Document ID: chunk:federal_register_of_legislation:F2018L01496:body:0:p26
Version: federal_register_of_legislation:F2018L01496
Segment Type: other
Provision Reference: 
Character Range: 68812–71913

the Reporting Period (labelled A on the various disputes sheets in the reporting form).
89.         The total number of claims-related disputes that have been lodged during the Reporting Period (labelled B). Lodged disputes should be split between the following Dispute Reasons:
(a)          'Claim outcome: decline decision' (labelled B.1). These are instances where the claim has been declined and the decline decision is challenged or disputed.
(b)          'Claim outcome: benefit adjustment (claim amount)' (labelled B.2). These are instances where a claim has been admitted but the benefit amount is challenged or disputed.
(c)          'Claim process' (labelled B.3). These are disputes that are not related to the claim outcome, but to any aspect related to the claim process: delays, requirements etc.
(d)          'Other disputes lodged' (labelled B.4). Any claims-related dispute not covered by one of the preceding categories.
    Each dispute should only have one dispute reason. Where a dispute has multiple dispute reasons, only the dominant reason should be recorded.
90.         The total number of disputes that have been withdrawn during the Reporting Period (labelled C). Disputes withdrawn should be split between the following withdrawal reasons:
(a)          'Withdrawn by the claimant' (labelled C.1).
(b)          'Withdrawn by the insurer' (labelled C.2).
(c)          'Withdrawn by EDR, court or tribunal' (labelled C.3).
(d)          'Other reasons for withdrawal' (labelled C.4).
91.         The total number of disputes that have been resolved during the Reporting Period (labelled E). Resolved disputes should be split between the following Dispute Outcomes:
(a)          'Original claims outcome maintained' (labelled E.1). These are instances where the dispute did not result in any change to the original claim declinature decision, including any benefit that may have been paid.
(b)          'Original claims outcome reversed (or amended)' (labelled E.2). These are instances where the original claim declinature decision is reversed to become a 'claim admitted' decision, as well as instances in which the insurer has agreed to pay an additional amount equivalent to the amount sought by the claimant. The Dispute Outcomes reported in this category should be split into the sub-categories defined in paragraph 92.
(c)          'Ex-gratia payment, premium refund, partial payment, settlement or non-cash benefit' (labelled E.3). These are instances where the original declinature decision is not reversed (as defined in paragraph 91(b)), but an amount of compensation is paid (including any amount that is less than the amount sought by the claimant). This can take the form of an ex-gratia payment, a partial benefit payment, a commercial settlement, a premium refund, or a non-cash 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