The General Insurance Code of Practice: What Your Insurer Promised to Do

The General Insurance Code of Practice is a set of binding standards that all Australian general insurers who are members of the Insurance Council of Australia must follow. It covers claim handling timeframes, communication obligations, and how disputes must be managed. If your insurer breaches the Code, you can cite the specific breach in your dispute letter and lodge a complaint with AFCA referencing it.

Key takeaways

• The Code sets binding standards for claim handling timeframes, communication, and dispute management.
• Insurers must make a decision within 10 business days for straightforward claims.
• A Code breach strengthens your dispute at AFCA. Cite the specific section the insurer failed to follow.
• All ICA member insurers are bound by the Code. Check your insurer's membership at insurancecouncil.com.au.

When your insurer handles your claim, they are not just bound by the terms of your policy. They have also signed up to a detailed set of promises about how they will treat you. These promises are set out in the General Insurance Code of Practice, and if your insurer breaks them, you can hold them to account.

Understanding the Code gives you real leverage. It sets clear, specific standards that your insurer must meet, and it provides a pathway for enforcement when they fall short.

What is the General Insurance Code of Practice?

The Code is a self-regulatory framework developed by the Insurance Council of Australia. It sets minimum standards for how insurers must handle claims, sell policies, and treat customers. Every major general insurer in Australia is a signatory, covering products including home, motor, contents, landlord, and business insurance.

"Self-regulation" does not mean "optional." If your insurer is a signatory, the Code's obligations are binding commitments. The Australian Financial Complaints Authority (AFCA) can consider Code breaches when deciding disputes, which means the Code gives you practical, enforceable rights. The Code operates alongside your statutory protections under the Insurance Contracts Act 1984 (Cth), including the duty of utmost good faith under section 13, which requires insurers to act fairly and with due regard to your interests.

The current version of the Code took effect on 1 July 2021 and was updated in 2024. It is independently monitored by the Code Governance Committee, which can sanction insurers for non-compliance.

Your insurer's key obligations under the Code

Timely claim decisions

Under paragraph 76 of the Code, once your insurer has all relevant information and has completed its enquiries, it must decide whether to accept or deny your claim and tell you within 10 business days. Under paragraph 77 the decision itself must be made within 4 months of receiving your claim, extending to 12 months under paragraph 78 in defined circumstances such as an extraordinary catastrophe. Paragraph 70 requires your insurer to keep you updated on the progress of your claim at least every 20 business days.

This matters because insurers sometimes leave claims sitting without action for weeks or months. If your insurer has everything they need and still has not made a decision within 10 business days, they are breaching the Code. Keep a record of when you provided each piece of information so you can demonstrate the breach if needed.

Clear reasons for claim decisions

When your insurer declines your claim or does not pay it in full, paragraph 81 requires them to tell you in writing which aspects of your claim they do not accept, the reasons for their decision, that you can ask for the information about you they relied on, that you can ask for copies of any service supplier or external expert reports they relied on, and how their complaints process works.

A vague refusal letter that says "your claim falls outside the scope of cover" is not good enough. Your insurer must point to the exact clause and explain how it applies to your circumstances. If they have not done this, they have breached the Code, and you should request proper reasons in writing.

Access to assessor reports

Under paragraphs 81 and 82 of the Code, you have the right to request copies of any reports your insurer obtained and relied on when assessing your claim, and they must provide them within 10 business days. This includes assessor reports, expert opinions, and investigation reports.

This is a powerful right. If your insurer relied on a building assessor's report to reduce your payout, you are entitled to see that report. You can then check whether the assessor's conclusions are fair and accurate, and challenge them if they are not. Insurers who refuse to provide these reports are in clear breach of their obligations.

Internal Dispute Resolution (IDR) timeframes

If you disagree with your insurer's decision, you can lodge a complaint through their Internal Dispute Resolution process. Under paragraph 147 of the Code, your insurer must make a decision on your complaint within 30 calendar days of receiving it, and under paragraph 146 they must keep you informed of progress at least every 10 business days.

If they cannot resolve it within that timeframe, they must write to you explaining the delay, giving you an expected resolution date, and informing you of your right to escalate to AFCA. If 30 days pass without a response, you do not need to wait any longer. You can go straight to AFCA.

Fair claim handling

Part 7 of the Code sets out broad obligations around fair claim handling. Your insurer must handle your claim in an honest, fair, transparent, and timely manner. They must not deny a claim without a reasonable basis, and they must consider all relevant information you provide. These obligations align with the duty of utmost good faith under section 13 of the Insurance Contracts Act 1984.

These are not just aspirational statements. They are enforceable commitments that AFCA takes seriously when reviewing disputes. An insurer that ignores evidence you have provided, or that applies policy exclusions unreasonably, may be found to have breached both the Code and their statutory obligations.

Financial hardship provisions

Part 8 of the Code requires insurers to identify and respond to customers experiencing financial hardship or vulnerability. If a delay in processing your claim is causing you financial stress, your insurer has an obligation to prioritise your matter and work with you to find a fair outcome.

You can request fast-tracking of your claim on hardship grounds, and your insurer must consider this request genuinely. If you are struggling to pay rent or temporary accommodation costs because of a delayed claim, make sure your insurer knows. Put it in writing.

Why Code breaches matter, even when the claim decision was correct

Here is something many policyholders do not realise: a Code breach is independently actionable at AFCA. This means you can complain about the breach itself, regardless of whether the underlying claim decision was technically correct.

For example, suppose your insurer declined your claim and, after review, the decline was reasonable under your policy terms. But suppose they also took four months to make that decision without any valid reason, failed to give you written reasons referencing your PDS, and refused to provide the assessor's report you requested. Each of those failures is a separate Code breach.

AFCA can award compensation for the impact of Code breaches, including stress, inconvenience, and financial loss caused by delays or process failures. Even if you cannot overturn the claim decision, you may still be entitled to a remedy for how your insurer handled it. This is why documenting every interaction with your insurer matters.

What to do if your insurer is not meeting its obligations

1. Document everything. Keep records of when you submitted information, when your insurer contacted you, and any delays or failures to respond. Save emails, take notes of phone calls, and record dates.
2. Put your concerns in writing. Send your insurer a written complaint that specifically identifies which Code obligations you believe they have breached. Reference the relevant paragraphs of the Code.
3. Request what you are entitled to. Ask for copies of assessor reports, written reasons with PDS references, and clear timeframes for decisions. These are your rights under the Code.
4. Lodge an IDR complaint. If your insurer does not resolve your concerns, lodge a formal complaint through their Internal Dispute Resolution process. They must respond within 30 calendar days.
5. Escalate to AFCA. If you are not satisfied with the IDR response, or your insurer fails to respond within 30 days, you can escalate to AFCA at no cost to you.

When escalating to AFCA, be specific about Code breaches. Do not just say "my claim was handled badly." Instead, explain exactly which Code obligations were breached, when, and what impact this had on you. Specific, well-documented complaints are far more effective than general grievances.

How The Fair Claims Co can help

Navigating the Code and building a structured complaint can feel overwhelming, especially when you are already dealing with the stress of a claim. The Fair Claims Co prepares professional dispute documents and AFCA submissions that clearly identify Code breaches, reference the right obligations, and present your case in a way that decision-makers take seriously.

If your insurer is not meeting its obligations under the Code, we can help you put together the documents you need to hold them to account.