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GENERAL INSURANCE CODE OF PRACTICE
(Including amendment effective 1 July 2012)

Introduction

The General Insurance Code of Practice is a self-regulatory Code that promotes good relations between insurers, authorised representatives, consumers and good insurance practices. The code sets out the minimum standards we will uphold in the service we provide.

This code covers all general insurance products except workers compensation, marine insurance, medical indemnity insurance and compulsory third party insurance.

The code does not apply to life insurers or health insurers.

The prescribed insurance products covered by the code include;

  • Motor vehicle – comprehensive, third party property damage only or extended third party property damage policies
  • Home buildings
  • Home Contents
  • Sickness and accident
  • Consumer Credit
  • Travel
  • Equity Plus Insurance or GAP Insurance
  • Contracts of insurance which insure personal and domestic property (including movables – such as household furniture or personal belongings in-transit, valuables, caravan, on-site mobile homes and marine pleasure craft)
  • Any other contracts of insurance that an individual insurer determines to apply the Code

The objectives of the code are:

  • To promote better, more informed relations between insurers and their customers
  • To improve consumer confidence in the general insurance industry
  • To provide better mechanisms for the resolution of complaints and disputes between insurers and their customers
  • To commit insurers and the professionals they rely upon to higher standards of customer service
  • The requirement of insurers to meet the prudential standards established under the Insurance Act 1973
  • The fact that insurance contracts and arrangements between customer and insurers are governed by the Insurance Contracts Act 1984, the Corporations Act 2001 and the Australian Securities and Investments Commission Act 2001
  • The fact that the insurance contract is the governing document of the relationship of the customer and the insurer
  • The need for effective competition and cost efficiency in the general insurance industry and flexibility in the development and enhancement of products and services for customers
  • Having regard to the fact that a contract of insurance is a contract involving the utmost good faith which requires each party to the contract to act towards the other party with the utmost good faith in respect of any matter arising under the contract
  • To be open, fair and honest in our dealings with customers and commits us to high standards of service when selling insurance, dealing with claims responding to catastrophes and disasters and handling complaints

Selling insurance

The following standards apply to the initial enquiry and selling of insurance and renewal of cover

  • We will only take into account relevant information when assessing an application for cover
  • The customer will have access to the information about them that we have relied on in assessing the application and the opportunity to correct any mistakes or inaccuracies.
  • Where an error has been identified we will immediately correct it
  • Our sales process with be conducted in a fair, honest and transparent manner
  • If cover cannot be provided we will advise the reason and will refer the customer to another insurer or the Insurance Council of Australia or NIBA for information about alternative insurance options
  • If the customer is unhappy with our decision, we will make available information about our complaints handling process
  • The customer can (if the policy permits) cancel the policy and any money owed will be refunded to the credit provider or the insured within 15 business days
  • Information about our products and this code will be available to the customer at the time of purchase as well as on request

Standards for our employees and our authorised representatives when selling our products

Our employees and authorised representatives will;

  • conduct their services in an honest, efficient, fair and transparent manner
  • inform us of any complaint they receive against them while acting on our behalf
  • inform customers of the service they have been asked to provide and the identity of the insurer for whom they are acting
  • not perform functions which do not match their expertise
  • adequate training to carry out their sales tasks and function competently
  • be trained in the principles of general insurance, any relevant consumer protection law, product knowledge and requirements of this code
  • keep records relating to such training for at least 5 years and on request shall make those available for examination by FOS

The insurer will;

  • measure the effectiveness of the training by monitoring the performance of our authorised representatives and employees
  • require additional or remedial training to address any identified deficiencies
  • handle complaints relating to authorised representatives under our complaints handling procedures, when they are acting on our behalf

Claims handing

All standards that apply to selling insurance also apply to claims handling.

Within 10 business days of receipt of a claim, we will decide to accept or deny the claim and notify the customer of our decision, if we have received all necessary information at the time the claim was lodged and no further assessment or investigation is required.

The following standards apply to all claims where further information, assessment or investigation is required;

  • within 10 business days of receiving the claim we will:
    a) notify the customer of the detailed information we require to make a decision on the claim
    b) if necessary, appoint a loss assessor or investigator
    c) provide an initial estimate of the time required to make a decision on your claim
  • if we decide to appoint a loss assessor or investigator we will notify the customer within 5 business days of appointing them
  • we will keep the customer informed of the claim at least 20 business days
  • we will respond to customer routine requests for information within 10 business days
  • when we have all the necessary information and completed all investigation that was required to assess the claim, we will decide to accept or reject the claim and notify the customer of our decision within 10 business days
  • if these time frames are not practical we will agree to a reasonable alternative time with the customer. If we cannot reach an agreement the matter will can be referred to our complaints handling procedures

Financial hardship

Where the customer can demonstrate that they are in urgent financial need of the benefits that they are entitled to under the policy as a result of the event causing the claim, we will:

  1. fast-track the assessment and decision process of your claim and/or
  2. make an advance payment to assist in the alleviating the immediate hardship within 5 business days of demonstrating urgent financial need
  3. will notify any financial institution that has an interest in the insurance policy

Supervision of Investigators, Assessors and Loss Adjusters

Insurers are responsible for these people and must make every reasonable effort to ensure that they:

  • Operate in a professional manner
  • Tell consumers of their status and which insurer they are representing
  • Comply with the law and the Code
  • Have authority matching their expertise
  • Have been approved by the insurer

Dispute Resolution Procedures

A dispute means an unresolved complaint about a product or service of an insurer. It is an expression of dissatisfaction conveyed to an insurer together with a request that the insurer remedies the complaint.

The insurer must:

  • Have a fully documented internal process for resolving a complaint
  • Make the process readily accessible by consumers and free of charge
  • Ensure that the internal process provides a fair and timely method of handling a dispute
  • Will respond to complaints within 15 business days provided all necessary information is provided and have completed any investigation required
  • Establish procedures for the monitoring of complaints
  • make available general descriptive information (eg brochures) on the handling of a complaint and the time period that the insurer will meet to respond to and resolve a complaint

If the complaint is not resolved to the customer's satisfaction, it can be referred to the Financial Ombudsman Service (FOS) Australia. The insurer is obligated to provide the customer with contact details for this service.

Review and Development of the Code

Many external parties are involved in ensuring that the Code is enforced and remains relevant. The Financial Ombudsman Service (FOS) Australia is responsible for the implementation, administration, monitoring and review of the Code. The Financial Ombudsman Service (FOS) Australia may take steps to enforce any sanctions imposed by it or the Code Compliance and may report any matter to the Australian Securities and Investment Commission (ASIC). The Insurance Council of Australia (ICA) developed the original Code, develops ongoing guidelines and commissions formal review of the Code.

More information on the Code, or a copy of the Code can be obtained from the Financial Ombudsman Service (FOS) Australia. You can contact Financial Ombudsman Service (FOS) Australia on 1800 367 287 (free call) toll free, or you can access the Code at www.codeofpractice.com.au

Dealing with Your Complaints and Disputes

As a member of the Financial Ombudsman Service (FOS) Australia, we are committed to the General Insurance Code of Practice.

If you have a complaint or dispute with MTA Insurance regarding a policy or claim the information below will provide you with details of how MTA Insurance will handle the dispute or complaints.

A requirement of Financial Ombudsman Service (FOS) Australia is that before they will review a complaint or dispute on your behalf, the matter must first be reviewed by MTA Insurance.

Disputes/Complaint Handling Procedure.

The contact details for MTA Insurance are:
PO Box 1453
IPC: 4GI109
Brisbane QLD 4001
Phone: (07) 3340 2700
Toll Free: 1800 634 294
Fax: (07) 3031 2862
Email: enquiries@mtai.com.au

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