General

Insurance
Code of
Practice
Setting out standards of conduct for the
general insurers who have adopted the
Code and their Employees, Distributors
and Service Suppliers.
President’s
foreword

On behalf of the Board of the Insurance There is also a new commitment to promote
Council of Australia, I am pleased to present improved awareness about the availability
this updated version of the General Insurance of Financial Hardship support on Code
Code of Practice 2020, which came into effect subscriber’s websites.
on 5 October 2021.
The Code reflects the general insurance
The industry understands the vital role it plays industry’s ongoing commitment to positive
in the community and the economy and the outcomes for consumers and its determination
General Insurance Code of Practice continues to provide best practice in conduct and
to set a benchmark for self-regulation in the customer service.
financial services sector. The 2020 Code was
developed by the industry in consultation I welcome the latest version of the 2020 Code
with multiple stakeholders and the result and its ongoing improvements.
is the most customer-focused Code in its
history, and one reflecting evolving community
expectations. This includes a strong focus
on supporting customers experiencing
vulnerability.

Most of the 2020 Code started on 1 July 2021, Sue Houghton

however some obligations, such as having President
a publicly available family violence policy, Insurance Council of Australia
and the Supporting Customers Experiencing 5 October 2021
Vulnerability and Financial Hardship parts, took
effect earlier.

As the Code is a living document, some

adjustments have now been made in this
October 2021 version to align with ASIC’s
new guidelines for complaints handling.
For example, a new timeframe to resolve a
complaint has been introduced reducing the
time from 45 to 30 days.

1
2
General insurance
in our society
Life can be unpredictable. The Code
Insurance can help protect you from life’s The General Insurance Code of Practice (the
unpredictability. Some of the ways general Code) was introduced in 1994 by the Insurance
insurance can protect you are: Council of Australia as a voluntary Code. It has
been regularly reviewed and updated.
• for loss or damage to your valuable
possessions — such as your home or The Code is independently monitored and
car, or even your Small Businesses and enforced by the Code Governance Committee.
infrastructure;
The Code has been developed through
• for your responsibility, or ‘liability’, to consultation with a range of stakeholders
another person if you cause them loss or including consumer and industry representatives,
damage; and the Code Governance Committee, the Australian
Securities and Investments Commission and the
• for loss you suffer from certain events such Australian Financial Complaints Authority.
as travel cancellation and many types of
natural disasters. The Code is intended to be a positive influence
across all aspects of the general insurance
By helping you to manage the financial impact industry including product disclosure, claims
of insured events, insurance can help reduce handling and investigations, relationships with
your stress. people who are experiencing vulnerability, and
reporting obligations.
Although insurance is important in your
personal and business affairs, insurance —
and the insurance industry — underpin the Meeting community needs,
Australian financial system. It does this by standards and expectations
insuring risks for people and for the community
The general insurance industry is an integral
and by helping them to rebuild and replace their
part of an inclusive, thriving and adaptable
assets after insured losses. Where a risk is not
community.
insured the burden of loss may have to be borne
by the community. The insurance industry also The industry must always strive to meet
contributes to improved risk management. the community’s evolving expectations for
To find out more about insurance, visit how it should support individuals and small
www.understandinsurance.com.au. businesses.

The Code is a key way the general insurance

industry makes sure it continues:

• to work towards this important goal; and

• to provide value to you and

the whole community.

3
Our principles • monitoring any concerns identified, and
making changes to prevent similar future
The principles that underpin the Code shape
concerns when this is reasonable.
the way the general insurance industry
behaves, treats people and approaches We will add value to the community by
decision-making. engaging with the government, consumers
and other relevant stakeholders in building an
We — the general insurance industry — will
inclusive, thriving and adaptable community.
be inclusive by providing insurance designed
to meet the diverse and changing needs of the
whole community.

We will provide value, transparency and

fairness of products and services by:

• designing and selling insurance products and

services that are of value to the community
they are sold to;

• designing and selling insurance products

and services in a clear, transparent and fair
manner; and

• continually reviewing and improving

insurance products and services offered to
ensure they remain of value to the changing
needs of the community.

We will promote trust, integrity and respect by:

• meeting promises made to the community in

a trusting environment;

• being open, fair and understanding, and

acting with integrity, in our dealings with the
community;

• being clear, transparent, fair and timely in

our communications with the community;
and

• treating the community with respect, dignity

and sensitivity.

We will provide accessibility and additional

support by:

• being accessible to the community and

making our processes simple and timely; and

• assisting members of the community who

are in need of additional support.

We will resolve any concerns and work to

prevent future concerns by:

• listening and seeking to resolve concerns in

an objective, truthful and timely manner;

• proactively resolving any concerns we may

identify; and

4
inclusive
value
transparency
trust
integrity
respect

fairness of
products
and services
accessibility
and additional
support

resolve any concerns

and work to prevent
future concerns

5
Table of contents
President’s foreword 1
General insurance in our society  3
Part 1: Objectives of the Code  9
Part 2: How the Code works 11
What the Code means for you  11
Who the Code applies to 11
Code commencement  11
Products the Code applies to 11
Complying with the Code 12
The Code and the law 12

Part 3: Our obligation to you 14

Part 4: Standards for us and our Distributors 16
Conduct standards for us and our Employees and Distributors  16
Education and training for our Employees and Distributors  16
Dealing with concerns about our Employees or Distributors 16
Concerns about other Australian Financial Service Licensees who sell our products 17

Part 5: Standards for our Service Suppliers 19

Conduct standards for our Service Suppliers 19
Appointing and monitoring Service Suppliers 19
Dealing with concerns about our Service Suppliers 19

Part 6: Buying insurance 21

Pressure Selling 21
Applying for or renewing insurance policies 21
Sum insured calculators for home building policies 21
Automatic renewal 21
Premium comparison  21
No Claims Discount 22
Consumer Credit Insurance 22

Part 7: Cancelling an insurance policy 24

Part 8: Making a claim 27
Before making a claim 27
Making a claim 27
Scope of works for a home building claim 27
Issues with your claim 27
Fast-tracking urgent claims  27
Assessing your claim 27
Using an External Expert, Loss Assessor, Loss Adjuster or Investigator  28
Claim decision 28
Cash settlements  28
Claims for total loss 28
Information we give you if we deny your claim or do not pay in full  29
Changes to timeframes 29
Use of repairers 29
How we respond to Catastrophes 29

6
Part 9: Supporting customers experiencing vulnerability 31
Internal policies and training  31
Support measures  31
Identification  32
Using interpreters 32
Mental health  32

Part 10: Financial Hardship 34

Individuals entitled to support  34
Identifying people experiencing Financial Hardship 34
Keeping you informed 34
Assessing your request for Financial Hardship support  34
Putting recovery on hold  35
Making our decision  35
If you are entitled to Financial Hardship support 35
Releasing your debt 35
If you are not entitled to Financial Hardship support 35
Standards for collecting money  36
Bankruptcy 36

Part 11: Complaints 38

Making a Complaint  38
Handling your Complaint 38
Decision about your Complaint 38
Mistakes when handling your Complaint 38
The Australian Financial Complaints Authority 39
Complaint management by third parties  39

Part 12: Your access to information 41

Part 13: Enforcement, sanctions and compliance 43
Reporting breaches 43
The Code Governance Committee  43
The responsibilities of the Code Governance Committee  43
Imposing sanctions 43
Types of sanctions  44
Our compliance with the Code 44

Part 14: Promoting, reviewing and improving the Code 46

Promoting the Code  46
Reviewing and improving the Code  46

Part 15: Claims investigation standards 48

General investigation obligations 48
Before any formal interview 49
During the formal interview 50
After the formal interview 51
External Investigators only 51
Surveillance  51
Guide: Interview consent form 53

Part 16: Definitions 55

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8
Part 1:
Objectives of the Code
1. The objectives of the Code are:

a. to commit us to high standards

of service;

b. to promote better, more informed

relations between us and you;

c. to maintain and promote trust and

confidence in the general insurance
industry;

d. to provide fair and effective

mechanisms for resolving Complaints
you make about us; and

e. to promote continuous improvement of

the general insurance industry through
education and training.

2. We will pursue the above objectives of

the Code with regard to the law and
acknowledging that every contract of
insurance is a contract based on the
utmost good faith.

9
10
Part 2:
How the Code works
3. Words and phrases that have a special Products the Code applies to
meaning in the Code are listed with their
10. The Code covers general insurance
meaning in part 16.
products with the exception of:

a. Workers Compensation Insurance;

What the Code means for you
4. We acknowledge that our customers, and b. Marine Insurance;
our relationships with our customers, are
c. Medical Indemnity Insurance;
the foundations of our business.
d. Motor Vehicle Injury Insurance; and
5. If you have a concern about us, or about
any aspect of your relationship with us, e. Domestic Builders Insurance or Domestic
then you may: Builders Warranty/Indemnity Insurance.
a. ask us to address the concern; 11. Also, the Code does not cover:
b. make a Complaint to us through our a. reinsurance;
Complaints process; and/or
b. life insurance products issued by a life
c. report your concerns to the Code insurer; and
Governance Committee.
c. health insurance products issued by a
registered health insurer.
Who the Code applies to
12. The Code applies differently to Retail
6. The Code applies to all insurers who have
Insurance and Wholesale Insurance. The
adopted it. An organisation may adopt
whole Code applies to Retail Insurance.
the Code if the organisation is a member
The following parts of the Code do not
of the Insurance Council of Australia;
apply to Wholesale Insurance:
a general insurer; or approved by the
Insurance Council of Australia. A list of a. part 5 — S
 tandards for our Service
Code subscribers is available at Suppliers
www.insurancecouncil.com.au.
b. part 6 — Buying insurance

Code commencement c. part 7 — Cancelling an insurance policy

7. The Code takes effect on 5 October 2021. d. part 8 — Making a claim
8. Once we have adopted the Code, then: e. part 9 — S
 upporting customers
experiencing vulnerability
a. all new policies and renewed policies
we enter into are covered by the Code; f. part 11 — Complaints (except in limited
circumstances).
b. all new claims we receive are covered
by the relevant parts of the Code; and

c. all new Complaints we receive are

covered by the Code.

9. If this Code applies, then any earlier

version of the Code does not apply.

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13. If more than one insurer has insured a
portion of the same risk under the same
insurance policy (that is, under a co-
insurance arrangement), then:

a. if all of those insurers have adopted

the Code, then the Code applies to that
insurance policy; and

b. if any of those insurers has not adopted

the Code, then the Code does not apply
to that insurance policy.

Complying with the Code

14. By adopting the Code, we enter voluntarily
into a contract with the Insurance Council
of Australia to comply with the Code.

15. The Code does not create legal or other

rights between us and any person or
entity other than the Insurance Council
of Australia.

16. If we breach our obligations under the

Code, the Code Governance Committee
may impose sanctions on us as set out
in part 13.

17. We are in breach of the Code if our

Employees, Distributors or Service
Suppliers do not comply with the Code
when they are acting on our behalf.
Although our Distributors and Service
Suppliers are not subscribers to this Code,
they are accountable to us for complying
with the relevant standards in the Code.

The Code and the law

18. The Code is designed to work with the
many laws that cover our conduct and
to deal with issues not dealt with in
legislation. The Code does not limit your
rights under law against us.

19. Where there is an obligation under the

Code in addition to a legal requirement,
we will also comply with the Code, unless
doing so would be in breach of the law.

20. If there is any conflict or inconsistency

between the Code and any
Commonwealth, State or Territory law,
then that law prevails.

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13
Part 3:
Our obligation to you
21. We, our Distributors and our Service
Suppliers will be honest, efficient, fair,
transparent and timely in our dealings
with you.

22. The Code sets out how we will meet this

obligation to you.

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15
Part 4:
Standards for us
and our Distributors
Conduct standards for us and our Dealing with concerns about
Employees and Distributors our Employees or Distributors
23. We will have policies and procedures for 30. We will have policies and procedures in
our Employees and Distributors that require place to monitor the performance of our
them to conduct sales appropriately and to Employees and/or Distributors.
prevent unacceptable sales practices.
31. We will investigate any concerns about the
24. We will only allow our Employees and conduct of our Employees or Distributors
Distributors to provide services that that you raise with us, or that we are
match their expertise. aware of. Where appropriate, we will
address these concerns by — for example:
25. When our Distributors are providing a
service to you, they must tell you the a. requiring them to go through further
service we have authorised them to provide training; or
and that they are acting on our behalf.
b. disciplinary action.
26. If you make a Complaint to one of our
Distributors, about either us or their 32. If we identify that any of our Employees or
conduct, then the Distributor must tell Distributors have engaged in poor conduct
us about the Complaint within 2 Business in breach of our policies or procedures that
Days. If your Complaint is about a Retail has caused you material harm, then we
Insurance product, then your Complaint will contact you to discuss an appropriate
will be handled under the Code’s
remedy. The remedy will depend on the
Complaints process.
circumstances and on what you agree to.
27. Our Distributors must notify us within For example, a remedy may include:
2 Business Days of any Code breaches by
a. us refunding any premiums paid;
them when acting on our behalf.
b. us paying interest on the refunded
premium;
Education and training for our
Employees and Distributors c. us adjusting the cover the product
28. We will require our Employees and provides;
Distributors to receive appropriate
d. us correcting information provided
education and training:
to you; or
a. to provide their services competently;
e. us paying a claim.
b. to deal with you professionally; and
33. If you are not satisfied with our proposed
c. about the Code. remedy, then we will tell you how to make
a Complaint.
29. Our Employees’ education and training
records will be kept for at least 7 years.
We will make those records available to
the Code Governance Committee at its
request. We will require our Distributors
to do the same.

16
Concerns about other Australian
Financial Service Licensees who
sell our products
34. If you have a concern about a person or
organisation selling our product who is not
one of our Distributors, you can contact
us and we will let you know how you can
have the matter addressed. You can also
contact the Code Governance Committee.

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18
Part 5:
Standards for our
Service Suppliers
This part applies to Retail Insurance 40. A Service Supplier must first get our
products only. approval before subcontracting any
services they perform on our behalf.

Conduct standards for

our Service Suppliers Dealing with concerns
35. When our Service Suppliers are providing about our Service Suppliers
a service to you, they must tell you the 41. If we are aware that our Service Suppliers’
service we have authorised them to provide performance does not meet the relevant
and that they are acting on our behalf. standards of the Code, then we will
address this — for example, by:
36. If you make a Complaint to one of our
Service Suppliers about either us or their a. cancelling our contract with the Service
conduct, then the Service Supplier will tell Supplier; or
us about the Complaint within 2 Business
Days. Your Complaint will be handled b. requiring them to go through further
under the Code’s Complaints process. training.

37. Our Service Suppliers must tell us within

2 Business Days about any breach of the
Code that they are aware of when acting
on our behalf.

Appointing and monitoring

Service Suppliers
38. We will have measures in place to ensure
that we appoint only suitable Service
Suppliers. In particular, when we appoint
a Service Supplier, they must:

a. hold any licence the law requires; and

b. reasonably satisfy us that they and their

employees are qualified by education,
training or experience (including but not
limited to whether they hold membership
with any relevant professional body) to
provide the required service competently
and to deal with you professionally.

39. All contracts entered into with Service

Suppliers after we have adopted
the Code, must reflect the relevant
standards of the Code.

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20
Part 6:
Buying insurance
This part applies to Retail Insurance d. give you information about our
products only. Complaints process if you tell us you
are unhappy with our decision.
42. We will take reasonable steps to make
sure that our communications are in
plain language. Sum insured calculators
43. We will have a publicly available policy
for home building policies
on our approach to the development 48. When you apply for or renew a home
and distribution of our products for building insurance product, but not a
appropriate target markets. This policy strata insurance product, we will provide
will be published on our website. you with access to a calculator that is
periodically reviewed and updated to
enable you to estimate your sum insured.
Pressure Selling
44. Pressure Selling of our products is
prohibited. We will make this clear to
Automatic renewal
our Employees and Distributors. 49. If we are offering you an insurance
product that can automatically renew,
then, at the time of purchase and at each
Applying for or renewing renewal we will:
insurance policies
a. remind you about the automatic
45. If we are assessing your application for renewal process;
insurance, then we will ask for and rely
on information and documents only if b. remind you that you can opt-out of that
they are relevant to our decision. process; and

46. Where we identify, or you tell us, about c. tell you to check the amount of your sum
a mistake in your application or in the insured to see if your level of insurance
information or documents we have relied cover is still appropriate for you.
on in assessing your application, we will
immediately take action to correct it.
Premium comparison
47. If we cannot provide you with insurance,
50. If we offer to renew any of the following
we will:
products that you bought directly from us:
a. give you our reasons for that decision;
a. home building;
b. tell you about your right to ask us for
b. home contents;
the information we relied on when
assessing your application — if you ask c. home building and home contents;
us for that information, then we will
give it to you as set out in part 12 of d. motor vehicle — unless you have a fleet
the Code; of vehicles or are a business or other
organisation;
c. refer you to either the Insurance Council
of Australia or the National Insurance then, in our renewal notice, we will give
Brokers Association of Australia for you a comparison between this year and
information about your options for last year’s premium and explain to you
alternative insurance, or approaching how it is calculated.
another insurer or another broker; and

21
No Claims Discount
51. If your insurance policy has a No Claims
Discount, we must tell you how it works.
A No Claims Discount is sometimes
called a ‘No Claims Bonus’ or a ‘No
Claims Entitlement’.

Consumer Credit Insurance

52. We will not sell you a Consumer Credit
Insurance product during the deferred
sales period.

53. If we, or any intermediary acting on

our behalf, offer you Consumer Credit
Insurance for credit cards, home loans
or personal loans, then we will take
reasonable steps to ensure that:

a. you are given clear information, before

the deferred sales period starts,
about the cost of the Consumer Credit
Insurance, the options for payment,
how long it lasts and its key exclusions
and limits;

b. you are informed that purchasing the

Consumer Credit Insurance has no
bearing on whether your application
for a credit card, personal or home
loan will be approved; and

c. no binding offer of Consumer Credit

Insurance can be made to you until the
end of the deferred sales period.

54. The deferred sales period is 4 days,

starting on the day after you are informed
that your credit card, home loan or
personal loan is approved.

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23
Part 7:
Cancelling an
insurance policy
This part applies to Retail Insurance
products only.

55. Your insurance policy may allow you to

cancel it and obtain a refund. If you are
entitled to a refund and you cancel your
policy, then we will return the amount
within 15 Business Days. However, if
you arranged your insurance through
an insurance broker, then different
arrangements will apply — you will need to
ask your broker about those arrangements.

56. If you have an Instalment Policy and we

have not received an instalment payment,
then we will send you a notice in writing
regarding your non-payment at least 14
Calendar Days before any cancellation by
us for non-payment.

57. If after sending the notice under

paragraph 56 we do not receive the
instalment payment for the Instalment
Policy, then we will send you a second
notice in writing either:

a. before cancellation, informing you

that your Instalment Policy is being
cancelled for non-payment; or

b. within 14 Calendar Days after cancellation

by us, confirming our cancellation of your
Instalment Policy.

24
25
26
Part 8:
Making a claim
This part applies to Retail Insurance how it works, its purpose and the
products only. process involved.

Before making a claim Issues with your claim

58. You can ask us if your insurance policy 62. If we identify, or you tell us about a
covers a particular loss before you mistake we make in handling your claim,
actually make a claim. When we answer then we will immediately take action to
your question, we will not discourage you correct the mistake.
from making a claim and we will tell you
that if you make a claim, we will fully 63. If you have a Complaint about anything to
assess whether your loss is covered. do with how we handle your claim, then
you may make a Complaint to us through
our Complaints process.
Making a claim
59. If you make a claim, then we will tell you: Fast-tracking urgent claims
a. about our claims process; 64. Where the event (for example, a natural
disaster) that caused you to make a claim
b. about any excess amounts you have to under your policy also caused you to be in
cover or pay in relation to your claim; urgent financial need of the benefits you
are entitled to under that policy, then we
c. about any waiting or no cover periods
will do either or both of the following:
that need to finish before we start
paying you under the policy; and a. fast-track both our assessment of your
claim and the process we follow to
d. how to contact us regarding your claim.
make a decision about your claim;
60. If we are contacted by an uninsured person
b. pay you an advance amount to help ease
who wishes to make a claim against one
your urgent financial need — we will do
of our customers, then we will tell them
this within 5 Business Days after you
about our claims process and what is
demonstrate your urgent financial need.
required for us to start a claim. If we have
accepted a claim under our insured’s motor 65. See part 10 of the Code to read more about
vehicle policy, then we will tell them: applying for Financial Hardship support.
a. about the next steps in the claims process; 66. If you are not happy with our response
to your request about urgent financial
b. about our Complaints process; and
need, then we will tell you about our
c. who to contact to find out about Complaints process.
any claim they make, and their
contact details.
Assessing your claim
67. When we are assessing your claim, we will
Scope of works for a only ask for and rely on information that
home building claim is relevant to our decision. If we ask you
61. If a scope of works is needed for a for information, then we will tell you why
home building claim, we will provide you we need it.
with information to help you understand

27
68. If you make a claim and we need further expertise to provide the opinion we ask
information or assessment, then within them for and that they comply with the
10 Business Days of receiving your claim rules and regulations relevant to their
we will: area of expertise.

a. tell you any information we need to

make a decision on your claim. We will Claim decision
use our best endeavours to do that in
76. Once we have all relevant information
one request;
and have completed all enquiries, we will
b. if necessary, appoint a Loss Assessor or decide whether to accept or deny your
Loss Adjuster to assess your claim; and claim and tell you of our decision within
10 Business Days.
c. provide our estimate of the likely
timeframe and process for us to make 77. Our decision will be made within 4 months
a decision about your claim. of receiving your claim, unless paragraph
78 applies. If we do not make a decision
69. When we assess your claim, we will within that time, we will tell you in writing
consider all relevant facts, the terms of about our Complaints process.
your insurance policy and the law.
78. In circumstances where:
70. We will tell you about the progress of your
claim at least every 20 Business Days. a. your claim arises from an Extraordinary
Catastrophe;
71. We will respond to your routine enquiries
about your claim’s progress within 10 b. your claim is fraudulent, or we
Business Days. reasonably suspect it is fraudulent;

c. you do not respond to our reasonable

inquiries or to our requests for
Using an External Expert,
documents or information about
Loss Assessor, Loss Adjuster your claim;
or Investigator
72. If we appoint a Loss Assessor or Loss d. we have difficulty communicating
Adjuster, then within 5 Business Days we with you about your claim due to
will tell you that we have appointed them circumstances beyond our control; or
and what their role is. An appointed loss
e. you request a delay in the claims process;
assessor or loss adjustor may be
an Employee. then within 12 months of receiving your
claim we will tell you our decision in
73. If we appoint an Investigator or Employee
writing. If we cannot make a decision
to investigate your claim, then within 5
within 12 months, we will tell you in
Business Days we will tell you that we
writing about our Complaints process.
have appointed them and what their role
is. When we appoint an Investigator or
Employee to investigate your claim, then Cash settlements
the investigation process will comply
79. If we offer a cash settlement under a
with the Claims Investigation Standards
home building policy, we will provide you
(see part 15).
with information to help you understand
74. If we engage an External Expert to how they work and how decisions are
provide us with a report that we need made on cash settlements.
to assess your claim, then we will ask
them to report to us within 12 weeks of
us engaging them. If the External Expert Claims for total loss
does not meet that timeframe, we will 80. When you have suffered a total loss,
tell you and keep you informed of our we and our Service Suppliers will treat
progress in obtaining the report. your claim with sensitivity. If we have
accepted your claim for a total loss
75. We will engage an External Expert only under your home building and home
if we believe they have the appropriate contents insurance policy and you are

28
 unable to provide proof of ownership for c. the reason we did not comply with
the relevant insured property because the timeframe was that a report from
it was lost in or damaged by the insured an External Expert was delayed, even
event (and we believe your ownership is though we used our best endeavours to
clear) we will not: obtain the report in time.

a. require you to provide proof of 85. The standards in this part of the Code
ownership; or do not apply to your claim if you have
commenced any proceedings against us
b. require a list of insured property that about your claim in any court, tribunal
was lost or damaged. or under any other dispute handling
process, other than through the Australian
Financial Complaints Authority.
Information we give you if we deny
your claim or do not pay in full
81. If we deny your claim, or do not pay it in Use of repairers
full, then we will tell you, in writing: 86. If we have selected and directly authorised
a repairer to repair your damaged property,
a. the aspects of your claim that we do
then we will accept responsibility for the
not accept;
quality of their work and the materials
b. the reasons for our decision; they use. Complaints about the repairer’s
conduct, timeliness, quality of work or the
c. that you have the right to ask us for the materials they use will be handled under
information about you that we relied on our Complaints process.
when assessing your claim;
87. If we have selected and directly authorised
d. that you have the right to ask us for a repairer and we are satisfied that
copies of any Service Suppliers’ or the repair requires rectification and
External Experts’ reports that we relied because of that you need a hire car or
on; and accommodation over and above what we
would provide to you in your policy, then
e. about our Complaints process. we will arrange these for you and cover
the reasonable costs.
82. If you ask for information or for copies
of any Service Suppliers’ or External
Experts’ reports that we relied on, then How we respond to Catastrophes
we will give you that information or
report within 10 Business Days, as set 88. We will respond to Catastrophes
out in part 12 of the Code. efficiently, professionally, practically
and compassionately.

89. We will co-operate and work with the

Changes to timeframes
Insurance Council of Australia on industry
83. If any of the timeframes in this part are coordination and communications under
not practical due, for example, to the the Insurance Council of Australia’s industry
complex nature of your claim, we will Catastrophe coordination arrangements.
agree a reasonable alternative timetable
with you. If we cannot reach an agreement 90. If you have a property claim resulting
on an alternative timetable, we will from a Catastrophe and we have finalised
provide details of our Complaints process. your claim within 1 month after the
Catastrophe event causing your loss, you
84. We must comply with the timeframes in can request a review of your claim if you
this part of the Code, unless any of the think that assessment of your loss was
following apply: not complete or accurate, even though you
may have signed a release. We will give
a. we have complied with an alternative
you 12 months from the date of finalisation
timetable to which you agreed;
of your claim to ask for a review of your
b. our conduct, and the actual timeframe, claim. We will inform you in writing about
were reasonable in all the circumstances; this entitlement and our Complaints
process when we finalise your claim.

29
30
Part 9:
Supporting customers
experiencing vulnerability
This part applies to Retail Insurance Internal policies and training
products only.
95. We will have a publicly available policy
91. We are committed to taking extra care with about how we will support you if you are
customers who experience vulnerability. affected by family violence. This policy
We recognise that a person’s vulnerabilities will be published on our website.
can give rise to unique needs, and that
96. We will have internal policies and training
their needs can change over time and in
appropriate to our Employees’ roles to
response to particular situations.
help them:
92. A person’s vulnerability may be due
a. understand if you may be vulnerable;
to a range of factors such as:
b. decide about how best, and to what
a. age;
extent, we can support you;
b. disability;
c. take account of your particular needs
c. mental health conditions; or vulnerability; and

d. physical health conditions; d. engage with you with sensitivity,

dignity, respect and compassion —
e. family violence; this may include arranging additional
support, for example referring you to
f. language barriers; people, or services, with specialist
g. literacy barriers; training and experience.

h. cultural background;
Support measures
i. Aboriginal or Torres Strait Islander status; 97. If you tell us, or we identify, that due to a
j. remote location; or vulnerability you need additional support
or assistance, we will work with you
k. financial distress. and try to find a suitable, sensitive and
compassionate way for us to proceed.
93. We encourage you to tell us about your We will do this as early as practicable and
vulnerability so that we can work with you we will protect your right to privacy.
to arrange support — otherwise, there is a
risk that we may not find out about it. 98. If you tell us, or we identify, that you need
additional support from someone else (for
94. If you are experiencing Financial Hardship, example, a lawyer, consumer representative,
see part 10 of the Code about the support interpreter or friend), then we will recognise
we can provide to you. this and allow for it in all reasonable ways.
We will try to make sure our processes are
flexible enough to recognise the authority of
your support person.

31
99. Additional support may include making it c. we will only ask relevant questions when
easier for you to communicate with us, deciding whether to provide cover for a
referring you to a financial counsellor or an pre-existing mental health condition;
appropriate community support service.
d. if we cannot provide you with cover
for that condition we will tell you
Identification about your right to ask us for the
information relied on when assessing
100. If you need support to meet identification
your application. If you ask for that
requirements, then we will take reasonable
information, then we will give it to you
measures to support you — particularly
as set out in part 12 of the Code.
if you are from an Aboriginal or Torres
Strait Islander community or a non-English
speaking background. Our approach to
supporting you with verification and
identification will be flexible.

Using interpreters
101. Where practicable, we will provide access
to an interpreter if you ask us to, or if
we need an interpreter to communicate
effectively with you. We will record if an
interpreter is used or if there are reasons
we are unable to arrange one.

102. We will arrange relevant training for our

Employees who are likely to be involved in
communications requiring an interpreter.

103. On our website there will be an easy-to-

find link to:

a. information on interpreting services;

b. teletypewriter services (TTYs);

c. any information on our products

that we have translated into other
languages; and

d. any other relevant information for

people with language barriers.

Mental health
104. When developing our internal processes
and procedures we will take into account
those who have a past or current mental
health condition by doing the following:

a. at a minimum, we will design and sell

our products and apply their terms in
compliance with the requirements of
the Disability Discrimination Act 1992
and/or any relevant State or Territory
anti-discrimination requirements;

b. we will treat people with any past or

current mental health condition fairly;

32
33
Part 10:
Financial Hardship
Individuals entitled to support a. details about how to apply for Financial
Hardship support; and
105. We will have information about applying
for Financial Hardship support on our b. if appropriate, contact details for the
website. The information will set out National Debt Helpline: 1800 007 007.
the types of support options that may
be available, and how you can access
Financial Hardship support. Keeping you informed
106. You have a right to ask us to fast-track a 112. We will communicate with you about your
claim if you have an urgent financial need. application and where possible, we will use
See paragraph 64. your preferred method of communication.

107. You may be entitled to support because you 113. If we know that you have nominated a
are suffering Financial Hardship if you are: representative, then we will keep that
person updated about your request for
a. an individual Insured or a Third Party Financial Hardship support, unless you
Beneficiary who owes us money tell us not to.
— including an excess — under an
insurance policy we have issued; or
Assessing your request for Financial
b. an individual and we are seeking to Hardship support
recover money from you because we
114. When we are assessing your request for
believe you caused damage or loss
Financial Hardship support, we will consider
to either an Insured, or a Third Party
all reasonable evidence — for example:
Beneficiary who we cover under an
insurance policy. a. evidence of serious illness that prevents
you from earning income;
108. The support that we provide does not
include support with paying the premiums b. evidence of a disability, including a
under an insurance policy we have issued. disability caused by mental illness;

c. if you are a Centrelink client, your

Identifying people experiencing Centrelink statements; and
Financial Hardship
d. evidence of your unemployment.
109. We will have internal policies and training
appropriate to our Employees’ roles to help 115. We will request information from you
them to identify if you are experiencing only if it is reasonably necessary for us
Financial Hardship and decide how they to assess your application for Financial
may be able to provide support to you. Hardship support.

110. We encourage you or your representative 116. If, after we receive your application for
to tell us about your Financial Hardship Financial Hardship support, we need more
so that we can work with you to discuss information from you before we can make
your situation and the options available our decision, then we will:
to support you — otherwise there is a risk
that we may not find out about it. a. tell you the information we need as
early as possible; and
111. If you tell us, or we identify, that you are
experiencing Financial Hardship, we will b. be specific about the information we need.
give you: 117. You have 21 Calendar Days from the date
of our request under paragraph 116 to

34
 provide that information to us, unless we b. paying us in instalments — we will not
have agreed to a different timeframe. refuse a reasonable request from you to
pay the amount you owe in instalments;

Putting recovery on hold c. paying a reduced lump sum amount;

118. If we are taking action to recover an d. delaying one or more instalment
amount from you, we will put that payments for an agreed period;
action on hold if we identify that you are
experiencing Financial Hardship, or if you e. deducting the excess from the claim
ask us for Financial Hardship support in amount we pay you;
relation to that amount.
f. waiving cancellation fees.
119. When we put the action on hold, we will
contact any Collection Agent or solicitor 124. We will confirm the agreed arrangement
that we have appointed and tell them the with you. Where possible this will be in
action is on hold. your preferred method of communication.

120. The action will stay on hold until we have 125. If we agree you are entitled to Financial
assessed your application for Financial Hardship support, but we are unable to
Hardship and notified you of our decision agree about how you can be supported,
about it. then we will tell you in writing, about our
Complaints process.

Making our decision

Releasing your debt
121. We will tell you in writing of our decision
about whether to give you Financial 126. If we decide you are entitled to Financial
Hardship support within 21 Calendar Days Hardship support, then you may ask us
after we receive your application, unless to release, discharge, or waive a debt
we have asked you to provide us with or obligation. However, you are not
more information. automatically entitled to this.

122. If we do ask you for more information 127. If we agree to release, discharge or waive
under paragraph 116 and: a debt or obligation, then we will confirm
this with you in writing.
a. you provide all information we
128. You can ask us to notify any financial
requested, then within 21 Calendar Days
institution with an interest in your
of receiving it we will tell you in writing,
insurance policy that you are entitled
our decision about whether to give you
to Financial Hardship support and,
Financial Hardship support; or
if applicable, that we have released,
b. you do not provide all information we discharged or waived a debt or obligation.
requested within 21 Calendar Days If you ask us to do this, then we will tell
(or by a later date we agree to), then them about this in writing.
within 7 Calendar Days of that deadline
passing, we will tell you in writing, our
decision about whether to give you
If you are not entitled to
Financial Hardship support. Financial Hardship support
129. If we decide that you are not entitled
to Financial Hardship support, we will
If you are entitled to Financial tell you the reasons for our decision and
Hardship support about our Complaints process. Where
123. If we decide you are entitled to Financial possible, we will tell you this in your
Hardship support, then we will work preferred method of communication.
with you to implement an arrangement 130. If your circumstances change, then you
that could include any one or more of may re-apply for Financial Hardship
the following: support in relation to the amount you owe.
However, for any further application you
a. delaying the date on which the payment
make, it will be at our discretion whether
must be made;
we again put any recovery action on hold.

35
Standards for collecting money Bankruptcy
131. We, as well as any Collection Agent or 137. If you tell us that you intend to declare
solicitor collecting money for us, will bankruptcy, then we will work with you
comply with the Debt collection guideline: (or your representative) to agree on the
for collectors and creditors published by amount owed. We will also give you written
the Australian Competition and Consumer confirmation of that amount for the
Commission and the Australian Securities purposes of your declaration of bankruptcy.
and Investments Commission.
138. If we cannot agree on an amount, then
132. We, as well as any Collection Agent or we will provide details of our Complaints
solicitor collecting money for us, are process in writing.
required to:

a. understand the Financial Hardship

requirements in the Code; and

b. receive training to help identify

whether you might need Financial
Hardship support.

133. When we, our Collection Agent or solicitor,

first communicates with you about any
money owed, then we will ensure that
this communication will provide you with
information to show that the amount we
are seeking to recover from you is fair and
reasonable. This may include:

a. information on the relevant loss and/or

damage and the claim;

b. the actual cost of completed repairs;

and

c. the evidence we relied on when we

calculated the amount.

134. This communication will also include:

a. information about our Financial

Hardship process; and

b. contact details to enable you to contact

us to discuss Financial Hardship
support or if you have any questions.

135. If our Collection Agent or solicitor

communicates with you about money
owed, then that communication will
identify us as the insurer that they are
acting on behalf of and will specify the
nature of our claim against you.

136. If you tell our Collection Agent or solicitor

that you are experiencing Financial
Hardship, then they must notify us and
give you information in writing about our
Financial Hardship process.

36
37
Part 11:
Complaints
This part applies to Retail Insurance products. 146. We will keep you informed about the
In addition, it is available to an uninsured progress of your Complaint at least every 10
person making a claim against a customer who Business Days, unless it is resolved earlier
we insure under a Retail Insurance policy (see or you agree to a different timeframe.
paragraph 60).

This part also applies to Wholesale Insurance Decision about your Complaint
products where you are entitled to Financial
147. We will make a decision about your
Hardship support under paragraph 107(b).
Complaint within 30 Calendar Days. If
we cannot make our decision within this
timeframe, then before this deadline
Making a Complaint
passes we will tell you, in writing, the
139. You may complain to us about any reasons for the delay and about your right
aspect of your relationship with us. to take your Complaint to the Australian
Financial Complaints Authority, and its
140. We will make readily available
contact details.
information about:
148. When we have made a final decision
a. your right to make a Complaint;
about your Complaint we will respond
b. our internal processes for dealing to you in writing, unless paragraph 150
with Complaints; and applies.

c. our external dispute resolution provider. 149. Our written response to you will include
the reasons for our decision and inform
This will be published on our website, you of your right to take your Complaint
other digital platforms and in our relevant to the Australian Financial Complaints
written communications. Authority if you are not satisfied with
our decision. We will provide you with
141. Our Complaints process will comply with its contact details and the timeframe in
the Australian Securities and Investments which you are able to complain to it.
Commission’s guidelines.
150. We will provide you with a written
response where your Complaint is about
Handling your Complaint Financial Hardship, a declined claim, the
142. When we receive your Complaint, we will value of a claim or you have requested
acknowledge that we have received it. a written response. Otherwise, a written
response may not be provided where,
143. We will tell you the name and relevant within 5 business days, we have been
contact details of the person assigned to able to resolve your Complaint to your
liaise with you about your Complaint. satisfaction, or we have given you an
explanation and/or an apology and can
144. Your Complaint will be handled by a
take no further action to reasonably
person with appropriate authority,
address your Complaint.
knowledge or experience. This will not
be the person whose decision or conduct 151. We must give you the information that we
is what your Complaint is about. relied on when making a decision about
your Complaint within 10 Business Days of
145. When we are considering your Complaint,
you asking us for that information. We will
we will only ask for, and rely on,
give you the information as set out in part
information that is relevant to our decision.
12 of the Code.

38
Mistakes when handling d. we will have processes in place to
your Complaint monitor their handling of Complaints
and take reasonable steps to ensure
152. If it is identified that we have made a that they are meeting the requirements
mistake when handling your Complaint, as specified in this part of the Code.
then we will take action to correct the
mistake.

The Australian Financial

Complaints Authority
153. We are part of an independent external
dispute resolution scheme administered
by the Australian Financial Complaints
Authority. The scheme is for customers and
third parties as allowed under its Rules.

154. You can take your Complaint to the

Australian Financial Complaints Authority
at any time and if we do not resolve your
Complaint within 30 Calendar Days after
we first received your Complaint.

155. Under the Australian Financial Complaints

Authority’s Rules, your Complaint may
be referred back to us if it has not gone
through our Complaints process.

156. The Australian Financial Complaints

Authority’s decisions are binding on us
in the way set out in its Rules.

157. If the Australian Financial Complaints

Authority tells you that under its Rules
it cannot assist you or consider your
dispute, then you can seek independent
legal advice. You can also access any
other external dispute resolution or other
options that may be available to you.

Complaint management
by third parties
158. We may authorise another person to act on
our behalf to receive and handle Complaints
about our products and services.

159. Where we authorise another person to

receive and handle Complaints under
paragraph 158, then:

a. that person must notify us of

Complaints made to them;

b. they must handle Complaints in

accordance with the requirements as
set out in this part of the Code;

c. any breach of this part of the Code by

them is a breach of the Code by us;

39
40
Part 12:
Your access
to information
160. We comply with the Principles of the of other individuals or government
Privacy Act 1988 and/or any relevant agencies; or
State or Territory requirements when we
collect, store, use, disclose and destroy c. if doing so may be prejudicial to us in
personal information about you. relation to a Complaint or a dispute
about your insurance cover or your claim
161. At your request, and subject to paragraph — however, even in this circumstance
163, we must give you — free of charge, we must give you access to any External
access to any information that we relied Experts’ reports we relied on.
on in assessing your application for
insurance cover, or in handling your claim,
or in responding to your Complaint. We
must give you this information within 30
Calendar Days unless paragraph 82 or
151 applies.

162. The information you may access includes:

a. documents and information we relied

on to deny your claim;

b. copies of your product disclosure

statement and insurance;

c. copies of any reports from Service

Suppliers or External Experts that we
relied on; and

d. copies of any recordings and/or

transcripts of any interaction we had
with you that we relied on.

163. If we refuse to give you access

to information, we will not do so
unreasonably, and we will tell you our
reasons for doing so and about our
Complaints process. We may refuse to
give you access to information in the
following circumstances:

a. where a law — for example, the Privacy

Act 1988 — says we do not have to;

b. in the case of a claim where the claim

is being or has been investigated,
and giving access would have an
unreasonable impact on the privacy

41
42
Part 13:
Enforcement, sanctions
and compliance
Reporting breaches c. liaising with the Insurance Council of
Australia on relevant matters;
164. Anyone can report alleged breaches of the
Code to the Code Governance Committee d. providing quarterly reports to the Board
at any time. of the Insurance Council of Australia;

e. publishing an annual public report

The Code Governance Committee containing aggregate industry data
165. The Code is monitored and enforced and consolidated analysis on Code
by the Code Governance Committee compliance.
which is an independent body. The Code
169. The Code Governance Committee is also
Governance Committee is made up of:
responsible for monitoring and enforcing
a. a consumer representative; compliance with the Code through:

b. an industry representative; and a. investigations, analysis of data,

analysis of evidence and stakeholder
c. an independent chair. engagement;

166. The Code Governance Committee’s b. receiving, investigating and making

constitution, functions and powers are set decisions about alleged breaches and
out in its Charter. giving us the opportunity to respond to
any allegations that we have breached
167. The Code Governance Committee the Code;
may outsource to an appropriate
service provider any of the following c. considering whether it is more
responsibilities: appropriate for the Australian Securities
and Investments Commission or another
a. monitoring and enforcing compliance enforcement agency to investigate an
with the Code; alleged breach of the Code;
b. annual reporting; d. agreeing with us on any corrective
c. the responsibilities under paragraphs measures to implement within an
168 and 169. agreed timeframe;

e. imposing sanctions; and

The responsibilities of the f. publishing breach decisions on a
Code Governance Committee de-identified basis.
168. The Code Governance Committee is
responsible for:
Imposing sanctions
a. providing stewardship of the Code by 170. The Code Governance Committee may
helping the general insurance industry impose sanctions on us for a breach of
understand and comply with the Code; the Code. When determining any sanctions
to be imposed, the Code Governance
b. identifying areas for improvement of
Committee will consider:
insurance practices;

43
 a. the appropriateness of the sanction; 175. When requiring us to pay compensation
or a community benefit payment, the
b. if we have not acted on — or have taken Code Governance Committee must take
too long to act on — a request from the into account any compensation awarded
Code Governance Committee to remedy by the Australian Financial Complaints
a breach; Authority or an enforcement agency.
The Code Governance Committee must
c. if we have breached an undertaking we
also take into account any impending or
gave to the Code Governance Committee;
ongoing investigation by the Australian
d. if we have not taken adequate steps Securities and Investments Commission.
to prevent a Significant Breach from
176. The Code Governance Committee will
reoccurring;
report Significant Breaches or serious
e. if we have not acted with the utmost misconduct to the Australian Securities
good faith. and Investments Commission.

171. Before the Code Governance Committee 177. The Australian Financial Complaints
imposes a sanction on us, it must give us Authority may report possible Code
the opportunity to provide a response. We breaches to the Code Governance
will respond within 10 Business Days. Committee.

172. The Code Governance Committee must give 178. The Code Governance Committee’s
us written reasons for its final decision. decisions and sanctions are binding
on us.

Types of sanctions
Our compliance with the Code
173. As a sanction for our breach of the
Code, the Code Governance Committee 179. We will have a governance process in
may require us to do any one, or more, place to report to our Board or our
of the following: executive management, on our
compliance with the Code.
a. take particular rectification steps within
a set timeframe; 180. We will have appropriate systems and
processes in place to enable the Code
b. audit our compliance with the Code at Governance Committee to monitor
our own cost; our compliance with the Code. We will
prepare an annual compliance report to
c. advertise to correct something that the the Code Governance Committee on our
Code Governance Committee decides compliance with the Code.
needs correcting.
181. If we identify a Significant Breach of the
174. The Code Governance Committee Code, then we will report it to the Code
may impose additional sanctions for Governance Committee within
Significant Breaches of the Code, 10 Business Days.
including requiring us to do any one
or more of the following: 182. We will cooperate with the Code
Governance Committee in its review
a. compensate an individual for any direct of our compliance with the Code and
financial loss, or damage, we caused its investigations of any breaches of
them arising from a Significant Breach; the Code.
b. publish the fact that we have committed
a Significant Breach of the Code;

c. pay a community benefit payment for

a Significant Breach up to a maximum
of $100,000. The size of the community
benefit payment must be in proportion
to our gross written premium and
number of customers.

44
45
Part 14:
Promoting, reviewing
and improving the Code
Promoting the Code industry representatives, relevant
regulators and other stakeholders to
183. The Insurance Council of Australia is
develop the Code on an ongoing basis.
responsible for promoting the Code to
customers and to industry participants 188. At least every 3 years the Insurance
that have not yet adopted the Code. Council of Australia will commission a
formal, independent review of the Code.
184. The Insurance Council of Australia
will work with the Code Governance 189. If the Code Governance Committee
Committee, the Australian Securities believes the Code is not meeting the
and Investments Commission, relevant objectives outlined in part 1 of the Code,
regulators and other stakeholders to then the Code Governance Committee
encourage all general insurers and other may recommend to the Board of the
industry participants conducting business Insurance Council of Australia that the
in Australia to adopt the Code. Code should be reviewed.
185. We will work with the Insurance Council 190. The Code Governance Committee may,
of Australia to promote and champion in its quarterly reports to the Board of
the Code. the Insurance Council of Australia, make
recommendations about any one or more
186. We will:
of the following:
a. provide information about the Code and
a. Code improvements, Code related
the Code Governance Committee on our
issues and matters of importance
websites, in our product information
as a response to its monitoring and
and in other places we consider it
enforcement;
appropriate to do so;
b. promoting the Code;
b. work with the Insurance Council of
Australia to provide general information c. education and training relevant to
to help you access insurance products; the operation of the Code;
c. work with the Insurance Council d. the Insurance Council of Australia’s
of Australia to initiate programs to industry Catastrophe coordination
promote insurance, financial literacy arrangements; and
and the insurance industry; and
e. the Complaints process.
d. support the Insurance Council of
Australia’s initiatives aimed at education 191. We must comply with any additional
on general insurance. obligations and binding standards that the
Insurance Council of Australia introduces
to the Code.
Reviewing and improving the Code
192. The Insurance Council of Australia may
187. The Insurance Council of Australia will
issue non-binding best practice guides
consult with the Code Governance
to help us meet our obligations under
Committee, the Australian Financial
the Code.
Complaints Authority, consumer and

46
47
Part 15:
Claims investigation
standards
Paragraph 73 of the Code states: If we appoint 197. During the review, the Employee will
an Investigator or Employee to investigate your determine if there is sufficient cause
claim, then within 5 Business Days we will tell for the investigation into your claim to
you that we have appointed them and what continue. If it is determined that the
their role is. When we appoint an Investigator investigation should stop, then your claim
or Employee to investigate your claim then the will be referred for a decision as set out
investigation process will comply with these in part 8.
claims investigation standards.
198. The review process will not exceed 30
Calendar Days. If we do not complete
General investigation obligations the review and notify you of the outcome
within that time, we will tell you in writing
193. If we appoint an Investigator, or Employee,
about our Complaints process.
to investigate your claim, then we will
make sure that they investigate: 199. After the review, we will tell you in writing,
why we have not been able to make a
a. only those matters they need to
decision on your claim and any information
investigate; and
we still need that we do not have.
b. in an appropriate and respectful manner.
200. To ensure our investigations are
194. We have a quality assurance program appropriately focused:
to regularly monitor and review our
a. we will ensure that any requests to you
investigations. That program might include
for more information, or documents, are
reviews of:
reasonable and relevant to the claim
a. recordings, statements, affidavits or under investigation. We will:
transcripts of interviews;
i. use our best endeavours to do that
b. Investigators’ records of investigation in one request;
activities; and
ii. tell you why we need the information
c. Complaints about investigations, that we are requesting.
including disputes referred to the
b. when we give our Investigators and
Australian Financial Complaints Authority.
Employees authority and instructions in
195. Our quality assurance program will relation to your claim, we will:
include reviews of our non-genuine
i. clearly limit the purpose of the
claims indicators to make sure they
investigation to the claim in question;
remain relevant, appropriate and do not
discriminate — we review these at least ii. carefully define their scope about
once a year. the type of information we are
requesting and the period covering
196. If an investigation has gone on for 4 months,
the request.
then we will have your claim independently
reviewed by an Employee with appropriate 201. Before we first start the investigation of
authority, knowledge or experience. We will your claim, we will discuss with you why
inform you if this happens. your claim is being investigated. We will

48
 train our Employees about how to have f. how long the Investigator expects
these conversations and the information the interview to take;
they need to discuss with you.
g. our contact details, so you can
202. Before we first start the investigation contact us with any questions about
of your claim, we will tell you, verbally the interview, the Investigator or the
and in writing: Employee appointed to investigate
your claim;
a. about our claims investigations process;
h. your right to have a legal representative
b. who is your primary contact for the or a support person, who may be a
investigation and their details; family member, friend or other person,
to support you through the interview
c. the role and responsibility of the
but may not answer questions on your
Investigator or any Employee that has
behalf; and
been appointed to investigate your claim;
i. how the interview is to be recorded.
d. when to expect to hear from the
Investigator or Employee — and what to 206. If you have asked us to communicate
do if you do not hear from them within through a representative, then we will
that timeframe; tell the Investigator, or Employee
appointed to investigate your claim,
e. that within 10 Business Days after we
to contact the representative first. If
have received all relevant information and
they cannot make contact with the
completed all of our enquiries, we will
representative within a reasonable
tell you if we are going to pay your claim,
time, then they will contact you.
unless an exception in the Code applies;
207. If an independent interpreter is needed
f. your rights and responsibilities under
either for you, or for us, we will arrange
the policy during the investigation;
for this at our cost.
g. about our Complaints process.
208. If you tell us, or we identify, that you need
203. If we need your authority to access additional support or have other particular
information from someone else, then needs, then we will arrange for the
we will explain to you why we think you Investigator or Employee to be someone
should give us that authority. who we are satisfied has appropriate
training or experience to conduct the
204. At least every 20 Business Days, we will interview in light of those needs.
update you about the investigation’s process.
209. If you request for the Investigator, or
Employee appointed to investigate your
Before any formal interview claim, to be the same gender as you we
205. If we need to formally interview you as will tell you if we can arrange for this.
part of the investigation, then before the We may not be able to do this if it is not
interview starts, we will tell you in writing: reasonably practical for us to do so.

a. the purpose of the interview; 210. When we are arranging the interview,
we will tell you:
b. your rights and responsibilities during
the interview; a. several possible convenient locations,
including your home, where the
c. your right to have an interpreter — interview can occur, and that you can
free of charge — to translate any suggest another location, provided it
information given to you and any is a reasonable place for both you and
answers you provide; the Investigator or Employee;

d. who will conduct the interview — b. that you can schedule the interview for
and their contact details; a time and date that suits you.

e. if an Investigator is appointed, that 211. If we intend to interview (or our

they are acting on our behalf; Investigators or Employees inform us that

49
 they wish to interview) someone who is honest, efficient, transparent and fair
under 18, then we will: manner at all times.

a. assess whether the interview is 214. A single interview sitting may only last for
necessary and whether the interviewee up to 90 minutes.
is capable of distinguishing truth from
fiction. We will use trained professionals 215. If another interview time is needed, it will
to assess this and they will record how not be organised without at least a 24
they made that assessment; hour break, unless otherwise agreed.

b. require any Investigator or Employee to 216. If the total interview time required is over
clearly set out the scope of the interview; 4 hours, the Investigator or the Employee
appointed to investigate your claim must
c. require any Investigator or Employee obtain written consent from us. In that
conducting the interview to obtain written consent, we will provide the
our written approval to the interview reasons why this time extension is needed.
and the scope of the interview before
interviewing the person who is under 18; 217. If during the interview it becomes
apparent that an interpreter is needed
d. require any Investigator or Employee either for you, or for us, (even though
conducting the interview to obtain our one had not previously been requested
written approval before expanding the or arranged), then the Investigator or
scope of the interview beyond what we Employee will:
consented to — that approval may be
given only by one of our Employees with a. pause the interview; and
appropriate experience and training;
b. restart it at a later time, or date,
e. use an Investigator or Employee who we once an independent interpreter has
are satisfied has appropriate training or been arranged.
experience to conduct the interview;
218. If during the interview you need additional
f. make sure that any interview takes support (for example a lawyer, consumer
place only in the presence of the representative or a friend), even though
interviewee’s parent, guardian or one had not previously been requested
responsible adult; and or arranged, then the Investigator or
Employee will:
g. make sure that the Investigator pauses
the interview: a. pause the interview;

i. if they are aware that the b. advise you of the support person’s role
interviewee is distressed by the in the interview process in accordance
interview process; or with paragraph 205(h); and

ii. at the request of the interviewee, c. restart the interview at a later time,
parent, guardian or responsible adult. or date, once the support person has
been arranged.

During the formal interview 219. We will offer you a 5 minute break in the
interview every 30 minutes. However, if
212. When the interview happens, the you tell us — or we identify — that you
Investigator, or Employee appointed to are experiencing vulnerability, then there
investigate your claim, will ask you a will be a 5 minute break every 30 minutes.
series of questions about the information Any break is a time-out and is not
contained in the interview consent included in the 90 minute period referred
form. Those questions are designed to to under paragraph 214.
make sure we have your consent to the
interview (or not). 220. Also, you can request additional breaks
and stop the interview early and
213. We require our Investigators or Employees reschedule if needed.
appointed to investigate your claim, to
conduct all interviews in an objective,

50
221. The Investigator or Employee must 229. Our Investigators must make or retain
record all offers of breaks, and the contemporaneous records in writing of all
interviewee’s responses. investigation activities, including but not
limited to details of:

After the formal interview a. conversations held in person;

222. We will offer you a transcript of the b. telephone conversations;
formal interview (or a digital copy of the
recorded interview), and it will be given to c. unanswered telephone calls — including
you for free. You can also request this at a any messages left;
later time and it will be provided for free.
d. all written communications sent —
223. Also, if we need to interview you more whether: letters, faxes, emails etc.;
than once, then before the second or any
e. their travel;
later interview, we will give you a copy of
the record of your previous interview. f. interviews and statements obtained;
and
External Investigators only g. any electronic checks — including
224. Our contracts with Investigators will set government and social media sites, for
out standards about how they are to example: internet, land titles, Facebook,
conduct themselves, and what they need or business affairs.
to do, when investigating people who may
be vulnerable. 230. We and/or the organisations that provide
our Investigators, must keep these records
225. If we appoint an Investigator to help us for at least 7 years.
with your claim, then we will:
231. We require all our Investigators:
a. give them written instructions about
each investigation; a. to collect information only if they
reasonably believe it is relevant to
b. confirm any changes to our instructions; their investigation;
and
b. to comply with any relevant law;
c. require them to get our consent before
they exceed their existing instructions. c. to not use illegal means or methods
to carry out the investigation;
226. We require our Investigators to:
d. to not induce someone to perform
a. record the requests they make to a task, or activity, that they would
individuals for written authorisation not have performed without the
to access the individual’s personal involvement of the Investigator;
information that is held by other
parties; and e. to not make any threat, promise
or inducement to any person when
b. to provide those records to us at the conducting an investigation on our behalf;
end of their investigation.
f. to comply with the standards in this
227. Before we authorise an Investigator document that are relevant to their
to investigate or interview a person activities performed on our behalf; and
who may be vulnerable, they will have
received training on how to work with g. to obtain authority by the insurer before
vulnerable customers. alleging fraud.

228. We keep an up-to-date register of our

Investigators’ licences, including their Surveillance
expiry dates. We do this to make sure the
232. Before we authorise any surveillance of
licences of any Investigators we engage
you, we:
are valid and current.
a. make sure that alternative methods of

51
 verifying the relevant information the
surveillance would relate to have been
considered;

b. must reasonably believe that your claim

appears to be inconsistent with the
information available to us — and we
must record our reasons for this belief;
and

c. arrange for a suitably experienced

Employee to review and approve the
request for surveillance.

233. We will not conduct surveillance of you:

a. inside any court, or other judicial facility;

b. in any medical, or related facility;

c. in any bathroom, change room, or

lactation room;

d. inside your house;

e. at a business premises — unless it is

open to the public;

f. where prohibited by relevant law.

234. We will stop surveillance of you if we

become aware that you have a pre-
existing mental health condition.

235. We will require our Investigators to not

communicate with your neighbours,
or your work colleagues, in a way that
might — directly, or indirectly — reveal
that surveillance will be, is being, or has
been, conducted.

52
Guide: Interview consent form

Interviewer name and contact details: Interviewee’s name and contact details:
[If under 18 parent, guardian or responsible adult]

Insurer’s details:

Subject matter of interview:

Need an interpreter, lawyer Your privacy statement,

or support person? acknowledgement and consent

You can have an interpreter, legal If authority to access information from

representative or other support person third parties is required, the following
present during your interview. may be provided:

If you would like to arrange this, • scope of authority

then please: • type of information to be requested
• let the Investigator know as soon • period of information requested
as possible; and • impact on the claim if the information
• confirm your request below in writing. is not provided
• date of issue and expiry of authority

Your interview preferences statement

I agree to be interviewed by the Investigator named above — who is a representative

of in relation to the above matter.

After discussing my options with the I would like to be provided with:

Investigator, I agree to: (Please select)
a typed statement of the interview
the interview being digitally audio recorded
a handwritten statement of the interview
the interview being digitally video recorded

other (please write in)

Signature: Date

53
54
Part 16:
Definitions
Business Days are Monday to Friday, b. has authority to issue, vary or dispose of,
excluding public holidays. a general insurance product covered by this
Code under a binder with us (excluding an
Calendar Day means any day, including interim contract).
weekends and public holidays.
Domestic Builders Insurance and Domestic
Catastrophe means an event declared by Builders Warranty/Indemnity Insurance means
the Insurance Council of Australia to be insurance as defined by the relevant State or
a Catastrophe - for example fire, flood, Territory legislation.
earthquake, cyclone, severe storm, or hail,
resulting in a large number of insurance Employee means a person employed either:
claims and involving multiple insurers.
a. by us; or
Code means the General Insurance Code b. by a related entity that provides services
of Practice 2020. to which this Code applies.
Collection Agent means a person, company External Expert means:
or entity who is not our Employee that we
a. a company, entity, or a person who is not
contract to recover money owing to us.
our Employee or a Service Supplier; and
Complaint means an expression of b. that we contract solely to provide an expert
dissatisfaction made to us, related to our opinion about the likely cause of your loss
products or services, our staff, or the handling or damage.
of a Complaint where a response or resolution
is explicitly or implicitly expected or legally Extraordinary Catastrophe means a Catastrophe
required. A Complaint also includes such that is so significant in size or magnitude or one
expressions of dissatisfaction made about that coincides with multiple other Catastrophes
us on a social media channel or account that the Board of the Insurance Council of
owned or controlled by us, where the person Australia declares it to be extraordinary.
making the Complaint is both identifiable
and contactable. Financial Hardship means you have difficulty
meeting your financial obligations to us.
Consumer Credit Insurance means insurance
as defined in regulation 7.1.15 under the in writing means a communication conveyed
Corporations Regulations 2001, but it excludes: by any one or more of mail, email, facsimile,
text message, or a document sent or given to
a. Consumer Credit Insurance sold through the relevant person.
motor dealer intermediaries; and
b. Consumer Credit Insurance sold alongside Instalment Policy means a Retail Insurance
a refinanced loan where Consumer Credit policy for which the premium is payable by 7
Insurance has been purchased with the or more instalments in a year, as defined in
original loan. the Insurance Contracts Act 1984.

Distributor means a person, company or entity Insured means a person, company or entity
when acting on our behalf, that is not an holding, or seeking to hold, a general insurance
Employee, and; product covered by this Code. It excludes a
Third Party Beneficiary.
a. is authorised to provide financial services,
other than a claims handling and settling Investigator means:
service, under our Australian Financial
a. a company, entity, or a person who is not
Services Licence, in accordance with the
our Employee; and
Corporations Act 2001; or

55
b. that we contract to verify the circumstances a. a motor vehicle insurance product
relating to your claim. (Regulation 7.1.11);

Loss Assessor or Loss Adjuster means: b. a home building insurance product

(Regulation 7.1.12);
a. a company, entity, or a person who is not
our Employee; and c. a home contents insurance product
(Regulation 7.1.13);
b. that we contract to:
d. a sickness and accident insurance product
i. examine the circumstances of your claim; (Regulation 7.1.14);
ii. assess the damage or loss; e. a Consumer Credit Insurance product
iii. determine whether your claim is covered (Regulation 7.1.15);
under your policy; f. a travel insurance product (Regulation 7.1.16);
iv. assist in obtaining a repair quote, or a g. a personal and domestic property
replacement quote; and insurance product (Regulation 7.1.17) as
v. help settle the claim. defined in the Corporations Act 2001 and
the relevant Regulations.
Marine Insurance means insurance to which
the Marine Insurance Act 1909 applies. The Service Supplier means an Investigator, Loss
Code applies to pleasure craft covered by the Assessor or Loss Adjuster, Collection Agent,
Insurance Contracts Act 1984. or a person, company or entity who is not our
Employee but is contracted by us to manage
Medical Indemnity Insurance means medical your claim on our behalf (including a broker
indemnity cover for health care professionals who manages claims for us) and any of their
under a contract of insurance covered by the sub-contractors who we have approved and
Medical Indemnity (Prudential Supervision and who are also acting on our behalf.
Product Standards) Act 2003.
Significant Breach means a breach that is
Motor Vehicle Injury Insurance means determined to be significant by reference to:
insurance that covers personal injury or death a. the number and frequency of similar
arising out of the use of a motor vehicle, previous breaches;
including cover for the injury or death of a
driver of a motor vehicle which is caused by b. the impact of the breach, or likely breach,
on our ability to provide our services;
the fault of that person when driving.
c. the extent to which the breach, or likely
No Claims Bonus, No Claims Discount or breach, indicates that our arrangements
No Claims Entitlement means a discount on to ensure compliance with the Code are
your premium that we offer you in which the inadequate;
discount increases (up to a maximum level)
for each consecutive insurance period during d. the actual, or potential, financial loss
which you do not make: caused by the breach; and

a. a claim about something involving e. the duration of the breach.

your fault; or Small Business means a business that employs:
b. a claim that we do not pay. a. less than 100 people, if the business is or
includes the manufacture of goods; or
Pressure Selling means unethical, misleading, or
extended sales techniques that place customers b. otherwise, less than 20 people.
under pressure, or that limit their ability to make
an informed purchase decision. This includes Third Party Beneficiary means a person,
the use of techniques to coerce a customer into company or entity who is not an Insured but
taking out a policy they do not wish to buy. who is seeking to be, is specified to be, or is
referred to as, a person to whom the benefit
Retail Insurance means a general insurance of the insurance cover extends. The relevant
product that is provided to, or to be provided product must be covered by this Code. The
to, an individual or for use in connection with person, company or entity may be specified
a Small Business, and is one of the by, or referred to by, name or otherwise.
following types:

56
we, us or our means the organisation that has
adopted this Code.

Wholesale Insurance means a general

insurance product covered by the Code which
is not Retail Insurance.

Workers Compensation Insurance means

insurance that covers an employer’s liability to
pay compensation for an employment-related
personal injury.

you or your means an Insured or Third Party

Beneficiary, or as otherwise stated in relation
to particular paragraphs of this Code.

57
Insurance Council of Australia

The Insurance Council of Australia is

the representative body of the general
insurance industry in Australia. Its
members represent about 95 per cent
of total premium income written by
private sector general insurers.

PO Box R1832
Royal Exchange
Sydney
NSW 1225

ABN 50 005 617 318

General enquiries:
8.30am to 5pm Monday to Friday
02 9253 5100 or 1300 728 228

www.insurancecouncil.com.au

Published 5 October 2021

All images, content and design are

the Copyright of the Insurance Council
of Australia 2021.