The General Insurance Code Governance Committee (CGC) has completed a Thematic Inquiry into Making Better Claims Decisions.
This report provides the findings of our inquiry into the practices of six general insurers that subscribe to the General Insurance Code of Practice (the Code).
The inquiry analysed data from complaints about denied claims. When a decision to deny a claim is overturned at Internal Dispute Resolution (IDR), we expect insurers to identify insights from the data to improve decision-making, business processes, practices and products in a way that enhances their compliance with the Code. Some insurers are doing this well, but more can be done to identify themes and action insights.
Over half of the sample claim files provided by participating insurers were overturns of claims that were originally denied based on wear and tear or maintenance exclusions. This provided us with insights about the way that insurers are applying these exclusions. We have therefore also made some recommendations to help insurers improve in this area.
The inquiry makes eight recommendations. All Code subscribers are encouraged to adopt the recommendations made in this report to improve their compliance with the Code.
The Committee thanks the six participating subscribers for their involvement in this inquiry.
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