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Insurance Claims - Responding to FOS

Information to provide to FOS regarding general insurance disputes

Applicants may find themselves in a dispute with a financial services provider (FSP) regarding a general insurance policy. This will often involve a claim that has been lodged by the applicant under their insurance policy where the insurer has either: 

  • denied the claim
  • accepted the claim but failed to provide the applicant with what they are seeking, or
  • refused to make a decision because it is investigating the claim.

 

This is a guideline to both applicants and FSPs regarding the information they should provide when the dispute involves a general insurance policy.


Unfortunately, FOS cannot consider all insurance disputes. Some products and issues are beyond our jurisdiction. We have listed some of these on this weblink:

 

www.fos.org.au/beforelodging

 

Upon receiving the parties’ information, FOS may consider contacting them to see if they would be interested in attempting to resolve the dispute by way of a conciliation conference. FOS has published a guide to conciliation conferences, which is available on this weblink:


/custom/files/docs/guide_to_conciliation_conferences.pdf

 

Information that an applicant should provide

There is information on our website regarding how an applicant can lodge a dispute with FOS. This can be found on this weblink:

 

www.fos.org.au/howtolodge

 

Before considering a dispute, FOS will normally ask the applicant to complete the Dispute Form that is available on the above weblink. In addition to this, applicants who have a dispute with a general insurer may want to consider including the following documents and/or information with their Dispute Form:

 

  • A summary of the events leading up to the claim;
  • Any expert reports supporting their position (e.g. a valuation report for a motor vehicle or a builder’s report regarding damage to the home);
  • The Certificate of Insurance and the policy.
    • The Certificate of Insurance should be for the period covering the time when the claim arose (e.g. if it involves a motor vehicle accident that occurred on 2/2/10, then this date should fall within the period of cover set out in the Certificate of Insurance);
  • Original or colour copies of any relevant photographs (such as the damaged vehicle or damaged parts of the home);
  • Copies of all letters received from the FSP; and
  • Any other documents considered relevant to the dispute.

 

This list is not compulsory as some of this information may not be applicable to the dispute. However, where the information and/or documents are available, we would appreciate receiving it as soon as possible as it will assist us in progressing the dispute more efficiently and effectively. 

 

FSPs responding to a general insurance dispute at FOS

Once the FSP receives the applicant’s Dispute Form and accompanying documentation, the FSP has 21 days to either resolve the dispute with the applicant or to provide a response to the dispute to FOS.

 

The new Terms of Reference do not prescribe a specific form of response but it is important an FSP’s response contains all relevant documents, information and submissions in relation to the dispute so that the matter can be handled efficiently, effectively and fairly.

 

FOS has developed a Guide for Response to Disputes.  This guide is designed to help FSPs to ensure that they include all relevant material in their responses to disputes.  This will benefit both parties to the dispute and FOS.  The guide also explains that certain information should be included in a letter accompanying the response.  For each dispute, the FSP should refer to the guide when preparing a response. We suggest that the items listed in the guide under Materials to Include in a Response be used as subheadings in responses.


Requests for extension of time to provide a response to FOS

If an FSP requires an extension of time to provide this response to FOS, it should contact us prior to the expiry of the 21 day timeframe with the following information:

 

  • Details of the extension sought
  • Reasons for the extension, and
  • Any material to support this request.

 

Paragraph 7.4 of the Terms of Reference gives FOS the discretion to extend the time limits if appropriate.

When considering whether it should grant an extension and, if so, how long the extension should be, FOS will consider the following:

 

  • FOS’s obligations to resolve disputes in a cooperative, efficient, timely and fair manner
  • The reasons for the delay
  • Whether the FSP could have taken steps to avoid or reduce the delay
  • Whether the FSP has acted promptly and diligently
  • How the extension may affect the Applicant, and
  • Any other relevant factor.