Insurance claim handling review checklist
Insurance claim disputes frequently arise from delays, inadequate reasons for denial, or failure to follow Code timeframes. This checklist helps lawyers review a claim file to identify procedural and substantive issues that may support the policyholder's position or expose insurer non-compliance.
This is a 12-step checklist for reviewing the handling of an insurance claim under the Insurance Contracts Act 1984 (Cth) and the 2020 General Insurance Code of Practice. It covers duty of utmost good faith, timeframes, and dispute pathways.
The checklist
Confirm policy coverage
Review the policy wording to confirm the claimed event falls within the insuring clause and is not excluded.
Check duty of disclosure compliance
Assess whether the insured met the pre-contractual duty of disclosure and whether any non-disclosure is actionable by the insurer.
Review notification timeliness
Confirm the claim was notified within the policy period or any applicable late notification clause, and check insurer prejudice.
Assess Code timeframe compliance
Check whether the insurer met the Code timeframes: 10 business days to decide straightforward claims and four months for assessed claims.
Review reasons for denial
If the claim was denied, review the written reasons to confirm they are clear, specific, and reference the relevant policy clause.
Check section 54 protections
Assess whether the insurer is improperly relying on a policy term to refuse a claim in breach of section 54 (acts or omissions after contract formation).
Review utmost good faith obligations
Assess whether the insurer has acted with utmost good faith throughout the claims process, including communications and delays.
Evaluate quantum and settlement offer
Review the insurer's assessment of the loss amount and any settlement offer against the policy terms and independent evidence.
Assess hardship obligations
If the claimant is in financial hardship, check whether the insurer has complied with the Code's financial hardship provisions.
Review IDR response
If an internal dispute resolution complaint was lodged, review the insurer's IDR response for compliance with RG 271 timeframes and requirements.
Consider AFCA lodgement
Assess whether the dispute is eligible for lodgement with AFCA and identify the relevant time limits.
Preserve evidence and correspondence
Compile and preserve all claim correspondence, assessor reports, expert reports, and policy documents for potential AFCA or court proceedings.
When this checklist applies
Use when reviewing an insurance claim that has been denied, underpaid, or delayed, to identify grounds for challenge.
Common pitfalls
- Overlooking section 54 protections when the insurer relies on a post-contract conduct term
- Missing Code timeframe breaches that support a complaint to AFCA
- Failing to request the insurer's complete claim file including internal assessor notes
- Not checking for financial hardship obligations when the claimant is vulnerable
- Letting AFCA lodgement time limits expire while negotiating with the insurer
Run this checklist on a real matter
Quillio can compare policy wording against claim facts, identify section 54 issues, and summarise Code timeframe obligations for specific claim types.
General insurance claim review guidance. Outcomes depend on policy wording, claim facts, and insurer conduct — obtain specialist insurance law advice.
Use this checklist on your matter.
Quillio can run this checklist on a specific NSW conveyancing matter — confirm each item, calculate adjustments, and generate the supporting documents. The free trial requires no credit card.
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