Need to know
- You should complain to the insurer first
- If the insurer doesn't resolve your complaint, you can escalate it to an ombudsman
- Legal action is the last resort
If your insurer has knocked back your claim, it's not the end of the road. Whether it's a health insurer or a home insurer, the process is straight forward, and persistence is the key. Stick up for your rights and don't put up with sub-standard service.
1. Internal dispute resolution – complain to the insurer
Gather your information together, and complain to the insurer first:
- Make a note of key details and dates.
- Include your membership number.
- Review any correspondence.
- Note any relevant contact.
For home, car, pet, travel or life insurance, once you've lodged your case and all the supporting information and documents, the insurer has 45 days to complete its internal dispute resolution process.
They'll usually keep you up to date about the progress of your complaint every 10 business days.
Whether it's a hard copy or in the cloud, keep your insurance policy documents handy. If you're travelling, keep your travel insurance policy details with you at all times while on your trip and share them with family or friends before you leave.
2. External dispute resolution – complain to the ombudsman
If you aren't happy with the insurer's decision, you can escalate your complaint to an external Ombudsman. For health insurance complaints, go to ombudsman.gov.au. When submitting your complaint:
- keep it brief (500 words)
- list key dates and any contact
- provide your contact details.
For all other insurers, take your complaint to the Australian Financial Complaint Authority (AFCA). They'll handle your case for free.
- AFCA will mediate between you and the insurer to find a resolution.
- If mediation is unsuccessful, they may make a preliminary assessment or give a determination straight away on your dispute.
- A determination is legally binding on the insurer but not on you.
- There's no appeal process with AFCA.
- For more information, visit afca.org.au.
3. Legal action – the last resort
If you're unhappy with an AFCA determination, you might want to consider taking legal action against the insurance company. It's not a step to take lightly, so seek advice. Legal centres such as the Financial Rights Legal Centre, and the Consumer Action Law Centre may be able to help you with the next steps.
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