REC206-1886

The Committee recommends that the Australian Government work with the Insurance Council of Australia to make the following amendments to the General Insurance Code of Practice by 1 July 2012:
- remove the clauses that set aside the Code standards in times of disasters;
- require insurers to refrain from advising policyholders against making a claim under their insurance policy, and incorporate a ‘right to claim’ so that policyholders who contact their insurer about their eligibility to make a claim are offered the opportunity to lodge a claim and have it assessed fully;
- ensure that a full explanation of the claims-handling process, including the right to escalate decisions to internal dispute and external dispute resolution systems, is given when policyholders lodge a claim;
- ensure that an acknowledgement of the claims lodgement, contact details of the claims officer, and expected timeframes for the claims-handling process are provided to policyholders in writing;
- require that copies of external expert reports used in the determination of a claim to be provided to claimants within 10 days of request; and
- introduce the following minimum standards for claims handling in times of exceptional circumstances such as declared disasters:
⇒ a timeframe for informing claimants of the progress of the claim;
⇒ a timeframe for advising claimants if an external expert has been appointed;
⇒ assurance that external experts are fully qualified to undertake assessments;
⇒ an undertaking to provide claimants with information about the qualifications, employer, and role of external experts that are appointed to assist with their claim;
⇒ a maximum timeframe of 12 weeks for external experts to provide reports;
⇒ a maximum timeframe for accepting or denying a claim;
⇒ a timeframe for responding to requests for information;
⇒ an undertaking to communicate all decisions about insurance claims to the claimant in writing with clear and explicit reasons relating to their particular claim; and
⇒ a timeframe for informing claimants of the progress of their complaint or dispute.