ASIC’s Corporate Plan 2024โ25 outlines the projects ASIC will undertake to deliver on their important mandate. ASIC makes a crucial contribution to maintaining Australiaโs fair, strong and efficient financial system. The priortites relevant for General Insurance have a focus on claims handling practices including enforcement actions. 1. ๐๐ข๐ฅ๐ง๐ค๐ซ๐ ๐๐ค๐ฃ๐จ๐ช๐ข๐๐ง ๐ค๐ช๐ฉ๐๐ค๐ข๐๐จ – undertake a cross-sector surveillance of compliance with the requirements outlined in Regulatory Guide 271 Internal dispute resolution (RG 271). – In 2024, ASIC will publish observations from the first year of IDR data reported by all firms, while in 2025 ASIC will publish firm-level IDR data. – take action against insurers in relation to claims handling, especially in relation to home insurance claims. – take action in response to harmful product design and distribution practices, including conduct that results in consumers receiving unsuitable products. – monitor general insurersโ improvements to claims handling and engage with the independent review of the 2020 General Insurance Code of Practice. 2. ๐ผ๐๐๐ง๐๐จ๐จ ๐๐๐ฃ๐๐ฃ๐๐๐๐ก ๐จ๐ฎ๐จ๐ฉ๐๐ข ๐๐ก๐๐ข๐๐ฉ๐ ๐๐๐๐ฃ๐๐ ๐ง๐๐จ๐ ASIC will review how general insurers are handling customer complaints and responding to recommendations from previous reviews about their handling of claims following severe weather events. 3. ๐ผ๐๐ซ๐๐ฃ๐๐ ๐๐๐๐๐ฉ๐๐ก ๐๐ฃ๐ ๐๐๐ฉ๐ ๐ง๐๐จ๐๐ก๐๐๐ฃ๐๐ ๐๐ฃ๐ ๐จ๐๐๐๐ฉ๐ฎ ASIC will continue to monitor how retail financial services use AI and advanced data analytics. ASIC will also assess their risk management and governance processes. ๐๐ฉ๐๐๐ง ๐ ๐๐ฎ ๐๐๐ฉ๐๐ซ๐๐ฉ๐๐๐จ 1. ASIC will continue to work closely with APRA to implement the FAR by providing guidance, engaging with industry and developing effective registration and other processes 2. ASIC will work with the Australian Government to support the introduction of the Regulatory Initiatives Grid (RIG). The RIG will provide industry with information, in a single location and from across multiple agencies, about upcoming reforms and regulatory actions that will materially affect the financial sector.
A new standard agreed by general insurers will provide additional clarity & certainty for customers when independent expertise is required to help determine a claim. The Expert Report Best Practice Standard has been developed by the Insurance Council of Australia to provide consistency when insurers are using reports by experts such as hydrologists, engineers, builders, or specialist tradespeople. The best practice standard has been developed using feedback provided by consumer advocates and AFCA. An Expert Report is a report produced by an External Expert as defined in the GI Code of Practice. The ICA will be recommending to the independent Code Review Committee that the Standard is referenced in the next version of the Code to provide additional certainty and rigour around the use of Expert Reports. The Standard contains the following requirements: ๐๐ง๐-๐ง๐๐ฅ๐ค๐ง๐ฉ ๐๐ค๐ข๐ข๐๐จ๐จ๐๐ค๐ฃ๐๐ฃ๐ 1. Relevant expertise – prior to an expert report being commissioned, insurers must ensure the expert being briefed is relevant, qualified, & objective 2. Capacity – The insurer should confirm that for each report commissioned the expert has the capacity to provide an expert report to the highest possible standard. 3. Briefing – The insurer should ensure that the expert has been fully briefed on relevant matters relating to the claim. 4. Advice to customers – The insurer should ensure that the customer is informed about the need to seek an expert report, the intended scope & use of the report, & is provided an opportunity to consider the need to submit any evidence to the insurer or expert in the commissioning process. 5. Exclusions – the insurer should make it clear to the expert exactly what they want the expert to provide an opinion on by including specific questions ๐๐๐ ๐ง๐๐ฅ๐ค๐ง๐ฉ ๐๐ฉ๐จ๐๐ก๐ Insurers should ensure that reports: – are neutral & in plain english – formatted with conclusions – consider all relevant matters – rely only on facts – provide clear & cogent reasoning – clear on whether an opinion is tenative or firm – identify the cause(s) contributing to the loss – provide a statement of objectivity – provide the expert’s qualifications ๐๐จ๐ ๐ค๐ ๐ฉ๐๐ ๐ง๐๐ฅ๐ค๐ง๐ฉ – the expert report should be considered by claims managers & critically examined – provided to the customer & the insurer should explain which parts of the report have been relied on for the claim decision & why – disregard any statements or opinions outside of the scope or expert’s expertise
Underwriting Agencies continue to play an important role in the Australian GI market. Underwriting Agencies (UA) provide specialist skills & services, often filling gaps with niche products. By nature, UA are agile & provide a mechanism for the industry to innovate through technology. UA can also assist in the growth & development of people competencies & skill-sets ๐พ๐ค๐ข๐ฅ๐ก๐๐๐ฃ๐๐ ๐๐ค๐ฃ๐จ๐๐๐๐ง๐๐ฉ๐๐ค๐ฃ๐จ UA are a core client segment for me. I provide AFS Licensing, risk & compliance frameworks, training & education together with general compliance advice. There are some unique compliance considerations for UA: 1. A UA may initially focus on underwriting & defer claims to their insurer partner or TPA. This brings benefits by being able to tap into wider expertise however it’s important that dedicated claims staff are appointed to manage the UA claims so that the UA market proposition & brand values are not compromised 2. Complaints. It’s important to triage new complaints to understand whose licence(s) the complaint falls under. If the UA has all AFSL authorisations (advice, issuing & claims) the complaint will be against the UA, & any referral to insurers, claim managers or Lloyds Australia (to tap into their skill-set) is done so on an outsourced basis. 3. Insurers have various obligations to monitor a UA (under AFSL, Code & CPS 230). This should be through initial due-diligence & the ongoing provision of data rather than constantly looking over the shoulder of the UA. 4. UA should push back when insurers try to implement an APRA regulated risk management system on the UA. UA compliance arrangements must be tailored & based on the nature, scale & complexity of the UA. 5. A UA should be a member of Underwriting Agencies Council (UAC), ensuring that they have a strong voice at the table to provide input for regulatory change & GI Code issues. 6. Excel spreadsheets & word docs are more than adequate to manage compliance at smaller UA. Automation & complex risk management practices are a factor of size & should be considered as the UA grows. 7. UA should adopt 3 lines of defence, risk maturity matrix & risk appetite statements to enable management to better manage risks. However, adopt the principle & tailor to the size of the UA 8. Unless large, most UA will default compliance to the COO or similar. It’s critical that business leaders manage compliance, with the COO providing support. Usually the COO will tap into someone like myself for more specialised compliance expertise ๐ผ๐๐๐๐๐ ๐๐๐๐๐๐๐๐๐๐ ๐๐๐๐๐๐๐๐๐๐ ๐๐๐ ๐ผ๐๐
๐๐๐๐๐๐๐๐๐ ๐จ๐๐๐๐๐๐๐ Underwriting Agencies are a critical part of our General Insurance industry & are very exciting to be part of. However, they present unique compliance challenges that must be understood & managed.
๐๐๐ค ๐๐๐จ ๐ฉ๐ค ๐๐ค๐ฃ๐๐ฉ๐ค๐ง? The obligation to monitor arises under financial service laws & industry Codes, these include: 1. Insurers have an obligation to monitor Distributors & Service Suppliers under the GI Code; 2. All AFS licensee’s have an obligation to monitor representatives (employees & ARs) under financial services laws. This obligation extends to referrers & distributors operating under ASIC instruments; 3. Insurance Brokers have an obligation to monitor AR’s & employees under the Insurance Brokers Code; 4. Claim Managers have an obligation to monitor service suppliers. 5. Agreements include a contractual obligation to monitor & be monitored. In addition FAR & CPS 230 creates additional monitoring obligations for APRA regulated insurers in respect of Insurance Key Functions (FAR) & Material Service Providers (CPS 230). ๐ฟ๐๐ซ๐๐ก๐ค๐ฅ๐๐ฃ๐ & ๐๐ข๐ฅ๐ก๐๐ข๐๐ฃ๐ฉ๐๐ฃ๐ ๐ ๐๐ค๐ฃ๐๐ฉ๐ค๐ง๐๐ฃ๐ & ๐๐ช๐ฅ๐๐ง๐ซ๐๐จ๐๐ค๐ฃ ๐๐ง๐ค๐๐ง๐๐ข A single, tailored, fit for purpose Monitoring Program can meet all your requirements irrespective of the source – a single program is efficient, risk-based & enables an Enterprise view to manage risk & compliance requirements. ๐๐จ๐จ๐๐ฃ๐ฉ๐๐๐ก ๐๐ค๐ข๐ฅ๐ค๐ฃ๐๐ฃ๐ฉ๐จ ๐ค๐ ๐ ๐๐ค๐ฃ๐๐ฉ๐ค๐ง๐๐ฃ๐ & ๐๐ช๐ฅ๐๐ง๐ซ๐๐จ๐๐ค๐ฃ ๐๐ง๐ค๐๐ง๐๐ข 1. Due diligence prior to engagement; 2. Agreements that capture obligations of the parties; 3. Onboarding (includes training & education) 4. Alignment to your Risk & Compliance framework 5. Ongoing Training (includes laws & Code, complaints, incidents & breaches) 6. Monitoring, including: a) file reviews b) call recording c) attestations d) control testing e) 3 lines of defence activities f) QA program g) external events incl regulator activity 7. Supervision, including: a) new starters without authority; b) delegated authority c) Standard Operating Procedures, systems & processes d) team meetings e) individual meetings f) hallway conversations 8. Using people as an ‘early warning system’ 9. Incident & breach management 10. Complaint management (IDR & EDR) 11. Data – what is it telling me? (complaints, incidents, Control testing etc) 12. Reporting
The purpose of compliance is to Protect Protect who? ๐๐ณ๐ฐ๐ต๐ฆ๐ค๐ต๐ช๐ฏ๐จ ๐ค๐ถ๐ด๐ต๐ฐ๐ฎ๐ฆ๐ณ๐ด & ๐ค๐ญ๐ช๐ฆ๐ฏ๐ต๐ด, ๐ต๐ฉ๐ฆ ๐ฃ๐ถ๐ด๐ช๐ฏ๐ฆ๐ด๐ด, ๐ช๐ต๐ด ๐ฑ๐ฆ๐ฐ๐ฑ๐ญ๐ฆ & ๐ฑ๐ข๐ณ๐ต๐ฏ๐ฆ๐ณ๐ด, ๐ด๐ต๐ข๐ฌ๐ฆ๐ฉ๐ฐ๐ญ๐ฅ๐ฆ๐ณ๐ด & ๐ต๐ฉ๐ฆ ๐ค๐ฐ๐ฎ๐ฎ๐ถ๐ฏ๐ช๐ต๐บ Protect from what? ๐ฉ๐ข๐ณ๐ฎ ๐ฐ๐ณ ๐ฅ๐ฆ๐ต๐ณ๐ช๐ฎ๐ฆ๐ฏ๐ต – financial, reputational, loss of licence, lost management time, disqualification, systematic failures, industry mistrust, regulatory scrutiny, anxiety etc Compliance provides a safe environment to operate, providing [insurance] products & services to customers. It does not matter whether you are an APRA regulated insurer, an underwriting agency, an insurance broker, a Claims manager (TPA) or material service provider. A systematic approach to compliance is critical. ๐๐ค๐ฌ ๐๐ค๐๐จ ๐๐ค๐ข๐ฅ๐ก๐๐๐ฃ๐๐ ๐ฅ๐ง๐ค๐ฉ๐๐๐ฉ? Think of a fortress, with inner & outer walls providing protection to those within. The 1st layer of protection is ๐๐ผ๐บ๐ฝ๐น๐ถ๐ฎ๐ป๐ฐ๐ฒ ๐ฎ๐ฟ๐ฟ๐ฎ๐ป๐ด๐ฒ๐บ๐ฒ๐ป๐๐ – policies, process, procedures , systems, trained & competent people that combined, form ‘a safe place to conduct business’ The 2nd layer is ๐๐๐ค๐ฅ๐ก๐ – employees, authorised reps, material service providers are ‘an early warning system’ reporting things that penetrate the 1st layer. Such as incidents, complaints, breaches, control breakdowns etc The 3rd layer of protection is your ๐๐ค๐ฃ๐๐ฉ๐ค๐ง๐๐ฃ๐ ๐๐ง๐ค๐๐ง๐๐ข – ‘providing assurance’ to board, management & stakeholders. The final layer of protection is ๐พ๐ช๐ก๐ฉ๐ช๐ง๐ – ‘a desire to do the right thing’, knowing what the right thing is, how to do the right thing & doing something when things go wrong – when no one is watching. ๐ง๐ต๐ฒ ๐ฐ ๐ฃ๐ถ๐น๐น๐ฎ๐ฟ๐ ๐ผ๐ณ ๐๐ผ๐บ๐ฝ๐น๐ถ๐ฎ๐ป๐ฐ๐ฒ It’s critical that the layers of protection are underpinned by a strong foundation. These are the ‘4 pillars of compliance’: 1. Governance & Frameworks 2. People & Culture 3. Procedures & Process 4. Systems & Reporting The 4 pillars of compliance, when combined, ensure a consistent, risk-based approach to compliance, with inherent oversight, monitoring & continuous improvement. The 4 pillars are used when: 1. Setting up & maintaining the compliance arrangements 2. Assessing the risk maturity of the arrangements 3. Managing regulatory change 4. Self-monitoring, highlighting potential areas of attention ๐๐๐ฉ๐ช๐ง๐, ๐จ๐๐๐ก๐ & ๐๐ค๐ข๐ฅ๐ก๐๐ญ๐๐ฉ๐ฎ A compliance framework, including the layers of protection & the 4 Pillars of compliance, is a conceptual, principle-based model that can be tailored to the nature, scale & complexity of any business operating within general insurance. The framework provides a compliance operating rhythm that is part of normal business operations with in-built early warning lights, self-monitoring, data-producing & continually evolving to meet consumer, regulatory & business standards & expectations.
AFS Licensee’s have several general obligations, these are set out in s912A(1) Corporations Act. Licensee’s must: 1. Provide their financial services (includes advice, dealing in general insurance products & claims handling) efficiently, honestly & fairly. Such as – acting without delay, responding to queries & claims – assessing claims & insurance applications in the least intrusive & onerous way – informing insured’s of processes & including fairness in those processes (eg procedural fairness for claim declines) – services tailored to customers experiencing vulnerability & – Code membership 2. adequately manage conflicts of interest. Disclosing conflicts, controlling conflicts & avoiding those conflicts that can’t be adequately managed (see RG 181) 3. comply with licence conditions. This may include a key persons requirement or the ability to use restricted broking terms. 4. comply with financial services laws. These include Corps Act Chap 7, ASIC Act Part 2 Div 2, Insurance contracts Act, Insurance Act & Privacy Act among others 5. Ensure representatives comply with financial service laws. This requires a monitoring program for employees, Authorised reps, claim servcie suppliers & material service providers. 6. Other than APRA regulated insurers, have adequate financial, people & IT resources to provide the financial services. Also refer RG 104 & RG 166. APRA insurers must comply with Prudential Standards 7. maintain the competence to provide the financial services. This entails having responsible managers with the requisite knowledge, skills & experience providing complete coverage of your financial services across the business (refer table 1 RG 105) 8. ensure that your representatives (see 5 above) are competent & adequately trained, including RG 146 when providing advice 9. Have a dispute resolution system complying with the enforceable paragraphs of RG 271, provide IDR data to ASIC & be a member of AFCA 10. other than APRA insurers have adequate risk management systems. APRA insurers must comply with CPS 220 & from July 2025 CPS 230 11. comply with Reg 7.6.04 which includes obligations to: – advise ASIC of material changes to financial position – adding/deleting Authorised reps – maintaining a training register – due diligence prior to appointing AR’s & including their AR number in documents – provdie a copy of AFSL/AR authorisations upon request – advise ASIC of change of control of licensee ๐ด๐๐๐๐๐๐๐ ๐๐๐๐๐๐๐๐๐๐๐ An obligations register or table (contained within a risk & compliance manual) should be used to manage these & other regulatory (& Code) obligations Accountability & key controls are aligned to the obligations, enabling management within risk appetite. Control testing, monitoring, data validation & reporting complete the picture. Speak to me to explore obligations management further.
The key to embedding compliance in your General Insurance business is ๐๐๐๐๐๐. Leave the technical side of compliance to specialists such as myself & focus on your people. 1. ๐ป๐๐ ๐๐๐๐ ๐๐๐๐๐๐๐ ๐๐ ๐๐๐๐๐๐๐๐๐๐ ๐๐ ๐๐ ๐๐๐๐๐๐๐ Don’t talk about laws or rules, not inspiring language. Talk about how compliance creates an environment that protects your customers, clients, people, the business, partners & other key stakeholders 2. ๐ช๐๐๐๐๐๐ ๐๐๐ ๐๐๐๐๐ ๐๐๐๐ ๐๐๐ ๐๐๐๐
Everyone has someone like my elderly mum in ther lives. Mum lives by herself. She banks & buys insurance. Compliance is about protecting my mum & people we deeply care about. Involving the heart, brings about caring & caring brings actions 3. ๐ป๐๐ ๐๐๐๐๐ ๐๐ ๐๐๐๐๐๐๐๐๐๐๐๐ A story about Paul’s mum is far more powerful than section 912(A)(1)(g)(ii). Use storytelling to sell the message of compliance. 4. ๐ฌ๐๐๐๐ ๐๐๐๐๐๐ ๐๐๐ ๐ ๐๐๐๐ ๐๐ ๐๐๐๐ Creating a compliance ecosystem needs everyone to actively play a part. From incident reporting to following the processes. We all have a role to play 5. ๐ฌ๐๐๐๐๐๐ ๐๐๐๐๐๐๐๐ Train people on the why & how, & less on the technical. How compliance protects? How to identify incidents & complaints? Why should I care? 6. ๐ฌ๐๐๐๐๐ ๐๐๐๐๐๐ ๐๐ ๐๐ ๐๐๐๐๐ We are human & stuff happens that’s not supposed to. The role of compliance is to make it easy to identify, remediate & rectify when stuff goes wrong. It’s impractical from a business viewpoint to build a compliance system that 100% prevents things going wrong – unless you want to stop being human. 7. ๐ช๐๐๐๐๐ ๐ ๐๐๐๐ ๐๐๐๐๐๐๐๐๐๐๐ If you want people to self-report & raise incidents & complaints promptly you need to create a safe environment for them to do so. 8. ๐ฏ๐๐๐ ๐ ๐๐๐๐๐๐๐๐๐ A framework provides a foundation to manage compliance in a systematic, risk-based approach. A fit-for-purpose framework supports & enables your people 9. ๐ซ๐๐’๐ ๐๐ ๐๐๐๐๐๐๐๐ ๐๐ ๐๐๐๐๐๐๐๐ ๐๐๐๐๐๐ ๐๐๐๐๐๐๐๐ At a time of ‘naming & shaming’ don’t be hesitant when deciding whether to report a breach to ASIC or a Code Committee. Timely reporting is a feature of good compliance arrangements & being a responsible corporate citizen. 10. ๐ฒ๐๐๐ ๐๐๐๐๐๐๐๐๐๐ ๐๐๐ ๐๐ ๐๐๐๐
Compliance is not a set & forget exercise or annual activity. To truly embrace compliance as a way of working it must be top of mind. Do leaders walk the talk? Is compliance part of your regular team conversations? Can you access FAQs easily on your internet? Do you know the risks & controls in your area of the business? ๐๐จ๐ฆ๐ฉ๐ฅ๐ข๐๐ง๐๐ ๐ข๐ฌ ๐๐๐จ๐ฎ๐ญ ๐ฉ๐๐จ๐ฉ๐ฅ๐ In summary, think less about rules, laws, clauses & sections & more about people.
๐๐๐๐ ๐ซ๐๐ ๐ฎ๐ฅ๐๐ญ๐จ๐ซ๐ฒ ๐๐ก๐๐ง๐ ๐ & ๐จ๐ญ๐ก๐๐ซ ๐๐๐ฏ๐๐ฅ๐จ๐ฉ๐ฆ๐๐ง๐ญ๐ฌ ๐ข๐ง ๐๐๐ง๐๐ซ๐๐ฅ ๐๐ง๐ฌ๐ฎ๐ซ๐๐ง๐๐ We are almost at the mid-point of the year & already we have seen a plethora of changes, consultations & reviews impacting the General Insurance industry. Compliance never sleeps in General Insurance. ๐ช๐๐๐๐๐๐๐๐๐๐๐๐, ๐๐๐๐๐๐๐, ๐๐๐๐๐ ๐๐๐๐๐, ๐๐๐๐
๐๐๐๐ & ๐๐๐๐๐ ๐๐๐๐๐๐๐ 11 June – Treasury – feedback on draft legislation (financial advice reform) which include requiring general insurance brokers to obtain commission consent from retail clients if personal advice has been or is likely to be provided. Closes July 8 May – 3 person-panel independent review of the GI Code of Practice – The Terms of Reference set out the reviewโs overarching principle of maintaining & enhancing consumer protections, along with Code modernisation, enhancement of customer experience, accessibility, effectiveness & efficiency, & providing customer value. Consultation closed, report due mid-year 28 May – ASIC to launch new Professional Registers search (for licences) late June 20 May – IBCCC publish guidance note ‘Supporting vulnerable clients’ as guidance for section 10.0 Insurance Brokers Code of Practice 16 May – Senate – Select Committee on the Impact of Climate Risk on Insurance Premiums & Availability established. The Committee has been established to inquire & report on the unaffordability & unavailability of insurance in some regions due to climate-driven disasters & the underlying causes & impacts of increases in insurance premiums. The committee is to present a final report by 19 November 2024. Submissions close 2 July 2024. 22 March – Federal Crt – In finding Auto & General did not include an unfair contract term in its PDS, determined that Utmost Good faith, Section 54 & construction of the PDS, must be taken into account when considering whether a term of the insurance contract is unfair. 7 March – Treasury – consultation on standardising definitions & standard cover for insurance terms – fire, storm, stormwater & rainwater run-off. Consultation closed 4th April 6 March – ASIC – letter to insurers to improve claims handling practices Feb – House of Reps – Parliament inquiry into insurersโ responses to 2022 major floods claims. Report due Sept 2024 Also, FAR commencing March 2025 – RG 279 issued 14 March 2024 CPS 230 commencing July 2025
๐๐น๐ฎ๐ถ๐บ ๐บ๐ฎ๐ป๐ฎ๐ด๐ฒ๐บ๐ฒ๐ป๐ ๐ฎ๐ฟ๐ฟ๐ฎ๐ป๐ด๐ฒ๐บ๐ฒ๐ป๐๐ – ๐๐ฒ๐ป๐ฒ๐ฟ๐ฎ๐น ๐๐ป๐๐๐ฟ๐ฎ๐ป๐ฐ๐ฒ Following on from my previous post on Distribution arrangements, I thought I would cover off the typical general insurance claim arrangements. ๐๐๐ฃ๐๐ฃ๐๐๐๐ก ๐จ๐๐ง๐ซ๐๐๐๐จ & ๐ก๐๐๐๐ฃ๐จ๐๐ฃ๐ Claims handling & settling services (CHSS) has been a financal service since 1 Jan 2022. CHSS covers the activities as defined under section 766G Corporations Act. The need to hold an AFS licence is determined by s 911A(2)(ek). You need to hold an AFSL for CHSS if you are: the insurer under the insurance product or an underwriting agency with authority from the insurer to provide CHSS; an insurance fulfilment provider but only where you have authority to reject all or part of a claim; an insurance claims manager aka TPA (acting for an insurer) but only where this is a primary part of your business. For example, if assessing or investigations is the primary part of your business, you don’t need an AFSL (Reg 7.1.04CB); an insurance broker, but only if they have authority from an insurer to provide the CHSS. Brokers acting on behalf of insured’s can rely on the exemption & not hold an AFSL; a claimaint intermediary, that is a person providing CHSS on behalf of an insured for a prescribed product other than insurance brokers, accountants, vets, travel agents, financial advisers & counsellors, property managers, estate management & public trustees. An exemption applies for CHSS where the issuer of the general insurance product is Lloyd’s underwriters or an UFI. A licensee may appoint others as an Authorised Rep to provide CHSS. ๐๐ ๐พ๐ค๐๐ ๐ค๐ ๐๐ง๐๐๐ฉ๐๐๐ There are obligations for CHSS under the Code. It is necessary to examine the definitions in Part 16 of the Code to determine how the Code applies to your business. Service Supplier – means an Investigator, Loss Assessor or Loss Adjuster, Collection Agent, who is not an employee of the insurer but is contracted to manage claims on behalf of an insurer (including a broker) & any of their approved sub-contractors. Investigator, Loss Assessor or Loss Adjuster, Collection Agent are all defined terms in Part 16. External Expert means a company, entity, or a person who is not an Employee or a Service Supplier & is contracted solely to provide an expert opinion about the likely cause of loss or damage. ๐ฎ ๐ฝ๐ฎ๐ฟ๐ ๐ฝ๐ฟ๐ผ๐ฐ๐ฒ๐๐ It follows from the above, in order to determine your obligations under financial services laws & the Code, you need to understand: 1. Your requirement to hold an AFS Licence; & 2. The category you fall within under the GI Code This starts with the questions (in context of CHSS): what CHSS do you do? how do you do the CHSS? who do you do the CHSS on behalf of?
Distribution Arrangements Compliance with requirements for 3rd party GI distribution arrangements is critical for Brokers, underwriting agencies & insurers. It is an offence to distribute general insurance products if you are not: an ASF licensee; an AR of a licensee; acting under an ASIC instrument; or relying upon an exemption. ๐๐๐๐๐ง๐ง๐๐ก ๐๐ง๐ง๐๐ฃ๐๐๐ข๐๐ฃ๐ฉ๐จ This arrangement allows a broker or MGA to access the referrer’s customer database & offer them insurance products/service. Typically the referrer is a non-financial service business. A referrer does not provide financial services (& is not required to hold a licence or be appointed as an AR) provided: they only inform their customers that another person (A) provides insurance products or services; provide the contact details of (A); & disclose to their client if they are being paid a referral fee by (A). It is critical that the referrer does no more than referring. The more involved in the insurance transaction, the more likely they are to provide a financial service. ๐ผ๐ช๐ฉ๐๐ค๐ง๐๐จ๐๐ ๐ง๐๐ฅ๐ง๐๐จ๐๐ฃ๐ฉ๐๐ฉ๐๐ซ๐๐จ An AR arrangement enables firm B to provide financial services under firm A’s AFS Licence. An AR may be authorised to provide all or part of the Licensee’s financial services. The licensee is responsible for ensuring the AR complies with financial service laws & its licence conditions however, the AR also has independent obligations. Generally, AR’s must be notified to ASIC within 30 business days of appointment. There are also a number of other formalities that are required. ๐ผ๐๐๐พ ๐๐๐จ๐ฉ๐ง๐๐๐ช๐ฉ๐๐ค๐ฃ ๐๐ฃ๐จ๐ฉ๐ง๐ช๐ข๐๐ฃ๐ฉ Under this instrument, a person may distribute insurance products on behalf of the licensee, subject to: the distributor not being an AR of the Licensee; provides details of the licensee’s IDR; discloses the relationship & remuneration received; & does not provide financial product advice. ๐๐ฆ๐๐ ๐๐ฟ๐ผ๐๐ฝ ๐ฃ๐๐ฟ๐ฐ๐ต๐ฎ๐๐ถ๐ป๐ด ๐๐ผ๐ฑ๐ ๐ถ๐ป๐๐๐ฟ๐๐บ๐ฒ๐ป๐ Under this instrument, typically a person is provided with a master insurance policy & extends cover to its clients as a named individual for payment of a premium. The GPB: must not be carrying on financial services as its primary business, the arrangement is ‘incidental’ to its primary business; & must not make a profit from the arrangement. They can only cover their reasonable expenses in administering the arrangement. ๐ ๐ผ๐ป๐ถ๐๐ผ๐ฟ๐ถ๐ป๐ด & ๐ฆ๐๐ฝ๐ฒ๐ฟ๐๐ถ๐๐ถ๐ผ๐ป A licensee has obligations to monitor all these arrangements & should adopt a systematic approach.