The Consumer Insurance Contracts Act 2019 (CICA) marked a significant reform of Irish insurance law, strengthening consumer protections and introducing a more transparent and consumer-focused framework for insurance contracts. Its impact extends across underwriting, claims handling and the resolution of coverage disputes.
While much of the commentary surrounding CICA has focused on disclosure obligations and proposal forms, some of its most significant practical consequences emerge when claims are notified and coverage decisions are challenged. Recent complaint trends suggest an increasing focus not only on policy wording and contractual rights, but also on how coverage decisions are reached and communicated.
Against a backdrop of increasing scrutiny from regulators and dispute resolution bodies, insurers and intermediaries are increasingly required to demonstrate that decisions are both contractually sound and reached through a fair and transparent process.
FSPO complaints: a useful indicator for the market
The Financial Services and Pensions Ombudsman’s (FSPO) ‘Overview of Complaints 2025’ provides a useful indication of the issues generating concern across the Irish insurance market.
The FSPO received a record 7,004 complaints in 2025, an increase of 13% on 2024. Of these, 2,142 related to insurance products, accounting for 31% of all complaints and representing an 18% increase in insurance complaints on the previous year. The Ombudsman noted that insurance complaints had almost doubled from 1,129 in 2022 to 2,142 in 2025 and described the scale of that increase as a matter of concern for the industry.
Claim handling was the most common conduct complained of within the insurance category, accounting for 26% of insurance complaints, followed by rejection of claims at 22%. Customer service and maladministration each accounted for a further 11%.
These figures do not establish that claims were wrongly decided, but they do identify those areas most likely to generate complaints and scrutiny.
The figures also underline the value of early and meaningful engagement. During 2025, the FSPO closed 6,282 complaints, with 90% concluded through its early-stage processes without the need for formal investigation or a legally binding decision. The Ombudsman expressly encouraged providers to engage with consumers at the earliest possible stage, noting the positive outcomes that early resolution can create for both customers and providers.
For insurers and intermediaries, the broader lesson is that scrutiny may extend beyond the substantive outcome of a claim to the process through which the decision was reached. Where a coverage decision is challenged, contemporaneous records, communications and decision-making processes may all come under examination. Clear reasoning, effective engagement and accessible explanations can become important factors if a matter develops into a formal complaint.
Coverage disputes remain fact-sensitive
Although the CICA introduced important protections for consumers, insurance disputes continue to depend on the terms of the relevant policy and the particular facts of the claim. Questions concerning notification, prior circumstances and policy response may require close examination of when the relevant events occurred, what was known at the time and how the matter was presented to the insurer. This can be particularly significant in professional indemnity and financial lines claims-made classes of business, where the relationship between a claim, an earlier complaint and a previously notified circumstance may affect which policy, if any, responds.
While CICA regulates matters such as disclosure, notification and claims handling, coverage disputes remain grounded in the policy wording and the underlying facts.
The practical effect is that, despite the reforms introduced by CICA, coverage disputes continue to turn on a combination of policy wording and factual context.
A more nuanced approach to late notification
The CICA has particular significance where an insurer seeks to rely on non-compliance with a specified notification period. Section 16(3) provides that, where the consumer’s non-compliance has not prejudiced the insurer, the insurer may not refuse liability on that ground alone.
The provision does not make notification requirements irrelevant. Rather, it directs attention to the practical effect of non-compliance in the circumstances of the particular claim. The existence and extent of any prejudice may therefore become central when a late-notification issue arises.
This reflects the wider balance struck by section 16. Consumers must cooperate with the insurer’s investigation and notify insured events within a reasonable time or in accordance with compliant policy terms. Insurers, in turn, must handle claims promptly and fairly, engage with consumers appropriately and provide reasons when a claim is settled or otherwise disposed of.
The result is a framework that focuses attention not simply on technical breaches, but on their practical consequences for both parties.
Clarity remains central to underwriting
CICA’s effect is not confined to the claims stage. Section 8 fundamentally changed the pre-contractual disclosure framework for consumer insurance contracts by replacing the former duty of utmost good faith and the consumer’s duty to volunteer material information.
Under the statutory framework, the consumer’s disclosure obligation is instead confined to answering the questions asked by the insurer. Where information is sought, the insurer must ask specific questions using plain and intelligible language, while consumers must answer those questions honestly and with reasonable care.
These requirements reinforce the importance of clear and carefully drafted proposal and renewal documentation, particularly where an insurer later seeks to rely on non-disclosure or misrepresentation.
More broadly, the reforms demonstrate the extent to which transparency and consumer understanding now sit at the heart of the legislative framework governing consumer insurance contracts.
Transparency in policy terms
The same emphasis on clarity extends to policy wording. Section 20 applies the unfair-terms regime to the wider statutory definition of consumer under CICA, highlighting the importance of clear, understandable policy terms.
Where disputes arise, attention may extend beyond the existence of a particular provision to its drafting, presentation and legal effect within the broader consumer-protection framework. The potential application of the unfair-terms regime means that significant exclusions, conditions and limitations may need to be considered within a broader consumer-protection framework. Where a coverage dispute arises, attention may consequently extend beyond the existence of a particular term to its drafting, presentation and legal effect.
For insurers, this reinforces the commercial and legal importance of policy documentation that communicates the scope and limits of cover clearly. It also reflects CICA’s wider movement towards transparency in consumer insurance contracts.
Distinguishing contractual and regulatory obligations
The interaction between CICA and the Consumer Protection Code 2025 also requires careful distinction.
The CICA governs consumer insurance contracts within its statutory scope, whereas the Consumer Protection Code establishes regulatory obligations for regulated financial services firms. The two regimes may be relevant to the same customer relationship, but they perform different functions and should not be treated as interchangeable.
The revised Consumer Protection Code, which took effect on 24 March 2026, places significant emphasis on customer interests, decision-making and consumer protection outcomes. As a result, a complaint or dispute may raise separate questions concerning both the contractual application of CICA and the regulatory standards governing a firm's treatment of its customers.
Maintaining that distinction is increasingly important as firms navigate both contractual coverage issues and wider regulatory expectations.
Looking Ahead
The CICA has not removed the possibility of legitimate coverage disputes, but it has altered the framework within which many of those disputes are assessed.
The FSPO's 2025 figures demonstrate that claims handling and claim rejection remain key areas of consumer concern. Against that backdrop, insurers and intermediaries are increasingly expected to combine technical coverage analysis with fair processes, clear communication and meaningful customer engagement.
Five years on, the CICA's significance extends well beyond disclosure. Its influence can be seen throughout the insurance lifecycle, from underwriting and policy wording to claims handling and dispute resolution. While contractual rights and policy terms remain fundamental, the wider context in which decisions are made, documented and explained is becoming increasingly important. In that environment, transparency, clarity and customer engagement are likely to remain central themes for insurers, brokers and claims professionals alike.
