A: Yes, if an investigator or employee is appointed to investigate your claim, then within 5 business days, your insurer will tell you that they have been appointed and what their role is.
Code of Practice
Q: What is a significant breach of the code?
A: A Significant Breach means a breach that is determined to be significant by reference to: a. the number and frequency of similar previous breaches; b. the impact of the breach, or likely breach, on an insurers ability to provide their services; c. the extent to which the breach, or likely breach, indicates that an insurers arrangements to ensure compliance with the Code are inadequate; d. the actual, or potential, financial loss caused by the breach; and e. the duration of the breach.
Q: Is the Code independently monitored to ensure insurers compliance with it?
A: Yes, the Code is monitored and enforced by the Code Governance Committee. Anyone can report alleged breaches of the Code to the CGC.
Q: What are some reasons that insurers may deny a claim?
A: Insurers accept around 96% of claims. In the small percentage of cases where a claim may be denied, reasons may include:
Policy exclusions. Insurance policies contain a list of exclusions outlining specific situations, circumstances or events your insurer will not cover you for when you make a claim
Conditions and responsibilities. You may not have met conditions outlined in your policy
Cancellation of your policy. Usually, if your policy has not been renewed, has been cancelled or you have not paid the premium, you will not be able to make a claim
Non-disclosure. You are obliged to tell the insurer about anything that might affect your risk when you take out or renew an insurance policy. Failure to disclose may affect your ability to claim on your policy
Failing to maintain your property. Your claim may be turned down or affected because your property has not be maintained properly to reduce the risk of damage
Q: What is the Australian Financial Complaints Authority and how can it help?
A: If you have made a complaint to your insurer and are dissatisfied with their internal dispute resolution decision, you can contact the Australian Financial Complaints Authority (AFCA). It independently and impartially examines general insurance disputes between general insurance companies and customers who hold policies for home and contents, motor vehicle, travel and other forms of general insurance.
AFCA is independent and provides a free service for consumers. It can mediate between the insurer and the consumer, and when mediation is unsuccessful, an ombudsman can make a determination. AFCA decisions are legally binding on the insurance company but you are not bound by its decisions.
Before AFCA can consider your case, your insurance provider must have been given an opportunity to resolve the dispute with you directly. In most cases, your insurer has up to 45 days to respond to your complaint.
Q: If I’m not satisfied with my insurer’s decision about my complaint, what can I do?
A: You can take your complaint to the Australian Financial Complaints Authority (AFCA).
It independently and impartially examines general insurance disputes between general insurance companies and customers who hold policies for home and contents, motor vehicle, travel and other forms of general insurance.
AFCA is independent and provides a free service for consumers. AFCA decisions are legally binding on the insurance company but you are not bound by its decisions.