The Australian Financial Complaints Authority (AFCA) are taking a particular focus this year on looking into the claims handling process as there has been a high number of breaches where insurers are denying claims and then subsequently approving them.

It appears that there are systemic issues of transparency and timeliness with some insurers when handling your claims. According to AFCA, there have been an increased volume of claims where insurers are initially denying indemnity to their insureds, and when reviewed or a complaint lodged, the decision are overturned, with the insurer confirming indemnity.

But where does this leave the insured?

It is important when you receive a decision from your insurer, particularly if it is a denial or only partial acceptance of your claim, that you review your policy wording and possibly seek legal assistance, if you believe the insurer may have got it wrong. AFCA are seeing a high volume of complaints lodged where insurers are reversing their incorrect decisions denying indemnity.

AFCA are investigating these issues and will be looking at the claims handling process in the general insurance area.

The other issue of concern that is evident is significant delays by insurers to make a determination on a claim when lodged. In this regard, there is a General Insurance Code of Practice (Code) that was updated on 5 October 2021. The Code sets the standard that general insurers must meet when providing services to their customers, such as being open, fair and honest. It also sets timeframes for insurers to respond to claims, complaints and requests for information from customers.

Insurers that are a party to the Code enter voluntarily and it is intended to be a positive motivator across the general insurance space for claims to be handled fairly and promptly. However, in recent times, significant delays in the claims handling process and provision of a determination have been seen in the general insurance area.

In this regard, AFCA are also looking into improvements regarding the complaints before it that remain unresolved for a period of more than 12 months. They will work with insurers and other relevant stakeholders regarding improving the claims handling process.

Elit Lawyers by McGirr & Snell has specialised experience in dealing with insurance claims, lack of providing determinations in a timely manner and/or incorrect denial of indemnity disputes. For more information, please contact Danielle Snell and Robert McGirr of Elit Lawyers on (03) 9098 8646.