The 10 Business Day Rule: When Your Insurer Must Respond

What is the 10 business day rule?

There is no single rule. There are four, and they answer different questions.

Paragraphs 68, 71, 76 and 82 of the General Insurance Code of Practice each set a 10 business day timeframe. Two of them run from something you do. One runs from the day you lodge your claim. One runs from the moment the insurer's file is complete.

None of them says that written correspondence must be answered within 10 business days. That shorthand appears widely, including in an earlier version of this page, and it is not what the Code says.

The distinction is not academic. Before you can tell whether a timeframe has been missed, you need to know which obligation your message actually triggered.

Which obligation applies to what you sent

Find the row that matches what happened most recently.

Two of those rows are worth pausing on.

The first is the last one. A large share of what passes between a policyholder and an insurer sits there, with no named timeframe attached. That does not mean nothing applies. It does mean the 10 business day figure will not help you.

The second is the complaint row, and it deserves its own section.

Three situations where the 10 business day figure does not apply

What you sent was a complaint

You may have made a complaint without knowing it.

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

ASIC is explicit about what that does not require: not the word complaint, not writing, not a complaints team or a designated address. The obligation starts when what you said meets the definition, not when it reaches the people whose job is complaints (RG 271.30, RG 271.35). What it does require is the second half of the definition. You must be expecting a response or a resolution, explicitly or by implication.

Once your message meets that definition, the response to it follows the complaint timeframe rather than the 10 business day one.

• The insurer must acknowledge that it has received your complaint (GICOP 142).

• A written response is due within 30 calendar days, counted from the day after the complaint is received (GICOP 147, RG 271.56). The same 30 day limit applies under ASIC Regulatory Guide 271, which sets enforceable standards rather than a voluntary commitment, and which covers complaints from retail clients and small businesses whether or not the insurer has signed the Code (RG 271.36 to 271.38).

• Updates on the complaint are due at least every 10 business days (GICOP 146).

• If the insurer cannot decide in time, it must tell you in writing before the deadline passes, give its reasons for the delay, and tell you about your right to take the complaint to the Australian Financial Complaints Authority (GICOP 147, RG 271.64 to 271.66).

The 30 days is not unconditional. A complaint resolved to your satisfaction by the end of the fifth business day needs no written response at all, and there are defined circumstances that remove even that exception (GICOP 150, RG 271.71, RG 271.75).

Your claim does not stop while this happens. Paragraph 146 sits in the complaints part of the Code and covers the progress of the complaint. Nothing in the Code suspends the claims obligations because a complaint has been made, so the 20 business day claim update at paragraph 70 keeps running alongside it. The complaint clock is in addition to the claim clock, not in place of it.

The complaint route, what each level of escalation sets in motion, and when the five business day exception applies are covered here: the escalation steps and what each one triggers →

Your claim is a life, trauma, TPD or income protection claim

None of the paragraphs above applies to your claim.

Life, trauma, TPD and income protection claims sit under the Life Insurance Code of Practice, and it contains no equivalent of paragraph 71. There is no stated timeframe for a life insurer to answer a routine enquiry about how your claim is progressing. There is also no equivalent of the general Code's 12 week limit on external expert reports.

What the life Code does require:

• Within 10 business days of the claim received date, the insurer tells you how to access the Code, about your cover and any waiting periods, about all relevant benefits, and about the claims process (LICOP 5.5). That is an information obligation, not a response obligation.

• A progress update at least every 20 business days (LICOP 5.6).

The decision timeframes differ again, and they are set out in full here: How Long Does an Insurance Claim Take in Australia? →

If your cover is held through a superannuation fund, the complaints route changes as well. A complaint to a superannuation trustee runs to 45 calendar days rather than 30 (RG 271.79).

Your policy sits outside the Code

Workers compensation, compulsory third party motor injury, marine, medical indemnity and domestic builders warranty insurance sit outside the Code altogether (GICOP 10, 11), and the claims standards apply to retail insurance only, so cover held by a business above the small business threshold is not reached by them (GICOP 12). If your policy falls on the wrong side of either line, none of the timeframes above binds your insurer.

One further limit is worth knowing before you need it. The claims standards stop applying to your claim if you commence proceedings against your insurer in a court, tribunal or other dispute handling process. A complaint to AFCA is specifically carved out of that, so taking a matter to AFCA does not switch the standards off (GICOP 85).

When the timeframes can bend, and what the Code requires in exchange

The timeframes are not absolute. An article that presents them as absolute is setting you up to draw the wrong conclusion from a missed date.

Paragraph 83 deals with the honest case. Where a timeframe is not practical, for example because of the complex nature of the claim, the insurer will agree a reasonable alternative timetable with you. If no agreement can be reached, it will give you details of its complaints process.

That obligation is worth reading twice. Paragraph 83 does not hand the insurer an automatic extension. It requires an attempt to agree a reasonable alternative timetable with you, and failing agreement, to point you at the complaints process. A claim that has quietly passed its timeframes, with no conversation about a revised one, has not used paragraph 83.

Whether that matters is a separate question, and paragraph 84 answers it.

Paragraph 84 sets out when the insurer does not have to meet these timeframes at all:

• it complied with an alternative timetable you agreed to

• its conduct, and the actual timeframe, were reasonable in all the circumstances

• the timeframe was missed because an external expert's report was delayed, even though the insurer used its best endeavours to obtain it in time

The second of those is broad, and it is the reason a missed timeframe is not by itself a breach, whether or not an alternative timetable was ever discussed.

It is also the reason specifics matter more than elapsed time. Conduct is harder to describe as reasonable in all the circumstances where nothing was communicated, no alternative timetable was proposed and no reason was given.

The estimate your insurer owes you at the start

Paragraph 68 runs without you asking for anything, and it contains the most directly useful thing in this part of the Code.

Where the insurer needs further information or an assessment, then within 10 business days of receiving your claim it will, among other things, provide its estimate of the likely timeframe and process for making a decision on your claim (GICOP 68).

That is your insurer's own answer to the question you are probably asking. It is owed to you without you requesting it. It is specific to your claim rather than general. And once it has been given, it becomes a fact both sides can refer back to.

Two things follow.

If no estimate ever arrived, that is a narrow question with a factual answer, which is a different kind of request from asking why a claim is taking so long.

If an estimate did arrive and the date has passed, you are no longer describing how the pace of your claim feels. You are describing a variance from a timeframe your insurer set itself.

What a missed timeframe changes, and what it does not

A missed timeframe is not proof of anything. It can be administrative. One late update in an otherwise well handled claim is not a pattern, and paragraph 84 means it may not even be a breach.

What changes is the specificity available to you.

"It has been more than 20 business days since I received an update" is a checkable statement about a standard your insurer has committed to meet. "I haven't heard anything" is not. Both describe the same silence. Only one of them can be answered.

That is the practical value of knowing which obligation applies. It moves the conversation from how the claim feels to what the record shows.

Where several timeframes are missed and the explanation changes between contacts, that is a pattern rather than an incident, and it is worth reading as one: Insurance Claim Delayed? 7 Signs Your Insurer May Be Stalling →

Common questions

Does my insurer have to reply to my email within 10 business days?

Only if the email is a routine enquiry about your claim's progress (GICOP 71) or a request for the reports the insurer relied on (GICOP 82). Other correspondence carries no stated timeframe under the Code, although the general obligation to handle the claim efficiently, honestly and fairly still applies.

Do weekends and public holidays count?

No. A Business Day under the Code is Monday to Friday, excluding public holidays. Ten business days is therefore at least two full calendar weeks, and longer across a public holiday period. A deadline that looks missed on a calendar count may not be.

I asked for an update a month ago and heard nothing. Has a timeframe been missed?

On the face of it, two. The 10 business day response to a routine progress enquiry (GICOP 71), and the 20 business day progress update (GICOP 70), which runs whether or not you ask. Whether either amounts to a breach depends on paragraph 84.

Does the 10 business day rule apply to my TPD or income protection claim?

No. Those claims sit under the Life Insurance Code of Practice, which sets no timeframe for answering a routine progress enquiry. The life Code does contain its own 10 business day obligation at the start of a claim (LICOP 5.5), but that requires the insurer to give you information about your cover and the process, not to respond to your enquiries. The two are easy to conflate and they do different things.

My insurer says my claim is too complex for the usual timeframes. Is that allowed?

Yes, but not unilaterally. Paragraph 83 requires the insurer to agree a reasonable alternative timetable with you, and if no agreement is reached, to give you details of its complaints process. Complexity on its own does not extend a timeframe.

I complained on the phone. Does that count?

Yes, if you were expecting a response or a resolution. ASIC states that a complainant does not have to use the word complaint or put it in writing, and that an insurer should not treat an expression of dissatisfaction as feedback simply because it was made verbally (RG 271.30, RG 271.31). The insurer must acknowledge receiving it (GICOP 142).

Does making a complaint pause my claim?

No. Nothing in the Code suspends the claim timeframes because a complaint has been made. The two run alongside each other, on different clocks.