Insurance Claim Delayed? 7 Signs Your Insurer May Be Stalling

One signal is not a pattern

Claims are complex processes involving assessors, experts, repairers, third parties and more than one internal team. Any single item below can have an ordinary explanation. A handler took leave. A report came back needing clarification. An attachment did not send.

One explanation is worth naming separately. If your claim followed a major weather event, the assessors, builders and case managers in your area are working through thousands of claims at once. That is a real queue, not a file that has been forgotten, and several of the signals below can appear in it without meaning what they otherwise would.

What changes the reading is accumulation. Several occurring together make it harder to treat each one as an isolated event.

None of this establishes that your insurer has acted improperly, and you do not need to establish that to be entitled to the standards it has committed to. The narrower question is whether all three momentum questions still have answers.

One note on wording. Where this article says your insurer will do something, it is describing a commitment made in a Code of Practice. Every Insurance Council of Australia member selling the products the general Code covers is required to sign one. You can check yours on the published list of subscribers. Whether that makes the timeframes enforceable is a fair question, and it is answered in full here.

1. Weeks of silence after you sent what was asked for

You supplied the documents. Nothing came back.

Silence during an assessment is ordinary. Silence immediately after you have supplied something is different, because the request you were answering has now been met. That is the point at which to look for acknowledgement and a defined next step.

The measure is not how long the silence has lasted. It is whether any contact has arrived that you did not have to initiate yourself.

The check: your insurer will tell you about your claim's progress at least every 20 business days, whether or not you ask. That applies on a general insurance claim (General Insurance Code of Practice, paragraph 70) and on a life, trauma, TPD or income protection claim (Life Insurance Code of Practice, clause 5.6). On a general insurance claim, a routine enquiry about progress gets a response within 10 business days (general Code, paragraph 71).

2. Being asked again for something you have already sent

The request arrives for a document you supplied six weeks ago.

Occasional duplication happens, particularly on claims that have run for a long time or passed through several teams. It is not, by itself, evidence that the claim is being mishandled.

What is worth noticing is the direction of the requests. Requests that build on what you have provided suggest a claim moving forward. Requests that repeat it suggest a claim not carrying its own information with it.

The check: on a general insurance claim, your insurer will tell you what information it needs to decide the claim within 10 business days of receiving it, using its best endeavours to do that in a single request (general Code, paragraph 68). A second request is not a breach. A fourth request for the same document is a reasonable thing to ask about in writing.

3. Updates that do not tell you anything

"Your claim is still under review." "It is with the assessment team." "We are progressing it."

An update that contains no stage, no outstanding item and no date is not an update. It is an acknowledgement that you asked. A substantive one should identify the recorded stage or the next action, and repeated updates that identify neither leave you no better placed than before you asked.

The check: on a general insurance claim, within 10 business days of receiving your claim your insurer will give you its estimate of the likely timeframe and process for making a decision (general Code, paragraph 68). If you have never received that estimate, or the estimate has passed without being revised, that is a specific and answerable question rather than a matter of opinion.

4. The claim keeps changing hands

Your third claims manager introduces themselves. Or nobody does, and you notice the name on the emails has changed.

Reassignment is normal over a long claim. Staff move, teams restructure, workloads rebalance. What matters is continuity: a handover that works should not require you to reconstruct the position each time, and earlier commitments should still be recognised afterwards.

The check: here the honest answer is that the Codes do not help you directly. Your insurer will tell you within 5 business days when it appoints a loss assessor, loss adjuster or investigator, and what their role is (general Code, paragraphs 72 and 73). There is no equivalent obligation covering a change of claims manager. That absence is exactly why it is worth asking, in writing, who currently holds your claim and what stage it is at.

5. A report that is always about to arrive

The claim is waiting on an engineering assessment, a medical report or a repair estimate. It has been waiting on it for some time.

External input is a legitimate reason for a claim to take time, and this is the signal most often mistaken for a problem when it is not. What separates the two is whether the report has a date attached. A named report from a named provider with an expected date is a claim that is waiting. "We are waiting on the report", repeated across three contacts with no date, is not the same thing.

The check: on a general insurance claim, where your insurer engages an external expert it will ask that expert to report within 12 weeks. If the expert does not meet that timeframe, your insurer will tell you and keep you informed of its progress in obtaining the report (general Code, paragraph 74). You can also ask for a copy of any report it relied on, and it will provide that within 10 business days (paragraph 82). The life Code sets no expert report timeframe, so on a life claim the 20 business day update obligation is the one to work from.

6. The explanation changes, and none of it is in writing

One person says the claim is under assessment. The next says documents are outstanding. The third says it is awaiting approval.

There may be a reasonable explanation. Different teams handle different parts of a claim, and each person may see only part of it. The concern is not that two people used different words. It is that their accounts point to different next steps, which leaves you unable to tell what is actually required from you.

The inconsistency is the visible part. What allows it to persist is usually that none of it was written down. A commitment made on a call cannot be pointed to afterwards, and a timeframe given verbally cannot be compared with the one given three weeks later. Where almost everything happens by phone, a pattern can run for months without ever becoming visible as a pattern. So it is worth noticing how much of your claim exists only as conversation.

The check: you can ask for a single written account of the current stage and the next step. On a general insurance claim, your insurer will respond to a routine progress enquiry within 10 business days (general Code, paragraph 71). Asking for the answer in writing is not an escalation and does not need to be framed as one.

7. Months have passed and you cannot say what is happening

Not "it is taking a long time". Something more specific: you could not currently say what the claim is waiting on, who owns the next action, or when it is due.

Length alone tells you very little. A six month claim can be well handled and a three week claim can already be in trouble. Losing sight of all three questions at once is usually the accumulation of the other six signals rather than a separate problem.

The check: on a general insurance claim your insurer will decide within 4 months of receiving it, and if it does not decide in that time it will tell you in writing about its complaints process (general Code, paragraph 77). The period extends to 12 months only in five defined circumstances: a declared Extraordinary Catastrophe, suspected fraud, your not responding to reasonable enquiries, the insurer being unable to communicate with you for reasons beyond its control, or your requesting a delay (paragraph 78). Complexity alone is not one of them. On a life claim, income-related benefits are to be decided within 2 months and lump sum benefits within 6 months, in each case from the claim received date or the end of any waiting period, whichever is later (life Code, clauses 5.48 and 5.49). The full timeframe reference is here.

What the momentum check is reading

Set out together, the seven signals are not really a list. They are the three momentum questions, and the ways each one stops having an answer.

Two things are worth noticing. Six of the seven signals sit under what and when. Only one sits under who, and it is the only one with no Code obligation behind it: ownership is both the hardest thing to see from outside and the least protected.

And whether your claim exists in writing is not a fourth question. It is the condition that decides whether the first three can still be answered in a month's time.

What to do when several signals appear together

The instinct is to send a longer email. A more useful move is to ask a narrower question.

Ask the specific question rather than the general one. "Which report is outstanding, who was it commissioned from, and when is it expected?" is answerable. "Can you update me?" is not. If you have been told the claim will take longer than four months, asking which of the five paragraph 78 circumstances applies is a factual question with a factual answer.

Name the obligation, not the delay. "It has been more than 20 business days since I received an update" is checkable. "I haven't heard anything" is not. Check which clock applies first, because general and life claims run on different ones. The full timeframe reference →   The 10 business day rule →

Recognise when the question has become a complaint. You can complain about the handling of a claim before it has been decided, and there is no minimum waiting period. Doing so moves the matter onto a different track, with a written decision due within 30 calendar days. The escalation stages and what each one triggers →

Common questions

How many of these should I be seeing before I do something?

There is no threshold, and any article offering you one is inventing it. The more reliable question is whether you can answer all three: what the claim is waiting on, who owns the next action, and when it is due. If you cannot, that is worth acting on regardless of the count.

An update did arrive, but it did not tell me anything. Does that satisfy the 20 business day rule?

The commitment is to tell you about the progress of your claim, not simply to make contact. A message containing no stage, no outstanding item and no next step is worth treating as an open question rather than a closed one.

My claim is a workers compensation or CTP claim. Do these timeframes apply?

No. The Code does not cover workers compensation, compulsory third party motor injury, marine, medical indemnity or domestic builders warranty insurance. Those run under separate schemes that vary by state and territory. The signals above may still be recognisable, but none of the timeframes here apply.