Insurer Not Responding? The Escalation Steps and What Each One Triggers

Before a complaint: two requests that carry their own clock

These two apply to general insurance claims covered by the General Insurance Code of Practice. Both are worth using before escalating further, because both produce something in writing.

A progress enquiry

Under paragraph 71 of the Code, a subscribing insurer will respond to a routine enquiry about the progress of your claim within 10 business days. This is a response obligation, not a decision obligation, and it does not start the complaints process.

The Code contains four separate 10 business day obligations, each with a different trigger. The 10 Business Day Rule: When Your Insurer Must Respond sets out which is which, and where the Code sets no timeframe at all.

A request for the reports relied on

Under paragraph 82, a subscribing insurer will give you copies of the service supplier and external expert reports it has relied on, within 10 business days of your request.

Paragraph 163 permits refusal in defined circumstances, but the insurer must give its reasons and details of its complaints process. If it refuses because access may prejudice it in a complaint or dispute, it must still provide any external expert reports it relied on.

Paragraph 84 qualifies the Part 8 timeframes, including where an agreed alternative timetable was met, the conduct and actual timeframe were reasonable, or an external report was delayed despite best endeavours. A missed date is worth noting. It is not, by itself, proof of a breach.

Making a complaint is the point where the obligations change

The word complaint carries a weight that can make it feel like an accusation. Under the Code and under ASIC's internal dispute resolution standards it is not one. It is a defined event, and it starts a separate process that runs alongside your claim.

What counts as a complaint

The Code defines a complaint as an expression of dissatisfaction made to the insurer, related to its products or services, its staff, or the handling of a complaint, where a response or resolution is explicitly or implicitly expected or legally required.

ASIC's Regulatory Guide 271 is explicit at paragraphs 271.30 and 271.35 that the word complaint, writing and a particular complaints channel are not required. What matters is that you express dissatisfaction and explicitly or implicitly expect a response or resolution.

Whether something is a complaint turns on what you said and what you were asking for, not on which channel you used.

Channel does not determine the legal position, but recognition matters in practice. ASIC Report 802 found that general insurers failed to identify one in every six customer complaints reviewed. If a communication meets the definition, the IDR obligations have been triggered whether or not the insurer records it correctly. Saying plainly that you are making a complaint, and using the published complaints channel, reduces the risk of it being treated as something else.

What a complaint sets in motion

For general insurance, Part 11 of the Code sets out what follows. A subscribing insurer will:

• acknowledge that it has received your complaint (paragraph 142)

• tell you the name and contact details of the person assigned to liaise with you about it (paragraph 143)

• have it handled by a person with appropriate authority, knowledge or experience, who is not the person whose decision or conduct the complaint is about (paragraph 144)

• ask for and rely on only relevant information (paragraph 145)

• keep you informed of the complaint's progress at least every 10 business days, unless it is resolved sooner or you agree otherwise (paragraph 146)

• make a decision within the applicable maximum period. The Code still prints 45 calendar days at paragraph 147, while ASIC's enforceable standard period is now 30 calendar days under RG 271.56

• respond in writing, unless paragraph 150 applies (paragraph 148)

• give reasons for the decision and tell you about your right to take the complaint to AFCA (paragraph 149)

• give you the information it relied on in deciding the complaint, within 10 business days of your request (paragraph 151)

Paragraph 144 is the one that changes most. The person reviewing the complaint cannot be the person whose decision or conduct the complaint is about. That is a change in who reviews the decision, and it is written into the Code rather than left to internal practice.

The complaint clock does not replace the claim clock

Making a complaint does not suspend or replace the insurer's obligations on the underlying claim.

Paragraph 146 sits in Part 11 and concerns the progress of the complaint. Paragraph 70, which requires progress updates on the claim at least every 20 business days, sits in Part 8 and keeps running. The two obligations are about two different things, and they run at the same time. Making a complaint adds a clock. It does not swap one for another.

You can ask for the decision in writing

A written IDR response is not always required when a complaint is closed within five business days. Under RG 271.71, the exemption can apply where the insurer resolves the complaint to your satisfaction, or where an explanation, an apology or both are the only reasonable actions available.

That second limb is narrower than it looks. Regulatory Guide 271 confines it at paragraph 271.74 to complaints where an explanation or apology is the only action the firm can take, giving a commercial decision such as a refusal to grant credit as the example.

Paragraph 150 of the General Insurance Code and RG 271.75 remove the exemption in defined situations. A written response must be given where the complaint is about financial hardship, a declined claim, the value of a claim, or where you have requested one. RG 271.75 also covers relevant complaints about a trustee decision or failure to decide.

That last situation is the one worth knowing about, because it is the only one you control. Asking for a written response is a request you can make at the time you complain, and it means the insurer cannot rely on the five business day exception to finish without one.

What happens if the insurer does not respond within 30 days

The enforceable 30 calendar day deadline for a standard complaint is set by ASIC's Regulatory Guide 271 at paragraph 271.56. The current General Insurance Code still prints 45 calendar days at paragraph 147. That Code figure has not been updated to reflect RG 271, so 30 calendar days is the operative maximum for a standard complaint.

An insurer is not simply free to run past it. Under paragraphs 271.64 to 271.66, a firm is relieved of the deadline only where there has been no reasonable opportunity to respond in time, because of the complexity of the complaint or circumstances beyond its control.

Where that applies, it must give you an IDR delay notification before the 30-day deadline expires. That notification has to explain the reasons for the delay, tell you about your right to take the matter to AFCA, and give AFCA's contact details. Paragraph 147 of the Code also requires written reasons and AFCA information before its stated deadline passes.

So there are two possibilities once 30 calendar days have passed.

• You received a delay notification before the deadline. The complaint is still with the insurer, you have written reasons for the delay, and you have been told you can go to AFCA.

• You received nothing. The deadline has passed without the response the standards require, and without the notification that would have explained it.

In both cases the same option is available: you can take the complaint to AFCA. The difference between them is what you now have in writing.

Taking the complaint to AFCA

The Australian Financial Complaints Authority is the external dispute resolution scheme for financial complaints, including insurance. ASIC oversees it under Regulatory Guide 267.

It is free

Regulatory Guide 267 states at paragraph 267.83 that it is a mandatory requirement that complainants are exempt from payment of any fee or charge in relation to a complaint. AFCA describes its own service as fair, free and independent.

The time limits

For non-superannuation complaints, Regulatory Guide 267 at paragraph 267.167 generally sets the limit as the earlier of:

• six years from the date you first became aware, or reasonably should have become aware, that you suffered the loss, or

• two years from when an internal dispute resolution response is given

The word earlier is doing real work there. Receiving a final response from your insurer starts a two year window that can close well before the six year one would have.

What lodging actually sets in motion

Lodging with AFCA does not move the complaint straight to an external decision. Regulatory Guide 267 describes a refer back process at paragraphs 267.190 to 267.196:

• Where the complaint has not been through internal dispute resolution, or the timeframe has not yet elapsed: AFCA registers the complaint and refers it back to the insurer, and the relevant timeframe under Regulatory Guide 271 applies to the referred back complaint (paragraphs 267.194 and 267.195).

• Where the complaint has been through internal dispute resolution, or the timeframe has elapsed: AFCA's refer back arrangements set a maximum period for the insurer to resolve the complaint or give a response, and provide for excluding some complaints from refer back altogether (paragraph 267.196).

If the complaint is not resolved during refer back, AFCA progresses it under its own process. Lodging before IDR has run is therefore not a shortcut. After the insurer's deadline has passed, AFCA's refer-back arrangements apply rather than a fresh internal cycle.

What AFCA does not consider

AFCA cannot consider a complaint about a business that is not an AFCA member at the time the complaint is lodged, or a matter already resolved by a court or tribunal. It does not consider private health insurance, which is dealt with by the Private Health Insurance Ombudsman, and it does not consider workers compensation. Compulsory third party motor injury and some commercial general insurance also sit outside what it can consider. That is not a complete list, and the AFCA Rules govern. Check with AFCA before assuming a complaint is in or out of its scope.

Taking a complaint to AFCA does not switch off the Code standards. Paragraph 85 of the Code stops the claims handling standards applying once a policyholder starts proceedings in a court, tribunal or other dispute handling process, and it specifically carves AFCA out of that.

If your cover is life, TPD, trauma, income protection, or held through superannuation

The escalation path is broadly the same, because ASIC's internal dispute resolution standards and AFCA apply across both general and life insurance. The Code paragraphs above do not carry across, and the Life Insurance Code of Practice 2025 sets its own.

• Final written response within 30 calendar days (clause 7.13), the same headline figure as general insurance.

• Documents and information used in assessing the complaint within 10 business days of your request (clause 7.14).

• Where 30 days cannot be met because of complexity or circumstances beyond the insurer's control, it will tell you why there is a delay and keep you updated (clause 7.15).

Cover held through a superannuation fund changes both the route and the timeframe. Under clause 7.16 you can complain to the insurer or to the trustee. Under clause 7.17 the trustee must give a final written response within 45 calendar days rather than 30, and Regulatory Guide 271 sets the same 45 day maximum for superannuation trustee complaints at paragraph 271.79. Under clause 7.19 the insurer generally gives its final decision in writing to the trustee, who passes it on to you, which is why responses on these claims can appear to come from a step further away.

Timeframes and obligations are not interchangeable between the two Codes. Check which one applies to your policy before relying on any figure above.

Common questions

Will making a complaint slow my claim down?

The complaint runs on its own clock, alongside the claim rather than instead of it. For general insurance, the 20 business day progress update obligation on the claim (paragraph 70) continues while the complaint's own 10 business day update cycle (paragraph 146) runs. Nothing in the Code suspends the claims handling obligations because a complaint has been made.

Do I have to put the complaint in writing?

No. ASIC's Regulatory Guide 271 is explicit at paragraphs 271.30 and 271.35 that writing is not required, the word complaint is not required, and it need not go to a complaints team. A written complaint is easier to evidence later, but it is not what creates the obligation.

Can I ask the insurer to put its decision in writing?

Yes. Under paragraph 150 of the General Insurance Code of Practice and paragraph 271.75 of Regulatory Guide 271, requesting a written response removes the insurer's ability to close the complaint without one, even where it would otherwise have resolved it within five business days.

Does going to AFCA stop the Code timeframes applying?

No. Paragraph 85 of the Code stops the claims handling standards applying once court, tribunal or other dispute handling proceedings begin, and AFCA is specifically excluded from that. Taking a complaint to AFCA does not switch off the insurer's obligations on the claim.

What if my claim is workers compensation or compulsory third party?

Neither is covered by the General Insurance Code of Practice, which excludes workers compensation, compulsory third party motor injury, marine, medical indemnity and domestic builders warranty insurance. AFCA also does not consider workers compensation, and compulsory third party motor injury sits outside what it can consider. These claims run under separate state and territory schemes with their own complaint routes.

Does the Code apply to every insurer and every policy?

No. The Code binds insurers that have subscribed to it, and its claims handling obligations apply to retail insurance, meaning cover for an individual or for a small business. ASIC's internal dispute resolution standards have a different reach: they apply to complaints from retail clients and small businesses, whether or not the insurer subscribes to the Code. Separately, every licensed insurer is required to handle and settle claims efficiently, honestly and fairly.