What Is AFCA? Australia's Financial Complaints Authority Explained

If you have a dispute with an Australian financial institution — including an insurer — and can't resolve it internally, the Australian Financial Complaints Authority (AFCA) is your most important free resource. Understanding how AFCA works, what it can do, and how to use it effectively is essential knowledge for any Australian dealing with a denied insurance claim.

What Is AFCA?

The Australian Financial Complaints Authority (AFCA) is an independent, not-for-profit organisation that provides free dispute resolution services to consumers and small businesses who have disputes with financial firms.

AFCA was established on 1 November 2018, replacing three separate dispute resolution bodies:

• The Financial Ombudsman Service (FOS Australia)
• The Credit and Investments Ombudsman (CIO)
• The Superannuation Complaints Tribunal (SCT)

All financial services licensees — including every insurance company operating in Australia — are required by law to be AFCA members. This is mandated by the Corporations Act 2001 and the National Consumer Credit Protection Act 2009 as a condition of holding an Australian Financial Services (AFS) licence.

AFCA is approved by ASIC (Australian Securities and Investments Commission) as Australia's external dispute resolution (EDR) scheme.

What Does AFCA Cover?

AFCA handles complaints about:

Insurance:

• Home and contents insurance
• Motor vehicle insurance
• Travel insurance
• Life insurance (death, disability, income protection)
• Health insurance (private health)
• Business insurance (for eligible small businesses)
• Consumer credit insurance
• Flood, fire, and natural disaster insurance
• Personal accident insurance

Banking:

• Transaction accounts and banking services
• Credit cards and loans
• Mortgage disputes

Financial advice:

• Poor or inappropriate financial advice
• Managed investments

Superannuation:

• Superannuation fund disputes
• Death benefit payments
• Disability payouts from super funds

For this guide, we focus on insurance disputes, which represent a significant and growing portion of AFCA's caseload.

What AFCA Cannot Do

AFCA's jurisdiction has limits:

• Disputes above its monetary limits (see below)
• Complaints about premium pricing (AFCA cannot order an insurer to lower premiums)
• Disputes already before a court
• Complaints about government decisions or regulators
• Disputes where AFCA determines it would not be fair and reasonable to consider the complaint given the circumstances

AFCA's Monetary Limits for Insurance

AFCA can consider insurance disputes up to:

• $1,085,000 for disputes about insurance claims (indexed annually)
• $7,500 for non-financial loss (distress and inconvenience)
• Additional amounts for consequential losses in certain circumstances

These limits are reviewed annually. They are among the most generous of any ombudsman scheme globally, covering the vast majority of consumer insurance disputes.

How the AFCA Process Works

Phase 1: Internal Dispute Resolution (IDR)

Before AFCA can accept your complaint, you must first attempt to resolve it with the insurer through their internal dispute resolution process. Under ASIC's Regulatory Guide 271 (RG 271), insurers must:

• Acknowledge your complaint within 5 business days
• Resolve your complaint within 30 calendar days for most complaints
• Provide a final IDR response explaining their decision

If you are not satisfied with the insurer's IDR response, or if 30 days pass without a response, you can go to AFCA.

Exception: If you are in financial hardship or there is an urgent health or safety issue, you can approach AFCA immediately without waiting 30 days.

Phase 2: Lodging with AFCA

File your complaint at afca.org.au or:

• By phone: 1800 931 678 (free call)
• By email: info@afca.org.au
• By post: GPO Box 3, Melbourne VIC 3001

AFCA will ask you to provide:

• Your contact details and those of the financial firm
• A description of the complaint
• What outcome you are seeking
• Supporting documents (upload copies of your policy, denial letter
• Insurance Claim Denied in Australia? Your AFCA Rights Explained

Related Reading

• How to Lodge an AFCA Complaint Against Your Insurer in Australia
• ahm Health Insurance Claim Denied Australia: How to Appeal
• AIA Australia Claim Denied: How to Appeal Your Insurance Decision
• Allianz Australia Insurance Claim Denied? How to Appeal in Australia
• Insurance Claim Denied in Australia? Your AFCA Rights Explained