I am in insurance claim limbo – what do I do?
Sometimes, people can get stuck in limbo where you have made the claim but have not had an answer. You ring the insurer and they keep asking for more information or saying your claim is still being processed.
Insurers are required to comply with the General Insurance Code of Practice. Section 3.1 of the Code states that an insurer must decide to accept or deny your claim within 10 business days of receiving the claim. If the insurer decides it needs further information or an assessment to decide your claim, then the insurer must notify you within 10 business days of receiving the claim:
- What further information is required;
- If a loss assessor needs to be appointed; and
- An estimate of the time required to make a decision.
So if the insurer is not making a decision and not informing you whether further information is required or why there is a delay try sending a letter to the Insurance company or call the insurance company and make a note of the call. To do so use our Request for progress on claim after insurer’s failure to reply Sample Letter. If this does not work you can send a letter of complaint to Insurance Code Compliance. Use our sample letter generator here.
The above complaint should assist in getting a response. However, if this is unsuccessful you can lodge a dispute in the Australian Financial Complaints Authority (AFCA). Use our Insurance Code Complaint Sample Letter.
If you on the other hand you suspect that you are being investigated you should get legal advice immediately. For further information on investigations read our What can I do if I am investigated on an insurance claim? Fact Sheet or call us on the Insurance Law Service on 1300 663 464.