Making an Insurance Claim in New Zealand

Most New Zealanders only learn how insurance claims actually work the first time they need to make one — after a car accident, a burst pipe, a burglary, or an earthquake. Insurance in NZ is regulated by a mix of contract law, the Insurance Law Reform Act 1977, an industry code of practice, and (increasingly) the Contracts of Insurance Act 2024. Knowing the rules before you claim puts you in a much stronger position if anything goes wrong.

Step 1 — Notify Your Insurer Promptly

Most policies require you to notify the insurer as soon as reasonably possible after an event, not after weeks of delay. Delaying notification can itself be used as a reason to decline or reduce a claim, even if the underlying loss is genuinely covered.

When you notify a claim, you will usually need:

·Your policy number and the date of the loss

·A clear description of what happened

·Photos or video of the damage, taken before any repairs begin

·Receipts, invoices, or valuations for damaged or stolen items

·A police report number, for theft, burglary, or some vehicle accidents

The Fair Insurance Code — What Insurers Must Do

Most general insurers in NZ are members of the Insurance Council of New Zealand — Te Kāhui Inihua o Aotearoa (ICNZ) and are bound by the Fair Insurance Code 2020. Under the Code, your insurer must:

| Step | Standard Timeframe |

|------|--------------------|

| Acknowledge your claim | Within 5 business days |

| Decide whether to accept the claim | Within 10 business days of having all the information needed |

| Provide a progress update if unresolved | At least every 20 business days |

During a declared catastrophe (e.g. a major flood or earthquake), insurers are allowed to take longer than these standard timeframes, but they must still update you regularly and act professionally.

Natural Disasters — Toka Tū Ake / the Natural Hazards Commission

If your home is damaged by an earthquake, landslide, volcanic activity, tsunami, or a related natural hazard fire, your claim is split between your private insurer and Toka Tū Ake — the Natural Hazards Commission (formerly known as EQC).

·You claim through your private insurer, not Toka Tū Ake directly — they assess and manage the claim on the Commission's behalf.

·Natural hazard cover for residential buildings is capped at $300,000 plus GST (increased from $150,000 in October 2022); your private insurer's policy covers loss above that cap.

·The cover is funded through the Natural Hazards Insurance (NHI) levy included in your home insurance premium — you don't apply for it separately.

When a Claim Is Declined

Insurers can lawfully decline a claim for several reasons, including:

·The loss falls within a specific exclusion in your policy (e.g. flood damage on a policy that excludes flood)

·You failed to disclose information relevant to the risk when you took out the policy

·The loss happened outside the policy period or at an uninsured address

·There is evidence of fraud or misrepresentation

If your claim is declined, the insurer must give you written reasons. Read the declinature letter carefully against your actual policy wording — insurers sometimes apply exclusions too broadly, and a wording dispute is one of the most common (and most winnable) areas of insurance complaint.

The Disclosure Rules Are Changing

Under the current law, consumers have historically had to disclose anything a "prudent insurer" might consider relevant. The Contracts of Insurance Act 2024 replaces this with a fairer test:

·Consumers must take reasonable care not to make a misrepresentation when answering an insurer's questions — judged against what a reasonable policyholder would understand and disclose.

·Non-consumers (businesses) must make a "fair presentation of the risk" — actively disclosing everything they know, or ought to know, that could affect the insurer's decision.

·Insurers also gain a duty to clearly explain disclosure obligations and the consequences of getting them wrong, and must respond proportionately to honest mistakes rather than declining the whole claim outright.

These changes come into force by Order in Council, with a final backstop commencement date of 15 November 2027 — check legislation.govt.nz for the current commencement status before relying on the old or new rules for a specific policy.

How to Dispute a Declined or Underpaid Claim

Step 1 — Complain to the Insurer Directly

Every insurer has an internal complaints process. Put your complaint in writing, reference your policy wording, and ask for a written response.

Step 2 — Get a Letter of Deadlock

If the insurer's internal process doesn't resolve things (or it has had a reasonable opportunity — generally up to 2 months), ask for a "letter of deadlock" confirming the matter is unresolved.

Step 3 — Free External Dispute Resolution

With the deadlock letter, you can take your complaint to a free, independent scheme:

·Insurance & Financial Services Ombudsman (IFSO) Scheme — ifso.nz | 0800 888 202

·Financial Services Complaints Ltd (FSCL) — used by some insurers instead of IFSO

Check which scheme your insurer belongs to using the scheme's "Find a Participant" search. You generally have 3 months from the insurer's final decision to refer the matter to the scheme.

Step 4 — Disputes Tribunal or Court

For claims up to $30,000, you can also file with the Disputes Tribunal without a lawyer. For larger or more complex disputes, the District Court or High Court may be the appropriate forum.

Quick Reference — Key Facts for NZ Insurance Claims

·Code of practice: Fair Insurance Code 2020 (ICNZ members)

·Acknowledge claim: within 5 business days; decide: within 10 business days

·Natural disaster claims: go through your private insurer; Toka Tū Ake building cap $300,000 + GST

·Free dispute resolution: IFSO Scheme or FSCL — get a deadlock letter first

·Time limit to refer to a scheme: generally 3 months from the insurer's final decision

·New disclosure law: Contracts of Insurance Act 2024 — in force by 15 November 2027 at the latest

LexNZ provides legal information only — not legal advice. For your specific claim, consult a qualified NZ lawyer or contact the IFSO Scheme on 0800 888 202.

How to Make an Insurance Claim in NZ — and What to Do If Refused