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Principles

4.5 Insurers and those acting on their behalf are to deal with claims in a manner consistent with the objects of the Act, the below principles and the general duties under Division 6.2 of the Act.

These principles apply across all claims management aspects for the life of a claim:

(a) proactively support the claimant to optimise their recovery and return to work or other activities

(b) make decisions justly and expeditiously

(c) act objectively with honesty and professionalism at all times

(d) detect and deter fraud

(e) communicate with the claimant and keep them informed of the progress of their claim

(f) take into account the health emergency caused by the COVID-19 pandemic on a claimant’s circumstances when making decisions about a claim, including decisions related to disputes, and the claimant’s ability to comply with obligations or timeframes under the Act, regulations or these Guidelines.

4.7 If an insurer does not deal with claims in a manner consistent with these principles, the Authority will take appropriate action as per the Authority’s compliance and enforcement strategy.

4.8 In circumstances where more than one insurer is involved in the management of a claimant’s statutory benefits claim and/or damages claim, the insurers must:

(a) proactively and regularly share information with each other

(b) promptly respond to requests from each other

(c) ensure the claimant understands which insurer will be managing each aspect of the claim process and the reasons why

(d) work collaboratively to ensure a consistent and seamless claim experience for the claimant.