Complaints
Before you complain
As a consumer you have the right to complain about your insurer’s products and services if you think your insurer has made a mistake. Complaints can vary from simple misunderstandings to more complex issues that take time to resolve.
Before you contact your insurer it’s important you have a clear understanding of what the issue is, why you believe your insurer is at fault and the outcome you would like to achieve. It is important to read and understand your policy schedule and Product Disclosure Statement (PDS), and consider how your concerns match up with the terms your insurer agreed to in the conditions of your policy.
Your insurer has a complaints handling process, which outlines the steps involved when lodging a complaint or dispute. Check your PDS for the insurer’s complaints process or look for it online.
Internal dispute resolution
Every insurance company must provide you with information on its internal dispute resolution process. This will include details of what you must do to lodge a complaint and how the insurance company will undertake to deal with the complaint. This information will be included in the Product Disclosure Statement.
Most insurers will also set out the internal dispute resolution process on their website.
You can use the internal dispute resolution process to address any issues you may have with the insurance company, the insurance company’s staff, an agent of the insurance company, or a loss adjuster, assessor or investigator.
The insurance company will allocate a person who has decision-making authority to review your dispute. This person is responsible for writing to you within 15 business days to let you know the outcome of the dispute, so long as the insurer has all relevant information.
Your insurer will work with you to resolve all complaints and disputes quickly and fairly. It will keep you informed of the progress of the response to your complaint. If you have lodged a dispute, your insurer will keep you informed of the progress of their review of your dispute at least every 10 business days.
Usually the internal dispute resolution team can sort out any problems you have, but if your dispute remains unresolved or you are unhappy with the decision, your insurer will provide you with information about options available to you.
This includes referring you to the free and independent external dispute resolution scheme administered by the Australian Financial Complaints Authority.
External Dispute Resolution
If you are not satisfied with the result of the internal dispute resolution process, you can choose to go through the approved external dispute resolution process.
The Australian Financial Complaints Authority independently and impartially examines general insurance disputes between general insurance companies and customers who hold policies for home and contents, motor vehicle, travel and other forms of general insurance.
AFCA is independent and provides a free service for consumers. It can mediate between the insurer and the consumer, and when mediation is unsuccessful, an ombudsman can make a determination. AFCA decisions are legally binding on the insurance company but you are not bound by its decisions.
You should contact AFCA as soon as possible if you are dissatisfied with your insurer's internal dispute resolution decision.
Before AFCA can consider your case, your insurance provider must have been given an opportunity to resolve the dispute with you directly. In most cases, your insurer has up to 45 days to respond to your complaint.
Visit the AFCA website for more information about the dispute handling process, or to lodge a dispute with the AFCA online click here.
You can contact AFCA at:
- Telephone: 1800 931 678
- Email: info@afca.org.au
