Under the 2020 General Insurance Code of Practice, an insurer tells a retail claimant what it needs within 10 business days, updates them at least every 20 business days, and decides within 10 business days of having everything and within 4 months of the claim. Complaints then run to ASIC's 30 calendar day maximum, and AFCA after that.
This article is general information, not legal or compliance advice. Check the current text of the code, standard or legislation, and take advice for your situation.
Key takeaways
- Paragraph numbers here are from the 2020 Code text, which has since been amended, so check the current version.
- The insurer must decide a claim within 10 business days of having all the information, and within 4 months of receiving it (paragraphs 76 and 77).
- Paragraph 78 allows up to 12 months in set cases, such as an extraordinary catastrophe or suspected fraud.
- ASIC's RG 271 sets a 30 calendar day maximum for responding to a standard complaint.
- AFCA generally accepts a complaint within two years of the insurer's final response, or six years of becoming aware of the loss, whichever is earlier.
What are the Code's claims timeframes at a glance?
The 2020 Code sets six main claims timeframes. Within 10 business days the insurer says what it needs and estimates a timeframe. It updates the claimant at least every 20 business days and answers routine enquiries within 10. It decides within 10 business days of having everything, and within 4 months overall.
- Tell the claimant what information is needed, appoint any assessor and estimate the timeframe. Timeframe: Within 10 business days of receiving the claim; 2020 Code paragraph: 68.
- Update the claimant on progress. Timeframe: At least every 20 business days; 2020 Code paragraph: 70.
- Respond to routine enquiries about progress. Timeframe: Within 10 business days; 2020 Code paragraph: 71.
- Tell the claimant a loss assessor or adjuster has been appointed. Timeframe: Within 5 business days of appointing them; 2020 Code paragraph: 72.
- Decide the claim once all information is in and enquiries are done. Timeframe: Within 10 business days; 2020 Code paragraph: 76.
- Decide the claim overall. Timeframe: Within 4 months of receiving it, unless paragraph 78 applies; 2020 Code paragraph: 77.
The update 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. The Code claims obligations guide explains each rule in full.
Meeting these deadlines depends on knowing when each one started. ClaimsGateway (claimsgateway.com) keeps audit logs of system and user activity, and its security and compliance page describes its approach.
When does the clock stop?
Under paragraph 78 of the 2020 Code, the 4 month limit can extend to 12 months in set circumstances. These include an extraordinary catastrophe, a suspected fraud, a claimant who does not respond to reasonable requests, communication difficulties beyond the insurer's control, and a claimant asking for a delay. Outside those cases, the 4 month limit applies.
The exceptions are narrow. Each must fit the circumstances the Code lists, and the insurer should record why it applies. A busy claims team is not one of them.
If the 4 month deadline passes, the claimant must be told. Paragraph 77 requires the insurer to tell the claimant in writing about its complaints process. As a result, a missed deadline turns straight into a possible complaint.
What are the complaints timeframes?
ASIC's RG 271 sets the timeframes for complaints. A firm is expected to acknowledge a complaint within 24 hours or one business day, or as soon as practicable. It must give a final response to a standard complaint within 30 calendar days. If the claimant is unhappy, they can take it to AFCA.
- Acknowledge the complaint. Timeframe: Within 24 hours (or one business day), or as soon as practicable; Source: RG 271.51.
- Give an IDR response to a standard complaint. Timeframe: No later than 30 calendar days after receiving it; Source: RG 271.56.
- Give an IDR delay notification, if the response will be late. Timeframe: Before the maximum timeframe expires; Source: RG 271.66.
- Lodge with AFCA after the insurer's final response. Timeframe: Generally within two years; Source: AFCA rules.
- Lodge with AFCA after becoming aware of the loss. Timeframe: Generally within six years; Source: AFCA rules.
A late response needs a reason. According to ASIC, a firm can go past the maximum only when the complaint is particularly complex or circumstances beyond its control cause delay. Even then, it must send a delay notice first, explaining the reasons, the right to go to AFCA and AFCA's contact details.
AFCA's limits apply to whichever comes first. According to Allianz's published dispute notice, AFCA may still consider a late complaint if it considers that exceptional circumstances apply.
Frequently asked questions
How long does an insurer have to decide a claim in Australia?
Under the 2020 General Insurance Code of Practice, the insurer must decide within 10 business days of having all the information it needs, and within 4 months of receiving the claim. Paragraph 78 allows up to 12 months in set cases, such as an extraordinary catastrophe or suspected fraud.
How often must an insurer update a claimant?
At least every 20 business days, under paragraph 70 of the 2020 Code. The insurer must also respond to routine enquiries about the claim's progress within 10 business days. Insurers breached the update rule 18,350 times in 2024-25, up 67%, according to the Code Governance Committee's data.
What if the insurer misses a timeframe?
If the 4 month deadline passes, the insurer must tell the claimant in writing about its complaints process. The claimant can then complain to the insurer, and take the complaint to AFCA if still unhappy. Missed timeframes are also Code breaches, which the Code Governance Committee monitors.
Do timeframes apply to brokers?
The General Insurance Code binds subscribing insurers, and it reaches service suppliers that handle claims on their behalf. Brokers acting for their clients follow the separate Insurance Brokers Code of Practice. A broker that handles claims under an insurer's authority should check both codes and its agreement with the insurer.
How long do I have to go to AFCA?
Generally, two years from the insurer's final response to your complaint, or six years from when you first became aware of the loss, whichever is earlier. AFCA may still consider a complaint lodged later if it considers exceptional circumstances apply. Check AFCA's current rules for your situation.
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
- AFCA and claims disputes: what drives complaints and how to reduce them.
- ASIC claims handling rules: claims handling as a financial service.
- Claims management systems explained: what a claims system does.
Sources
- Insurance Council of Australia. General Insurance Code of Practice (2020 Code), Part 8, paragraphs 68 to 78. https://insurancecouncil.com.au/code-of-practice
- ASIC. "Regulatory Guide 271: Internal dispute resolution." Issued 2 September 2021, in effect from 5 October 2021. https://download.asic.gov.au/media/3olo5aq5/rg271-published-2-september-2021.pdf
- Allianz Australia. "Dispute resolution." Checked 24 October 2026. https://allianz.com.au/contact/dispute-resolution (states AFCA's time limits)
- 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 (reports the Code Governance Committee's 2024-25 data)
