The Insurance Code of Practice requires our members to be open, fair and honest in dealings with customers and commits insurers to high standards of service when selling insurance, dealing with claims, responding to disasters and handling complaints.
Before you complain
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.
Making a complaint
If you are unhappy with a decision made by your insurer, you can ask for your claim to be reviewed. There are two levels to the claims review process.
Level 1 - Lodge a complaint with your insurer – Internal Dispute Resolution
Contact your claims manager or your insurer’s customer relations team and let them know you would like to lodge a complaint. Contact details can be found in your PDS.
Your complaint will be reviewed by an employee with the appropriate experience, knowledge and authority to review the complaint. They may require additional information from you and may need a second opinion from an assessor or engineer as part of their investigation. Your insurer will inform you of the outcome of your complaint in writing.
Level 2 - Lodge a dispute with the Ombudsman – External Dispute Resolution
If you are unsatisfied with the outcome of your complaint, you can lodge a dispute with the Australian Financial Complaints Authority (AFCA). Your insurer will provide you with guidance on how to lodge a dispute with AFCA when they respond to your complaint. AFCA will review the decisions made by your insurer and has the authority to make a binding decision regarding the actions of the insurer.
The Insurance Council can provide you with general advice at any stage during your complaint. You can contact us on our 24 hour hotline 1800 734 621 or by visiting disasters.org.au/contact