Good claims management in Australia follows the claim's stages and the rules behind each one. Capture a complete claim at intake, tell the claimant what is needed within 10 business days, update them at least every 20, give written reasons for decisions, control payments, and treat dissatisfaction as a complaint. Then review closed files to find what went wrong.
Key takeaways
- Every practice below ties to an Australian obligation: the General Insurance Code of Practice, ASIC's guidance or a regulator finding.
- According to ASIC, handling claims efficiently, honestly and fairly generally means acting in a timely, least intrusive, fair and transparent way.
- Communication is the weakest point: according to the Code Governance Committee, insurers breached the 20 business day update rule 18,350 times in 2024-25.
- ASIC's Report 768 told insurers to start "with what is directly within their control".
- Some delay, such as parts and labour shortages, is outside any insurer's control, but how it is communicated is not.
What are the best practices at intake and triage?
At intake, capture a complete claim the first time: the policy, the loss, the claimant's contact preferences and any signs of vulnerability. At triage, route each claim by type and complexity, and appoint any assessor quickly. Under the 2020 Code, the insurer tells the claimant what it needs within 10 business days of receiving the claim.
Ask once, and only for what is needed. According to ASIC, claims should be handled "in the least onerous and intrusive way possible". Repeated or unnecessary information requests slow the claim and frustrate the claimant.
Spot vulnerability early. ASIC's Report 768 named the treatment of vulnerable consumers as one of five areas needing improvement. A claimant in financial hardship may need a faster decision or an advance payment, which paragraph 64 of the 2020 Code provides for in urgent cases.
How should claims teams communicate with claimants?
Claims teams should update claimants before they have to chase. The 2020 Code requires an update at least every 20 business days and a reply to routine enquiries within 10. Good practice goes further: explain what is happening, what is causing any delay, and what comes next, in the claimant's preferred channel.
The rule is often missed. According to the Code Governance Committee, insurers breached the 20 business day update requirement 18,350 times in 2024-25, up 67%, as reported by Insurance Business. That makes it the most practical place to improve.
Communication was ASIC's first finding too. Report 768 listed communication about decisions, delays and complications among its five areas for improvement. A short, honest update is better than silence.
What are the best practices for decisions and payments?
Decide promptly and explain the decision in writing. The 2020 Code requires a decision within 10 business days of having all the information, and within 4 months overall in most cases. A declined claim should state the reasons and the policy wording relied on. Payments should be approved, checked and reconciled before and after they are made.
Reasons reduce disputes. According to Insurance Business, claim rejection was among the top three general insurance issues at AFCA in 2025-26. A claimant who understands a decision is less likely to dispute it.
Payments need controls. Each payment should match an approved amount, a valid payee and the policy limit. Reconciliation then catches errors. The guide to claims leakage covers what happens when these controls fail.
What are the best practices at closure and for complaints?
Close a claim only when every step is complete: payments made, recoveries pursued, and the claimant told. Treat any expression of dissatisfaction as a complaint, not only formal ones. Under ASIC's RG 271, a standard complaint needs a final response within 30 calendar days, with AFCA's details if the claimant remains unhappy.
Recognising complaints is a known gap. ASIC's Report 768 named "recognition of expressions of dissatisfaction" as an area for improvement. A complaint missed at the claims desk often reaches AFCA later.
Closed files are also a learning tool. Reviewing a sample of finalised claims shows where decisions varied, payments leaked or updates were missed.
How should insurers measure claims performance?
Insurers should measure what claimants and regulators care about: time to decision, Code timeframes met, complaints per thousand claims, AFCA outcomes, accuracy found in closed-file reviews, and recoveries made. Measures should be tracked by line of business and handler, so problems can be traced to their cause rather than averaged away.
Resourcing belongs on the list. ASIC's Report 768 found an increase in claims resourcing "albeit with a significantly increased reliance on temporary staff". It also found "under-resourcing of dispute resolution". Tracking open claims per handler and complaint backlogs shows strain early.
Avoid measures that reward the wrong behaviour. Closing claims fast looks good on a chart but can push errors into complaints and reopened files.
Where does software help, and where does it not?
Software helps with consistency, records and controls: one record per claim from first notice of loss to close, workflow steps that match the process, and checks on payments. It does not fix causes outside the claims team, such as shortages of parts, repairers or tradespeople, and it does not replace judgement on difficult claims.
Some delay is genuinely external. According to Insurance Business, AFCA links motor claim delays to "industry-wide shortages in vehicle parts and skilled labour". No system shortens that wait, but a team can still update the claimant on time and explain why.
ClaimsGateway (claimsgateway.com) covers the claim from first notice of loss to close, and its workflows are configured without developers, so the business can match steps to its own process. The ClaimsGateway insurers page describes its approach.
Frequently asked questions
What is effective claims management?
Effective claims management handles each claim promptly, fairly and transparently, from intake to closure. In Australia, that means meeting the General Insurance Code of Practice timeframes, updating claimants regularly, giving written reasons for decisions, controlling payments and recognising complaints. It also means reviewing closed files to find and fix recurring problems.
What is the claims management process?
The claims management process runs from first notice of loss to closure. It covers intake, triage and assignment, investigation and assessment, the decision, payment, recovery and closure. Communication with the claimant runs through every stage, and complaints handling sits alongside it whenever the claimant is unhappy.
How do insurers measure claims performance?
Insurers measure claims performance through time to decision, Code timeframes met, complaints per thousand claims, AFCA outcomes, accuracy in closed-file reviews and recoveries made. Tracking these by line of business and handler helps trace problems to their cause. Resourcing measures, such as open claims per handler, show strain early.
What does the Code expect?
The 2020 General Insurance Code of Practice expects insurers to tell retail claimants what is needed within 10 business days, update them at least every 20 business days, decide within 10 business days of having all information, and decide within 4 months in most cases. Check the current amended Code for exact terms.
What causes poor claims outcomes?
Poor claims outcomes usually come from poor communication, inconsistent decisions, under-resourcing, missed vulnerability and complaints not recognised early. ASIC's Report 768 named most of these as areas for improvement. External causes, such as parts and labour shortages, add delay but do not prevent good communication.
About the author
ClaimsGateway builds cloud claims management software for insurers, underwriting agencies, brokers, TPAs and self-insured organisations in Australia and New Zealand. Every regulator figure in this article links to its source, and every vendor fact was checked on the vendor's own site on the date shown.
Related reading
- Code of Practice timeframes: a quick reference to claims deadlines.
- ASIC claims handling rules: claims handling as a financial service.
- AFCA and claims disputes: what drives complaints and how to reduce them.
Sources
- Insurance Council of Australia. General Insurance Code of Practice (2020 Code), Part 8, paragraphs 64 to 78. https://insurancecouncil.com.au/code-of-practice
- ASIC. "Claims handling and settling: How to comply with your AFS licence obligations (INFO 253)." Published 16 June 2025. https://download.asic.gov.au/media/q2ybygwo/info253-published-16-june-2025.pdf
- ASIC. "Report 768: Navigating the storm: ASIC's review of home insurance claims." 16 August 2023. https://download.asic.gov.au/media/tgrozota/rep768-published-16-august-2023.pdf
- ASIC. "Regulatory Guide 271: Internal dispute resolution." Issued 2 September 2021. https://download.asic.gov.au/media/3olo5aq5/rg271-published-2-september-2021.pdf
- Insurance Business Australia. "Insurer claim delays top complaints again as brokers report no change." 11 September 2026. https://www.insurancebusinessmag.com/au/news/claims/insurer-claim-delays-top-complaints-again-as-brokers-report-no-change-589274.aspx
- Insurance Business Australia. "Record AFCA complaints mask a worse story in insurer compliance data." 4 August 2026. https://www.insurancebusinessmag.com/au/news/breaking-news/record-afca-complaints-mask-a-worse-story-in-insurer-compliance-data-584812.aspx
