Insurer Stalling on Your Claim? Send a Final Demand (Australia)

You did it the right way. You complied with the claims process. You sent the polite chase emails. You sent a Letter of Demand. And the insurer is still dragging — extending the assessment, asking for the same documents twice, “escalating internally” without movement. Three months in, you’re staring at unpaid bills, no payout, and the slow realisation that delay is the strategy.

This is where a formal Insurance Complaint comes in. It’s not another polite chase. It puts your complaint into the insurer’s internal dispute process in writing, and if the insurer does not resolve it, the next step is a complaint to AFCA.

The legal framework

The General Insurance Code of Practice imposes hard timeframes: a decision within 4 months for straightforward claims (12 months for exceptional circumstances), and 30 days to respond to internal disputes (ASIC RG 271). Section 13 of the Insurance Contracts Act 1984 (Cth) requires utmost good faith — and unreasonable delay can itself breach that duty. Once an insurer is in breach of the Code’s timeframes, you have grounds at AFCA for both the underlying claim AND the delay itself.

Common stalling tactics and the legal response

• “We’re still gathering information.” The Code limits how long this can run. Once you’re past the 4-month mark without a Code-recognised exception, they’re in breach.
• Repeat document requests. Code requires them to ask for everything they need at the start of the assessment. Repeat asks are bad faith.
• “Awaiting external expert.” They have to actually instruct one and pay them. You can request the instruction date.
• “Internal dispute is being reviewed.” RG 271 caps this at 30 days. Past that, you can lodge with AFCA without further internal exhaustion.
• Silence. The Code requires updates every 20 business days at minimum.

What the document does

The Insurance Complaint sets out the claim, the time that has passed, every chase you’ve sent and the Code timeframes and Insurance Contracts Act duty the delay engages, and asks the insurer to respond within 30 days, failing which you will take the complaint to AFCA.

What Claim Done delivers

Wizard takes about ten minutes. Our Programmatic Algorithms draft a formal complaint to your insurer citing the right Code timeframes, ICA sections, and AFCA jurisdiction, plus the AFCA complaint if it still does not resolve your claim. Flat fee.

What to expect after sending

If the insurer does not pay or decide by the deadline, lodge with AFCA immediately citing both the delay and the underlying claim. AFCA can award interest, compensation for non-financial loss, and the underlying claim amount.