What insurers must do when you make a claim, dispute a decision, or owe them money
Last checked
You have strong legal protections when dealing with insurers. They must handle claims promptly, can't deny claims based on information they didn't ask about, and must help you if you're in financial hardship.
This is general information, not financial or legal advice. For help with your specific situation, call the National Debt Helpline on 1800 007 007 (free, confidential).
Within 10 business days of receiving your claim, your insurer must advise you of required information, appoint any loss adjuster, and provide an initial estimate of the claims timeline.
Your insurer must make a decision on your claim within 4 months of receiving your claim, The limit becomes 12 months for an Extraordinary Catastrophe declared by the Insurance Council, fraud or suspected fraud, if you don't respond to reasonable requests, if they can't contact you for reasons outside their control, or if you ask for a delay. If they miss the limit, they must tell you in writing how to complain.
If you owe your insurer money — an excess, or an amount they are recovering from you — you can ask for financial hardship support under the General Insurance Code of Practice, and they must tell you their decision in writing within 21 calendar days (if they ask for more information: 21 days after you give it, or 7 days after the deadline if you don't). Support can include more time to pay, instalments, a reduced lump sum, or taking the excess out of a claim payment. The Code's hardship section does not cover help with paying premiums: for premium affordability, ask the insurer what it offers or talk to a financial counsellor about your cover.
From 5 October 2021, you only have a duty to take reasonable care not to make a misrepresentation. The insurer must ask the right questions — you don't have to guess what they need to know.
The insurer must respond to your complaint within 30 calendar days. If they cannot respond in time, they must explain why and tell you that you can go to AFCA.
Lodging a complaint with AFCA is completely free. If AFCA makes a determination in your favour and you accept it within 30 days, the insurer must comply. If you disagree, you can reject it and still pursue the matter in court.
If your claim is rejected, the insurer must provide written reasons explaining the decision, information about their complaints process, and copies of any service provider reports on request.
Usually not at first. Most creditors start with questions, not documents, and many ask about your income, spending and debts. Some want documents or a full statement before deciding, especially for longer help or a waiver.
All of Australia, for insurers that signed the General Insurance Code
The insurer asks for information only if it is reasonably necessary, and has to be specific about what it needs. You have 21 days from its request to provide it, or longer if it agrees.
Most insurers start with an application form. Some forms ask for your income and a full list of spending; some ask for bank statements or payslips.
“I'm in financial hardship and I'd like to apply for financial hardship support for the amount I owe.”
All of Australia, for insurers that signed the Life Insurance Code
The insurer will only ask for evidence it reasonably needs, such as Centrelink statements, bank statements, or a statement that your employment has ended. This doesn't apply to group policies.
“I can't afford my premiums right now. What options do you have to help me keep my cover?”
A financial counsellor can negotiate with companies on your behalf — for free.