A claim starts with telling your insurer as soon as practical, even before you know the full extent of the damage. From there, if your insurer has adopted the General Insurance Code of Practice, Moneysmart says your insurer will respond within 10 business days, and the Code sets updates at least every 20 business days and, in most cases, a decision within 4 months.
Moneysmart’s guide to a home insurance claim, in its order:
Re-read the policy if you have time, and write down your questions: what the excess will be, whether temporary accommodation is provided, and whether you can choose your own repairer.
Contact the insurer as soon as practical. Some policies have time limits for lodging a claim. If the damage came from criminal activity, contact the police as well. In a wider disaster, phone lines may be busy and lodging online could be quicker.
Talk to the insurer before paying for temporary repairs. Many insurers can arrange emergency repairs, such as removing loose debris or putting a tarp on a roof.
Take photos and videos of the damage as you found it, before moving anything.
For a car, Moneysmart lists what to exchange at the scene with anyone else involved: contact details, the owner’s details if the driver isn’t the owner, licence and registration, insurance company, and the car’s make, colour and model. An excess is generally payable whether or not you were at fault. For travel, Moneysmart says to register the claim as soon as you can: some insurers require notice of an incident within 24 hours.
Not sure whether you’re covered? Under the Code you can ask before you claim. The insurer will not discourage you from claiming, and will tell you that a claim would be fully assessed.
The clock
The timeframes in part 8 of the Code
These apply to retail insurance from insurers that have adopted the Code.
General Insurance Code of Practice, part 8: assessing your claim
Where the insurer needs more information or an assessment to decide your claim, the Code has it act “within 10 Business Days of receiving your claim”. In that time it will tell you what information it needs to decide, doing its best to ask for it all in one request; appoint a Loss Assessor or Loss Adjuster to assess the claim, if one is needed; and give you its estimate of how long the decision will take and how it will be made.
within 10 Business Days of receiving your claim
Read plainly
If the insurer needs more, it says what within 10 business days, ideally in one request, and estimates how long a decision will take.
5 business days
Urgent needWhere an event such as a natural disaster leaves you in urgent financial need, the insurer will fast-track the claim, pay an advance, or both. The advance comes within 5 business days after you demonstrate the need.
10 business days
What else is neededThe information it needs, any loss assessor or adjuster, and its estimate of the timeframe.
5 business days
Who has been appointedAfter appointing a loss assessor, loss adjuster or investigator, the insurer tells you, and explains their role.
Every 20 business days
ProgressAn update at least this often, and replies to routine enquiries within 10 business days.
12 weeks
Expert reportsAn external expert is asked to report within 12 weeks. If they don’t, the insurer tells you and keeps you informed.
10 business days
The decision, once enquiries endOnce it has all relevant information and has completed its enquiries, the insurer decides and tells you within 10 business days.
4 months
Four monthsThe decision is made within 4 months of receiving the claim. If not, the insurer tells you in writing about its complaints process.
12 months
The exceptionsFor an extraordinary catastrophe, suspected fraud, unanswered requests, communication difficulties beyond the insurer’s control, or a delay you asked for, the decision comes in writing within 12 months.
If a timeframe isn’t practical, for example because a claim is complex, the insurer will agree a reasonable alternative timetable with you, or give you details of its complaints process if you can’t agree. The Code also excuses a missed timeframe where the insurer’s conduct and the timeframe were reasonable in all the circumstances, or where an expert’s report was delayed, and its claims standards stop applying if you start court proceedings against the insurer (other than through AFCA).
The answer
If the claim is denied, or not paid in full
The insurer tells you in writing which parts it doesn’t accept and why, that you can ask for the information about you it relied on, that you can ask for copies of any service suppliers’ or external experts’ reports it relied on, and how to complain. If you ask for that information or those reports, they come within 10 business days. The Code lets the insurer refuse access to some information in some circumstances; if it refuses, it tells you why. Where it refuses because access may prejudice it in a complaint or dispute about your claim, it must still give you any external experts’ reports it relied on.
After a catastrophe, if your property claim was finalised within 1 month of the event, you can ask for a review within 12 months of finalisation if you believe your loss was not fully or accurately assessed, even if you signed a release. Moneysmart notes this holds even if you agreed to a full or partial cash settlement.
Settling
Repairs by the insurer, or cash
An approved home claim involving repairs comes with a written scope of works, setting out what will and won’t be repaired or replaced and the materials to be used. The insurer may then manage the repair or rebuild, offer a cash settlement, or combine the two. When the insurer manages the work, it is responsible for the quality of work and materials of anyone it directly authorised.
With cash, you manage the work yourself. ASIC reviewed cash settlements in home building claims from Cyclone Jasper and found 52% of settlements involved only one quote, and 73% of one-quote offers came from the insurer’s preferred supplier. Moneysmart’s caution is that the insurer may get discounts from its preferred suppliers, so the quote may reflect what the repair costs the insurer, not what it will cost you.
Where a cash settlement is offered and it isn’t the only option, Moneysmart says you’ll receive a Cash Settlement Fact Sheet showing the sum insured, the amount offered and a breakdown of each part, along with your right to a review. It also suggests contacting your bank before accepting if you have a mortgage, as the payment may go to the bank.