The Code defines a number terms to assist Code users to correctly interpret its standards.
Expand the following Code terms to reveal their definitions.
ACCC means the Australian Competition and Consumer Commission.
APRA means the Australian Prudential Regulation Authority.
ASIC means the Australian Securities and Investments Commission.
Authorised Representative means a person, company or other entity authorised by us to provide financial services on our behalf under our Australian Financial Services licence, in accordance with the Corporations Act 2001.
Business days are Monday to Friday, excluding public holidays.
Catastrophe means an event declared by the ICA to be a catastrophe, including, but not limited to, fire, flood, earthquake, cyclone, severe storm and hail, resulting in a large number of claims and involving multiple insurers.
CGC means the Code Governance Committee as explained in Section 12.
Claims Management Service
Claims Management Service means a person or company who is not our Employee but is contracted by us to manage your claim on our behalf.
Co-Insurance means where two or more insurers agree to insure a proportion of the same risk under the same policy.
Code means the General Insurance Code of Practice 2014.
Collection Agent means a person or company who is not our Employee but is contracted by us to recover money owing to us.
Complaint means an expression of dissatisfaction made to us, related to our products or services, or our Complaints handling process itself, where a response or resolution is explicitly or implicitly expected.
Declined Claim means you have made a claim on an insurance policy, and:
- we have declined or not accepted the claim; or
- we have not determined the claim within 10 business days of receiving all the information necessary to do so.
Employee means a person employed by us or by a related entity that provides services to which this Code applies.
Exceptional Circumstances means:
- the claim arises from an extraordinary Catastrophe as declared by the ICA Board;
- the claim is fraudulent or we reasonably suspect fraud;
- there is a failure by you to respond to our reasonable inquiries or requests for documents or information concerning your claim;
- there are difficulties in communicating with you in relation to the claim due to circumstances beyond our control; or
- you request a delay in the claims process.
External Expert means a person or company who is not our Employee or a Service Supplier, but is contracted by us solely to provide an expert opinion as to the likely cause of your loss or damage.
Financial Hardship means where you have difficulty meeting your financial obligations to us.
FOS means the Financial Ombudsman Service.
ICA means the Insurance Council of Australia.
In writing means a communication conveyed by mail or electronically via email, facsimile or text message.
Instalment Policy means a Retail Insurance policy for which the premium is payable by seven or more instalments in a year, as defined in the Insurance Contracts Act 1984.
Insured means a person, company or entity seeking to hold or holding a general insurance product covered by this Code, but excludes a Third Party Beneficiary.
Investigator means a person or company who is not our Employee but is contracted by us to verify the circumstances relating to your claim.
Loss Assessor or Loss Adjuster
Loss Assessor or Loss Adjuster means a person or company who is not our Employee but is contracted by us to examine the circumstances of your claim, assess the damage or loss, determine whether your claim is covered under your policy, assist in obtaining repair/replacement quotes and help settle the claim.
Marine Insurance means insurance to which the Marine Insurance Act 1909 applies. This Code applies to pleasure craft covered by the Insurance Contracts Act 1984.
Medical Indemnity Insurance
Medical Indemnity Insurance means medical indemnity cover for health care professionals under a contract of insurance covered by the Medical Indemnity (Prudential Supervision and Product Standards) Act 2003.
Motor Vehicle Injury Insurance
Motor Vehicle Injury Insurance means insurance that covers personal injury or death arising out of the use of a motor vehicle, including cover for the injury or death of a driver of a motor vehicle which is caused by the fault of that person when driving.
NIBA means the National Insurance Brokers Association of Australia.
Retail Insurance means a general insurance product that is provided to, or to be provided to, an individual or for use in connection with a Small Business, and is one of the following types:
- a motor vehicle insurance product (Regulation 7.1.11);
- a home building insurance product (Regulation 7.1.12);
- a home contents insurance product (Regulation 7.1.13);
- a sickness and accident insurance product (Regulation 7.1.14);
- a consumer credit insurance product (Regulation 7.1.15);
- a travel insurance product (Regulation 7.1.16); or
- a personal and domestic property insurance product (Regulation 7.1.17),
as defined in the Corporations Act 2001 and the relevant Regulations.
Service Supplier means an Investigator, Loss Assessor or Loss Adjuster, Collection Agent, Claims Management Service (including a broker who manages claims on behalf of an insurer) or its approved sub-contractors acting on our behalf.
Significant Breach means a breach that is determined to be significant by reference to:
- the number and frequency of similar previous breaches;
- the impact of the breach or likely breach on our ability to provide our services;
- the extent to which the breach or likely breach indicates that our arrangements to ensure compliance with Code obligations is inadequate;
- the actual or potential financial loss caused by the breach; and
- the duration of the breach.
Small Business means a business that employs:
- less than 100 people, if the business is or includes the manufacture of goods; or
- otherwise, less than 20 people.
Third Party Beneficiary
Third Party Beneficiary means a person, company or entity who is not an Insured but is seeking to be or is specified or referred to in a general insurance product covered by this Code, whether by name or otherwise, as a person to whom the benefit of the insurance cover provided by the product extends.
we, us or our
We, us or our means the organisation that has adopted this Code.
Wholesale Insurance means a general insurance product covered by this Code which is not Retail Insurance.
Workers Compensation means insurance that covers an employer’s liability to pay compensation for an employment-related personal injury.
you or your
You or your means an Insured or Third Party Beneficiary, or as otherwise stated in relation to a particular section of this Code.
Refer to the ANZIIF Insurance Glossary for explanations of any other terms and acronyms that are relevant to the insurance industry.