Document ID: chunk:federal_register_of_legislation:F2018L01496:body:0:p27
Version: federal_register_of_legislation:F2018L01496
Segment Type: other
Provision Reference: 
Character Range: 71631–74757

benefit.
(d)          'Outside jurisdiction (EDR only)' (labelled E.4). This category applies only to EDR disputes and refers to instances where the relevant dispute does not fall within the relevant dispute resolution scheme or tribunal's jurisdiction in accordance with the scheme or tribunal's rules.
(e)          'Other dispute outcomes' (labelled E.5):
(i)            'Process related' (labelled E.5.1). This category applies to all disputes related to the claims process.
(ii)         'Other disputes' (labelled E.5.2). Any resolved disputes not covered by the preceding categories should be reported in this category.
92.         Resolved disputes where the original claims outcome was reversed (or amended) should be split into the following sub-categories:
(a)          'Original outcome incorrect' (labelled E.2.1). These are instances where, after review of all relevant detail and information provided, the insurer, an external dispute resolution scheme, tribunal or court of law decides that the original decision was incorrect.
(b)          'Additional information received' (labelled E.2.2). These are instances where the insurer, an external dispute resolution scheme, tribunal or court of law has received additional information and, based on the additional information, decided to reverse (or amend) the original claims decision.
(c)          'Other reasons for reversal/amendment' (labelled E.2.3). Any instances not covered by the preceding categories should be reported here.
93.         Total number of disputes that are undetermined at the end of the Reporting Period (labelled F).
94.         The reporting form will automatically calculate 'Disputes Open for Assessment in period' as paragraphs 88 plus 89 minus 90, labelled as D in the form. In addition, the form will perform a check to confirm reconciliation of the various items of entry. It is expected that D minus E minus F should equal zero.
95.         Internal, External and Litigated Disputes relating to the same Claim Event ('duplicate disputes') should be reported as they exist on the administration systems of the insurer. Where the same dispute exists in multiple Dispute Types (e.g. both as an Internal and External dispute), all should be reported.
    To enable a more complete understanding of disputes, additional information on the interaction between different dispute types is requested in the SUPPLEMENT_Disputes sheet of the reporting form. In the relevant table, report the number of all disputes open for assessment in the Reporting Period, split between those without duplicates ("None") and those duplicated across multiple Dispute Types.
96.         'Dispute Processing Durations' should be reported in respect of Disputes Resolved during the Reporting Period, measured as the period between the Dispute Lodged Date and the Dispute Resolved Date.
97.         'Dispute Processing Durations' should be reported by allocating the number of disputes (by Policy Benefit count) into the following 'disputes duration categories':
(a)          0 to 45 days
(b)          >45 days to 90 days
(c)          >90 days to 6 months
(d)