General Insurance Claims Handling Framework

The recent implementation of licensing requirements for Claims Handling has provided an opportunity for the insurance industry to establish a minimum professional standards framework for Claims Handling and Settling Services in such a way that we can focus on professionalising Claims Handling for the benefit of all.

Claims General Insurance

The insurance industry is fundamental to our economy, and our Claims teams are the proof point for insurance.

As an industry we are not well understood by our broader community - and the less we are understood, the more important it is that we can point to a frame of reference of ‘what good looks like’. Industry Codes, such as the General Insurance Code of Practice is an excellent example of this.

“ANZIIF is such an important part of the Australian Insurance Industry landscape. As the leading professional membership association serving all parts of our industry, it is the only association with the expertise, capability and authority to develop such a framework on behalf of industry” says Ben Bessell, President of ANZIIF.

Read the media release

After extensive consultation there is broad support for having a framework that provides minimum standards. In welcoming the development of this framework, some of the benefits identified through industry workshops include:

It provides flexibility on an ‘if not, why not’ approach to cover wholesale/retail and differing business models;
The framework does not require organisations to pay any annual or other licensing fees;
The framework does not require any independent certification;
It provides an opportunity to improve the professionalism of Claims Handling, including improving attraction and retention of employees;
The framework is flexible enough to align easily to existing role structures; and
An appreciation of the consistency this could drive across industry.

What is the Framework?

The Framework covers all claims handling roles within the scope of the license for a Licensed Claims handler (whether employed directly or by delegation), and provides the standards required for Unlicensed Insurance Fulfilment Providers. The roles are grouped into clusters, and standards are set according to complexity and responsibility.

There are three clusters in the framework:

1. Licensees, Authorised Representatives, Sub Authorised Representatives with Decision Making Authority

2. Licensees, Authorised Representatives, Sub Authorised Representatives with No Decision-Making Authority

3. Unlicensed Insurance Fulfilment Providers – No decision-making authority

All competencies have been linked to the Australian Qualifications Framework (AQF) for transparency, robustness and mapped to ASIC Information Statement 253 requirements. The full requirements for each Group and level are laid out in the General Insurance Claims Handling Framework PDF, below.

To review what endorsing the framework entails and the timeline for implementation download the PDF.

Download the Claims Handling Framework PDF