How to Lodge an AFCA Complaint Against Your Insurer in Australia

When your Australian insurer denies your claim or handles it unfairly, the Australian Financial Complaints Authority (AFCA) is your most powerful free tool. AFCA replaced the Financial Ombudsman Service (FOS), the Credit and Investments Ombudsman, and the Superannuation Complaints Tribunal in November 2018 to become Australia's single external dispute resolution (EDR) scheme for financial services.

This guide walks you through exactly how to prepare and file a complaint, what AFCA can do for you, and how to maximise your chances of success.

What Is AFCA and What Can It Do?

AFCA is an independent, not-for-profit organisation authorised by the Australian government under the Corporations Act 2001 and the National Consumer Credit Protection Act 2009. All Australian Financial Services (AFS) licence holders — including every insurance company operating in Australia — must be AFCA members and must participate in the complaints process.

AFCA can:

• Review the insurer's decision and all relevant documents
• Mediate between you and the insurer to reach a resolution
• Issue a determination that is binding on the insurer (if you accept it)
• Award compensation for financial loss, non-financial loss (distress and inconvenience), and consequential losses
• Require the insurer to take specific action (e.g., pay a claim, change a decision, provide information)

AFCA compensation limits (as at 2025, indexed annually):

• General insurance: up to $1,085,000 for disputes about a claim
• Life insurance: up to $1,085,000
• Non-financial loss (stress, inconvenience): up to $5,500
• The AFCA service is completely free for consumers

What Types of Insurance Complaints Does AFCA Handle?

AFCA handles disputes involving:

• Home and contents insurance
• Motor vehicle insurance
• Travel insurance
• Life, income protection, and disability insurance
• Private health insurance (claims disputes and complaints about fund conduct)
• Business insurance (for small businesses)
• Flood and storm insurance
• Consumer credit insurance

AFCA does not handle complaints about workers' compensation insurance (handled by state-based schemes) or compulsory third party (CTP) motor insurance (handled by state regulators).

Before You Can Go to AFCA: The Internal Dispute Resolution Requirement

AFCA requires that you first attempt to resolve the dispute through the insurer's internal dispute resolution (IDR) process, unless it is urgent (e.g., financial hardship or serious risk to health or safety).

The IDR requirement means:

1. You must lodge a formal complaint with your insurer
2. The insurer has 30 days to resolve your complaint (ASIC requires IDR response within 30 calendar days under RG 271)
3. If unresolved within 30 days, or if you're not satisfied with the outcome, you can go to AFCA immediately

Key AFCA rule: You do not need to wait the full 30 days if the insurer tells you it won't change its decision. You can go straight to AFCA once you have a final IDR response.

Step-by-Step: How to Lodge an AFCA Complaint

Step 1: Prepare Your Documentation

Before lodging, gather:

• Your insurance policy (the Product Disclosure Statement and Policy Schedule)
• All claim-related documents (lodgement confirmation, assessor reports, correspondence)
• The written denial letter or IDR response
• Your formal internal complaint and the insurer's response
• Supporting evidence (medical records, repair quotes, photos, receipts, police reports)
• A chronological timeline of events

Organise these into a logical bundle. AFCA case handlers review large volumes of documentation, so clear labelling and a concise cover summary will help your case.

Step 2: Draft Your Complaint Summary

Write a clear, factual summary of:

• What happened (the insured event)
• How the insurer handled the claim
• Why you believe the denial or outcome is wrong
• What outcome you are seeking (what you want AFCA to do)

Keep this summary to one to two pages. AFCA does not need your full story at this stage — they need a clear understanding of the core dispute.

Step 3: Lodge the Complaint with AFCA

Online: Go to afca.org.au and click "Make a complaint." The online form guides you through the required information.

By phone: Call 1800 931 678 (free call) Monday to Friday.

By post: AFCA, GPO Box 3, Melbourne VIC 3001

By email: info@afca.org.au

You will need to provide:

• Your contact details
• The name of the insurer you're complaining about
• Your policy and claim reference numbers
• A description of the dispute and what outcome you want
• Uploaded copies of key documents

Step 4: AFCA Registration and Initial Review

After lodging, AFCA will:

• Register your complaint and assign a complaint reference number
• Send you an acknowledgement (usually within a few business days)
• Check that the complaint is within AFCA's mandate (correct type of financial product, within time limits, monetary limits)

AFCA time limits: Complaints generally must be lodged within 2 years of the insurer's IDR response (or within 6 years of the event if you received no IDR response). Don't wait.

Step 5: Referral to the Insurer for Resolution

AFCA first refers your complaint to the insurer with an invitation to resolve the matter directly with you. This "referral and registration" stage often prompts insurers to reconsider their position — particularly for smaller claims.

Many complaints are resolved at this stage, often within 30 to 60 days. If the insurer offers a resolution, AFCA will facilitate the agreement and ensure it is documented.

Step 6: Case Management

If the complaint is not resolved at the referral stage, AFCA assigns a case manager. The case manager will:

• Request information from both you and the insurer
• Review all documents
• May conduct a telephone conference to clarify issues
• Issue a preliminary assessment of the likely outcome

At this stage, both parties have an opportunity to respond to the preliminary assessment. Many cases settle at or before the preliminary assessment stage.

Step 7: Determination

If the case remains unresolved after the preliminary assessment stage, AFCA issues a formal determination. The determination is:

• Binding on the insurer once the complainant accepts it
• Not binding on the complainant (you can reject it and pursue other remedies)
• A reasoned decision addressing each issue raised

The insurer must implement the determination within the timeframe specified.

How to Build the Strongest Possible AFCA Case

Be specific, not emotional: AFCA case handlers are objective. Focus on facts, policy terms, and the specific reasons the denial is incorrect — not how frustrated you are.

Reference the policy and the law: Where possible, reference the specific clause of your PDS that you believe supports your claim, and note any relevant provisions of the Insurance Contracts Act 1984 (particularly section 54 which limits insurers' rights to deny claims based on acts or omissions that didn't cause or contribute to the loss).

Use section 54 of the Insurance Contracts Act: This is one of the most powerful provisions available to Australian insurance complainants. Section 54 prevents an insurer from refusing a claim solely because of an act or omission that didn't cause or contribute to the actual loss. If you failed to notify the insurer within the required timeframe but the claim itself is valid, section 54 may prevent the insurer from using that delay as grounds for refusal.

Provide all evidence upfront: Don't hold anything back. AFCA's process is document-driven, and surprises don't help your case.

Address the insurer's reasons directly: Your complaint should respond to each specific denial reason the insurer gave, not just assert that you should be paid.

Expert reports matter: For building damage, medical conditions, or motor vehicles, an independent expert report directly challenging the insurer's assessor can be decisive.

Common Mistakes to Avoid

Not exhausting IDR first: AFCA will bounce your complaint back if you haven't tried the internal process.

Waiting too long: The 2-year time limit from the IDR response is strict. Don't let it pass.

Overloading the complaint with irrelevant material: Relevance and clarity help. Don't submit every piece of paper you have — include what's relevant.

Not asking about hardship provisions: If the denied claim is causing you financial hardship, tell AFCA and the insurer. Hardship provisions can fast-track certain complaints.

Accepting the first offer without considering it fully: The insurer may offer a partial settlement at the referral stage. You don't have to accept. Assess whether it fairly compensates you.

What to Do If AFCA Determines Against You

If AFCA's determination is not in your favour, you have several options:

• Reject the determination and pursue the insurer through the courts
• Accept a partial determination and seek additional remedies through litigation for any amounts above AFCA limits
• Consult a plaintiff insurance lawyer to assess the merits of legal action

Getting Help Preparing Your AFCA Complaint

The strength of your AFCA complaint often comes down to the quality of your complaint summary and the relevance of your supporting documents.

ClaimBack (claimback.app) helps Australians prepare professional complaint letters and appeal documents specifically designed for the AFCA process. The free tool generates structured, regulation-referenced documents tailored to your specific insurance dispute — making your AFCA submission as strong as possible from day one.

Summary

1. File a formal IDR complaint with your insurer and wait up to 30 days for a response
2. If unresolved or unsatisfied, go directly to afca.org.au — it's free
3. Prepare a clear, factual complaint summary with a well-organised evidence bundle
4. Reference specific PDS clauses and, where applicable, section 54 of the Insurance Contracts Act
5. The referral stage often resolves disputes — many insurers back down once AFCA is involved
6. If a determination is issued and unfavourable, you can reject it and pursue alternative remedies