Document ID: chunk:federal_register_of_legislation:F2024L00653:body:0:p8
Version: federal_register_of_legislation:F2024L00653
Segment Type: other
Provision Reference: 
Character Range: 27918–32085

result of a claim that the insurer has determined. Possible values are:

                                                                                                   * Admitted;
                                                                                                   * Declined; and
                                                                                                   * Finalised Other.
Claim declined                                                                                 Means a claim where a final decision to decline the claim has been made.

Claim duration                                                                                 Means a length of time, in calendar days, between when a claim was received and when the claim was finalised, inclusive of the day the claim was received and the day the claim was finalised.

Claim finalised                                                                                Means when the insurer has made a final decision on the claim (e.g. whether to admit or decline the claim) and communicated this decision to the claimant and is not dependent on payment to the insured having been made. Communication by email, text message, facsimile or telephone is deemed to have occurred on the date it was sent. Communication by postal service is deemed to have occurred three business days after it was sent.

                                                                                               Where income protection (IP) payments have commenced prior to a final claim decision being made (so-called goodwill payments), the claim should not be classified as finalised. Such a claim should only be classified as finalised once a final claim decision has been made. If that claim decision is to decline the claim, the claim should be recorded as such, regardless of payments already made.

Claim finalised - other                                                                        Means the insurer has made a final decision on the claim, but it does not meet the definition of claim finalised.

Claim paid                                                                                     Means an insurance provider has made a payment with respect to a claim made by an RSE licensee. Includes: rehabilitation costs or benefits that minimise claims experience or potential prepayment of insured amounts.

Claim paid to member by                                                                        Means who has paid the claim to the member.  The claim paid to member by options are:

                                                                                                   * RSE Licensee;
                                                                                                   * Insurer;
                                                                                                   * Other; and
                                                                                                   * Not Applicable.
Claim received                                                                                 Means the point in time where the first piece of information (not necessarily all information) is received by the insurer to allow it to commence the assessment of a claim. At this stage, the insurer has confirmed there is a policy in force that could potentially cover the indicated claim event and has recorded the existence of a claim.

Claim re-opened                                                                                Means instances where a claim has previously been finalised or withdrawn, but is re-opened by the insurer during the reporting period. It is expected that a re-opened claim would predominantly relate to a claim that has been finalised or withdrawn during previous reporting periods. It is, however, possible (and acceptable) that re-opened claim could also relate to a claim that has been finalised or withdrawn in the same reporting period as the claim being re-opened.

Claim withdrawn                                                                                Means the instance where