What insurers must do when you make a claim, dispute a decision, or owe them money
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, except in cases of suspected fraud or extraordinary catastrophe.
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. 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 give you a new timeframe.
Lodging a complaint with AFCA is completely free. If AFCA makes a determination in your favour, 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.
A financial counsellor can negotiate with companies on your behalf — for free.