How to Lodge an AFCA Insurance Complaint in Australia

The Australian Financial Complaints Authority (AFCA) is Australia's free, independent dispute resolution service for financial complaints — including insurance claim disputes. If your insurer has denied your claim, delayed payment, or treated you unfairly, AFCA can investigate and require the insurer to fix the problem.

AFCA replaced the former Financial Ombudsman Service (FOS), the Credit and Investments Ombudsman (CIO), and the Superannuation Complaints Tribunal (SCT) in November 2018. It is the primary avenue for insurance dispute resolution in Australia outside of the courts.

What Complaints Can AFCA Handle?

AFCA can investigate complaints about:

• General insurers (car, home, contents, travel, business interruption)
• Life insurers (life insurance, income protection, total and permanent disability)
• Private health insurers (note: for private health fund disputes, the Private Health Insurance Ombudsman (PHIO) is the primary avenue — AFCA can also assist in some circumstances)
• Funeral insurers
• Consumer credit insurance
• Add-on insurance products (sold by car dealers, travel agents, etc.)

AFCA cannot handle complaints about policies issued by non-AFCA member firms, or complaints about the actions of APRA-regulated superannuation funds in their trustee capacity (these go to AFCA's superannuation division or to APRA).

Who Can Complain to AFCA?

You can complain to AFCA if you are:

• An individual (personal complainant)
• A small business with fewer than 100 full-time staff
• A non-profit organisation

The complaint must relate to a financial product or service provided by an AFCA member firm operating in Australia.

Before You Can Go to AFCA: The 30-Day Rule

You must complain to your insurer first. The insurer then has 30 days to resolve your complaint (45 days for life insurance, superannuation, and certain other categories). If you are not satisfied with the insurer's response, or if the 30-day period passes without resolution, you can go to AFCA.

For some complaints, particularly urgent ones (e.g., imminent financial hardship), AFCA may accept a complaint before the 30-day period ends.

How to Lodge an AFCA Complaint

Step 1: Gather Your Documents

Before lodging, collect:

• Your insurance policy document or certificate of currency
• The claim denial letter or other correspondence
• Supporting evidence: invoices, medical reports, police reports, photos, expert opinions
• Any internal complaint correspondence with the insurer

Step 2: Lodge Online

Go to afca.org.au and complete the online complaint form. Provide:

• The insurer's name and your policy number
• A clear description of what happened, the amount in dispute, and what you want AFCA to do
• Upload your supporting documents

You can also call AFCA on 1800 931 678 (free call) or write to them.

Step 3: AFCA Registers and Forwards Your Complaint

AFCA will register your complaint and send it to the insurer. The insurer then has a further opportunity to respond directly. Many complaints are resolved at this stage.

Step 4: AFCA Considers the Dispute

If the complaint is not resolved through direct contact with the insurer, AFCA will:

• Assign a case manager
• Gather information from both parties
• Issue a preliminary view
• If the preliminary view is not accepted, the matter proceeds to an AFCA decision

Step 5: AFCA Decision

An AFCA decision is binding on the insurer if you accept it. AFCA decisions are published in their determinations database (in de-identified form) and form an important body of insurance dispute precedent.

What AFCA Can Award

AFCA can:

• Direct the insurer to pay your claim in full or in part
• Award interest on delayed payments
• Award compensation for non-financial loss (distress, inconvenience) up to $5,500
• Award compensation for financial loss up to $1,150,000 for general insurance
• For life insurance: up to $1,150,000 for a benefit amount dispute

Time Limits

AFCA can generally only consider complaints about events that occurred within the past six years, or within two years of the consumer first becoming aware of the issue (whichever is later). Complaints must be lodged within these periods.

Private Health Insurance: PHIO vs AFCA

For private health fund disputes (Medibank, Bupa, HCF, nib, etc.), the Private Health Insurance Ombudsman (PHIO) is the primary dispute body under the Private Health Insurance Act 2007. AFCA also accepts some private health insurance complaints — particularly where the dispute involves financial products associated with health insurance.

Fight Back With ClaimBack

ClaimBack helps Australian policyholders prepare strong AFCA complaints with structured case submissions, supporting evidence frameworks, and insurer-specific arguments. Whether your claim was denied by a general insurer, life insurer, or health fund, ClaimBack gives you the tools to succeed.

Start your AFCA complaint with ClaimBack

Related Reading

• How to Write an Insurance Appeal Letter
• Internal vs External Insurance Appeal: What's the Difference?
• How to Use the Insurance Ombudsman