act promptly
- Communicate clearly
You significantly reduce the risk of stress during the claim process.
Are you fully covered?
Understanding your rights and obligations is just one part of being prepared. The bigger question is:
- Does your current policy reflect your real risks?
- Do you understand your exclusions?
- Would you feel confident making a claim tomorrow?
If you’re unsure, now is the time to review your cover.
Ready to get covered?
Talk to NZ Insurances today.
Call, email, or book a free review with an experienced insurance adviser nz and make sure you’re protected and informed before you ever need to claim.
