Last updated 1 September 2022

The General Insurance Code of Practice (Insurance Code) is an industry agreement adopted by most leading insurers. It is administered by the Australian Financial Complaints Authority (AFCA) and a failure by the insurer to comply with the Insurance Code may be addressed by the General Insurance Code Governance Committee.

Some relevant claims procedure deadlines include:

  • advise the insured of required information, appoint loss adjuster and/or provide initial time estimate of claims decision on initial claims receipt (10 business days)
  • advise insured about the progress of the claim (at least every 20 business days)
  • respond to the insured’s information requests (10 business days)
  • accept or reject the claim once all relevant information in hand (10 business days)
  • make decision about the claim except in specific circumstances such as fraud or extraordinary catastrophe (within 4 months)
  • make decision about complaint (30 calendar days).

For claims rejections, it is required for the insurer to provide:

  • written decision reasons
  • information on complaints handling procedures
  • copies of service provider reports upon which the rejection was made upon request.

A copy of the Insurance Code is available from the Insurance Council of Australia.

Most leading insurers are members of AFCA, which is not a government ombudsman but a company limited by guarantee that administers an industry dispute resolution scheme controlled by its Australian Financial Complaints Authority Operational Guidelines to the Rules. For more information visit the AFCA website.