What is an ombudsman?
An ombudsman is an independent person, usually appointed by the government, who investigates and resolves disputes.
Typically, an ombudsman handles complaints about businesses, financial institutions, government departments or similar entities.
If you have a complaint about your car insurer and you have not been able to successfully resolve it with them, one possible avenue might be contacting the Australian Financial Complaints Authority (AFCA) and going through its financial complaints process.
What is the Australian Financial Complaints Authority?
The AFCA handles complaints from individuals and small businesses with fewer than 100 employees.
On hearing a complaint, an ombudsman at the AFCA will impartially consider both sides of the dispute, make decisions based on the facts and circumstances of each complaint, and work with all parties involved to achieve a fair resolution as quickly as possible.
What should you do before contacting the Australian Financial Complaints Authority?
Before contacting the AFCA, it is important to try to resolve your dispute with your car insurer.
It's a good idea to use email for a written record of your correspondence, in order to show you have made an effort to resolve the complaint yourself.
If you haven’t attempted to resolve your complaint directly with your insurer, it's unlikely an ombudsman at the AFCA will be willing to deal with your dispute.
In general, you must lodge a complaint within two years of your insurer’s final response, or within six years of when you first became aware (or should have become aware) of the loss, whichever comes first.
How do I complain about my insurance provider?
If you want to complain about your car insurer, and you have been unable to resolve the matter with them directly, you can complain about them to the AFCA.
It accepts complaints online, via email, over the phone, and in writing.
What kinds of complaints does the ombudsman handle?
If you are in a dispute with your car insurer, you might make a complaint to the AFCA if your insurer has:
- Incorrectly calculated or charged your premiums
- Provided you with misleading or incorrect information about a product
- Made an unfair decision when assessing your claim, either by denying it or incorrectly assessing the value of a loss or the cost of repairs
- Not taken adequate steps to facilitate the repair of your vehicle, or not attempted to negotiate a fair and workable solution
- Incorrectly decided that you were liable in the case of a car accident or incorrectly applied an excess
- Delayed the resolution of a claim
- Breached your privacy or confidentiality
What can the car insurance ombudsman do?
If the AFCA upholds all or part of your complaint, it can compel the insurer to:
- Pay your claim, or pay you some other sum of money
- Vary or cancel outstanding debts
- Vary, waive or repay fees
- Vary, reinstate or cancel a contract
What can the car insurance ombudsman not do?
There are things the AFCA can not do:
- Provide financial or legal advice, but it may be able to refer you to a relevant legal or financial counselling service.
- Assist with Compulsory Third Party (CTP) insurance disputes – these must be dealt with by relevant authorities in your state or territory.
- Assist with matters that are currently the subject of legal proceedings.
- Deal with a complaint that has already been dealt with by a court, tribunal, arbitrator or another ombudsman.
How do I file a case against my car insurance company?
To file a complaint with the AFCA, you can start an online complaint form on its website or call them on 1800 931 678 (free call) for more information or support.
After receiving a complaint from you, it will consider the facts. If the complaint is within its scope, it will then contact your car insurer.
From there, an ombudsman may try to resolve the complaint through informal processes such as negotiation between the parties, or conciliation in the form of a phone call where both sides state their case.
If these informal methods do not work, an ombudsman will make a decision known as a ‘determination’, based on the facts of the case.
Sometimes, the ombudsman will provide the parties with a preliminary assessment of the facts and ask if they are willing to make a settlement based on this. They may, however, proceed straight to making a binding decision.
An ombudsman will make their decision based on legal principles, applicable industry codes, good industry practice and precedent.
Are the ombudsman’s decisions binding?
Yes, decisions made by an ombudsman at the AFCA are binding on your insurer, if you accept them. If you are happy with the decision and decide to accept it, then your car insurer is required to provide any remedy that has been ordered within the time frame laid out. If you don't accept, you can still take other actions, such as going to court.
If your car insurer does not comply with the decision within the stated time frame, then it will be reported to the Australian Securities and Investments Commission (ASIC).
