Claims handling a focus for AFCA, code monitoring

Claims handling is expected to be a focus this financial year for the Australian Financial Complaints Authority (AFCA) while the issue is also set to be examined as part of code of practice independent monitoring activity.

Code Compliance and Monitoring GM Prue Monument told the AFCA members’ forum today that a range of inquiries are planned for this financial year, looking at known and emerging areas of risk across sectors overseen by independent committees.

“We will be looking at claims handling in the general insurance space, in particular where we are seeing high numbers of breaches when claims are declined and subsequently approved,” Ms Monument said.

The work will also examine what general insurers have learned as a result of recent responses to natural disasters, she says.

Deputy Chief Ombudsman June Smith says AFCA has seen delays in the handling of home, contents and motor claims following the Queensland and NSW floods, and that’s likely to continue showing up in complaints this financial year.

“We expect we will be working with insurers in relation to some of those pressures,” she told the forum.

AFCA is also looking toward business insurance complaints that may come forward once claims are lodged after the High Court decision on the second industry business interruption test case, she says.

The court is yet to determine if it will allow an appeal to go ahead following the Full Court decision on the issues handed down in February.

CEO and Chief Ombudsman David Locke says AFCA is continuing to respond to a review of the organisation last year, including on recommendations around handling of systemic issues, transparency and timeliness.

Mr Locke says AFCA will work with regulators and other agencies, particularly the Australian Securities and Investments Commission (ASIC) and code compliance committees, to minimise overlap and enhance information sharing.

“Next AFCA will be engaging with ASIC to investigate options to increase the visibility and clarity of our role in managing systemic issues,” he said.

AFCA is also focusing on improvements where complaints remain unresolved beyond 12 months, and is replacing the complaint management system and upgrading the member portal as part of an IT transformation project.