Re: Claim number: ______________
Date of accident: ___________________
I refer to the above incident, where your insured has accepted liability and fault in the accident.
I understand that your insured has not paid their excess
My damages are [insert amount].
I refer to s51 of the Insurance Contracts Act, the Australian Financial Complaints Authority (AFCA) position on excesses, the General Insurance Code of Practice and the Court of Appeal decision of Calliden Insurance Limited v Chisholm  NSWCA 398
On the basis of the above, I seek that you:
- Accept the claim;
- Deduct the excess from the damages set out above and pay me the balance forthwith.
Please provide me a written response. If I do not hear from you by close of business on [Insert a date] I reserve my right to lodge in the Financial Ombudsman Service without further notice to you.