What does gicop-p8-76-78-decision-timeframes require?

Once all relevant information is in and all enquiries are complete the insurer decides whether to accept or deny the claim and tells the customer within 10 Business Days. The decision is made within 4 months of receiving the claim, failing which the customer is told in writing about the complaints process. Where the claim arises from an Extraordinary Catastrophe, is or is reasonably suspected to be fraudulent, the customer does not respond to reasonable enquiries or requests, communication is difficult for reasons beyond the insurer's control, or the customer requests a delay, the decision is communicated in writing within 12 months of receipt, failing which the customer is told in writing about the complaints process.

Australia General Insurance Code of Practice (2020 Code as updated) gicop-p8-76-78-decision-timeframes: Decide the claim within ten business days of having all information and completed enquiries, within four months of receipt overall, or within twelve months where an extraordinary catastrophe, fraud, non-response, communication difficulty or a customer-requested delay applies, telling the customer about complaints if the time is missed

Other controls in Part 8: making a claim (timeframes, experts, decisions, denials, catastrophes) – Australia General Insurance Code of Practice (2020 Code as updated)

gicop-p8-58-63-claim-start-information Answer pre-claim coverage questions without discouraging a claim, explain the claims process, excesses, waiting periods and contact points, inform uninsured third parties, explain scopes of works, and correct claim-handling mistakes immediately
gicop-p8-64-66-urgent-financial-need Fast-track assessment and decision, or advance a payment within five business days, where the event causing the claim left the customer in urgent financial need
gicop-p8-67-71-assessment-timeframes-updates Ask only for relevant information and say why, within ten business days of the claim state the information needed, appoint any assessor and give the likely timeframe, update progress every twenty business days and answer routine enquiries within ten
gicop-p8-72-75-experts-assessors-investigators Tell the customer within five business days when an assessor, adjuster or investigator is appointed and what their role is, run investigations under Part 15, require external experts to report within twelve weeks, and engage only experts with appropriate expertise who comply with their professional rules
gicop-p8-79-82-cash-settlements-total-loss-denials-information Explain cash settlements under home building policies, treat total losses sensitively without demanding proof of ownership where it was lost in the event, give written reasons and rights on a denial or partial payment, and supply the information and expert reports relied on within ten business days of request
gicop-p8-83-87-timeframes-alternatives-repairers Agree alternative timetables where the Code's timeframes are impractical, comply with the timeframes otherwise, stand behind the quality of directly authorised repairers' work and materials, and cover rectification-related hire car or accommodation
gicop-p8-88-90-catastrophes Respond to catastrophes efficiently, professionally, practically and compassionately, cooperate with the Insurance Council of Australia's catastrophe coordination, and allow a review of property claims finalised within one month of a catastrophe for twelve months

Query this from an agent

The graph holds this control, the 0 it maps to, and the evidence behind each claim, over MCP and REST.

MCP endpoint All Australia General Insurance Code of Practice (2020 Code as updated) controls