What types of insurance disputes can AFCA handle?
The Australian Financial Complaints Authority (AFCA) handles disputes about general insurance (home, contents, car, travel, pet, and business insurance), life insurance including income protection and trauma insurance, consumer credit insurance, and mortgage insurance. AFCA does not handle disputes about the level of a premium or a decision made solely based on underwriting criteria where no policy is in force.
What is the internal dispute resolution step I must complete before going to AFCA?
Before lodging with AFCA you must first make a formal complaint to your insurer through their internal dispute resolution (IDR) process. The insurer must acknowledge your complaint within 24 hours and respond within 30 calendar days. If they do not respond within 30 days, or you are unhappy with their response, you can immediately proceed to AFCA.
How do I lodge a complaint with AFCA about an insurance dispute?
Lodge your complaint online at afca.org.au, by phone on 1800 931 678, or in writing. You will need to provide details of the insurer, your policy number, the nature of your complaint, what outcome you are seeking, and evidence of the IDR response or that 30 days have passed without a response. The AFCA process is free for consumers.
What are the time limits for lodging an insurance complaint with AFCA?
You must lodge your AFCA complaint within two years of the date of the insurer's IDR response. If the insurer did not respond to your IDR complaint within 30 days you can lodge immediately. There is also a general six-year time limit from when you first became aware of the conduct giving rise to the complaint.
What compensation can AFCA award for a general insurance dispute?
AFCA can award compensation of up to $1.085 million for general insurance disputes. It can direct the insurer to pay the claim, vary the terms of the policy, correct information, waive fees, or pay compensation for financial loss and consequential loss. AFCA can also award up to $5,500 for non-financial loss such as stress, inconvenience, or distress in appropriate cases.
How do life insurance disputes work and what is the Life Insurance Code?
Life insurance disputes including claims for death benefits, total and permanent disability, income protection, and trauma cover are handled by AFCA. The Life Insurance Code of Practice sets out minimum standards for how insurers must handle claims, communicate with customers, and conduct internal reviews. Code breaches can be raised as part of your AFCA complaint.
What evidence do I need to support an insurance dispute claim?
Gather your insurance policy document and product disclosure statement, the insurer's written decision declining or limiting your claim, all correspondence with the insurer, photos or video evidence of loss or damage, receipts or valuations for lost or damaged property, and any medical or expert reports relevant to the claim. The stronger your documentary evidence the better your position at AFCA.
What are common grounds for disputing a home or car insurance claim refusal?
Common grounds for disputing a refusal include that the insurer incorrectly applied a policy exclusion, misinterpreted policy wording, failed to consider all available evidence, relied on an inadequate expert or assessor report, did not act in good faith, or that the loss clearly falls within the cover you purchased. AFCA applies the policy terms as written and assesses whether the insurer acted reasonably.
Does any part of the insurance dispute process in Australia require notarization?
No. IDR complaints, AFCA complaint forms, and supporting documents do not require notarization. Documents are submitted in writing with your signature. If a statutory declaration is required for any supporting document it can be witnessed by a justice of the peace at many post offices and Service NSW or Service Victoria centres at no cost.
How does uplaw.ai help with an insurance dispute in Australia?
Tell uplaw.ai the type of insurance, what your claim was for, what the insurer decided, and what reasons they gave. We help you prepare a formal IDR complaint letter to your insurer and, if that does not resolve the matter, assist you in completing your AFCA complaint submission with the relevant facts and policy references.
Free to start
Insurance dispute in Australia? Tell uplaw.ai what happened.
No account required. uplaw.ai helps you prepare your IDR complaint letter and AFCA complaint submission.