The fund’s own review of a declined claim, and the first formal step after a decline.
When a claim is declined, the first step is usually to lodge a formal complaint, which then causes the claim to go through the internal dispute resolution (IDR) process. Every fund is required to run an IDR process. The member, or their representative, lodges a complaint responding to the decline, and the insurer or trustee reviews it.
A good submission engages with the trustee’s specific reasoning rather than restating the original claim, and is usually supported by further evidence. There are no fixed deadlines for lodging the complaint itself, but the trustee or insurer must respond within set timeframes, generally 45 days, extending to 90 days for some superannuation matters. Time limits also apply to taking the matter further, both to AFCA and, ultimately, to court, so they should be factored in from the outset.