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When will my insurer advise if my claim is accepted?

Your insurer may have further reasonable questions about your claim. If you can, answer them as quickly and completely as you can, or advise the insurer that you cannot help with their questions. Your insurer should let you know how long a fully completed claim will take to assess.

The General Insurance Code of Practice (“the Code”) provides that where there is a disaster with a large number of claims, the insurer may not be able to meet all of the usual timelines (clause 9).

The usual timeframes under the Code (clause 7) (unless there is urgent financial hardship) are:

  • a decision to accept or reject the claim within 10 business days of a receipt of a complete claim once all assessment is complete or
  • notification within 10 business days that a loss assessor/loss adjuster will be appointed or that further information is required. In this case, your insurer will also provide an initial estimate of the time required to make a decision on your claim.

Your insurer is required to provide an update on the progress of your claim at least every 20 business days.

It is perfectly acceptable to call your insurer to check on progress (keep notes of these calls) and to expect to be given updates on timelines.

If your claim becomes urgent (because of your finances or otherwise), let your insurer know in writing.

What if after my claim is paid I realise there is more to claim?

If you received an insurance claim payment for damage caused by a catastrophe or disaster and then realise you have more damage to claim, you have six months from the finalisation of your claim (if finalised within one month of the disaster) to ask for a review of your claim.

If the review is refused or partially rejected then you can complain about this to the insurer’s Internal Dispute Resolution (IDR) department and then to the AFCA. Read the “My insurance claim has been refused – what are my options?” section of this guide for more information.

I still haven’t received a decision from my insurer about my claim

Sometimes you can get stuck in limbo waiting for your claim to be finalised, eg where you have submitted a claim but have not received an answer from
your insurer, or you ring your insurer and they keep asking for more information or they are saying your claim is still being processed.

The Code (clause 7.9) states that an insurer must respond to a claim within 10 business days of receiving the claim. If your insurer requires further information or assessment then they must notify you within 10 business days of receiving your claim, and outline:

  1. if any further information required
  2. if a loss assessor needs to be appointed
  3. an estimate of the time required to make a decision on your claim.

If your insurer is not making a decision and not informing you if further information is required or why there is a delay, you could send a letter
to your insurer. Refer to the sample letter “Delay” in Sample letters.

If your letter doesn’t result in a response from your insurer you can send a letter of complaint to Insurance Code Compliance Committee. Refer to the sample letter “Complaint to Insurance Code Compliance” in Sample letters.

A written complaint should assist in getting a response. However, if this is unsuccessful you could refer the matter to the AFCA. Refer to the sample letter “AFCA” in Sample letters.

If you are concerned at any stage in this process, seek legal advice.

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