Physio or Chiropractic Claim Rejected? What to Do

Before you claim

Receiving an unexpected claims decision can be frustrating, especially when you were counting on reimbursement. Before sending the same documents again, read what the insurer has actually decided and what it says is needed. A focused response is easier to assess than a general request to “please reconsider”.

Identify the exact issue

Check whether the message says the claim is incomplete, awaiting assessment, partially approved or declined. Ask for the policy clause and the calculation where relevant.

Useful questions include: Was the service excluded? Was the provider ineligible? Was a referral missing? Had a limit been reached? Was the treatment outside an eligible period? These are possible points to clarify, not assumptions about why your claim failed.

If you believe the decision refers to the wrong benefit, explain which section you think applies and ask the insurer to review that point.

Match your evidence to the reason

If a document is missing, confirm exactly what is required and who must issue it. If a date or service description is wrong, ask the original issuer to correct the genuine error.

If the problem is a policy exclusion, uploading a clearer receipt will not resolve that issue. Instead, ask the insurer to explain how the exclusion applies to the documented facts and whether any other relevant benefit has been considered.

Keep originals and a dated record of corrections. Never alter an invoice, invent an accident or request a backdated referral to improve the appearance of a claim.

Write a concise review request

Please review claim [reference] for treatment on [date]. Your response states [reason]. I have attached [specific evidence] because it clarifies [point]. Please explain how clause [number, if given] applies and confirm whether this changes the assessment or payment calculation.

Add a short timeline if the sequence matters. Attach only relevant records through the insurer’s official channel. Ask when to expect a response, and keep the correspondence together.

If the matter remains unresolved, use the insurer’s complaints process. The General Insurance Association describes escalation through the insurer before seeking external dispute resolution. GIA’s insurance-dispute guidance (see Sources).

When FIDReC may be an option

FIDReC provides a process for eligible disputes with participating financial institutions. Its FAQ says consumers must first approach the financial institution and file within six months of receiving its final reply. Eligibility and jurisdiction still apply; lodging a complaint does not guarantee payment. FIDReC’s FAQs (see Sources).

Check the date and wording of the final reply, and contact FIDReC promptly if you are considering this route. MoneySense also explains the escalation process and six-month timing. MoneySense’s dispute-resolution guide (see Sources).

Frequently asked questions