Assess whether section 54 stops an insurer refusing a claim
Key facts
- Human involvement
- RedLawyer-led
- How AI is used
- From the policy, the claim file and the insurer’s decision, identify the act or omission the insurer relies on, when it occurred relative to the contract, the policy term it engages, and the evidence about whether it caused or contributed to the loss and any prejudice to the insurer, set out in the order AFCA’s approach uses. The tool states no conclusion.
- What the lawyer must review
- The lawyer decides whether the refusal rests on an act or omission after the contract, whether the act could reasonably be regarded as capable of causing or contributing to the loss, what reduction for prejudice is available, and advises on the claim or the insurer’s position.
- Written for / version
- US
Open a jurisdiction version of this task to see which instruments apply: US
Who does what
| Role | What they do |
|---|---|
| Assistance | Do not begin AI assistance until the responsible lawyer has defined and confirmed its permitted scope. |
| Lawyer | Perform the substantive analysis and decisions. Independently check any permitted supporting work and approve the exact output for its intended use. |
Checklist
- Check the date of each act or omission against the policy period and inception.
- Separate evidence of causation from evidence of prejudice.
- Check each entry against the file document it cites.
Sources
- Insurance Contracts Act 1984 (Cth) s 54 — Insurer may not refuse to pay claims in certain circumstances · 2026-10-18
- AFCA — The AFCA Approach to section 54 of the Insurance Contracts Act · 2026-10-18
These are suggested working checks. Confirm the required checking with the responsible lawyer before work starts; the checking approach does not establish permission to use AI.