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For a period of 12 months starting 1 July 2019, the Australian Financial Complaints Authority’s (AFCA) jurisdiction will be expanded to allow them to consider previously unheard disputes falling within its terms of reference relating to conduct dating back to 1 January 2008.
Insurance helps protect you from financial loss when something goes wrong.
There are many different types of insurance policies including car, house, contents, health, travel and life insurance.
When buying insurance, you should read all of your insurance policy’s terms and conditions carefully to make sure it meets your needs.
If you have an insurance policy you are always entitled to make a claim and have it assessed by your insurer.
If you make an insurance claim and it’s refused or unreasonably delayed, you should get legal advice.
If you have a complaint or dispute with your insurance provider, you should try and resolve this with your provider. If the matter can’t be resolved the Australian Financial Complaints Authority (AFCA) may be able to help (visit www.afca.org.au). Get legal advice.
The Insurance Law Service has factsheets and information about insurance.
Before buying insurance you should read all of your insurance policy’s terms and conditions carefully to make sure it meets your needs.
An insurance policy is the document that sets out what is covered by your insurance provider under your insurance contract.
You should keep a copy of the insurance policy and your certificate of insurance in a safe place. If your copy is lost or destroyed, you can contact your insurer to get another copy.
When buying insurance, the insurance company may give you a cover note—this is a temporary insurance cover until your formal insurance policy is processed and issued.
Sometimes, instead of giving you a cover note, insurers may opt for a cooling-off period in the policy, during which they can choose to refuse a claim.
When buying insurance you must tell the insurer anything you know which is relevant to their decision to accept the insurance. For example, if you’re applying for car insurance, you may need to answer questions about your driving history and your insurance claims history.
This is called a duty of disclosure. If you fail in your duty of disclosure, your future claims may be rejected. You should get legal advice if you make a claim and it’s rejected because you haven’t met your duty of disclosure.
If you suffer a loss which is covered by your insurance policy, you can make a claim on your insurance. To make a claim, you must follow the insurance company's claims process.
You’re entitled to make a claim to your insurer and have it assessed by the insurer even if you think that you may not be covered.
You should notify your insurer quickly of any loss you want to claim. Usually the insurance company will appoint a person known as an adjustor or assessor to investigate your claim.
Most insurers have agreed to comply with an insurance code of practice, which you can find on the Insurance Council of Australia’s website.
The Insurance Council of Australia is the industry body for most insurers who offer general insurance (home, building, contents, cars etc).
When registering your car you‘re also covered for compulsory third party (CTP) insurance. This insurance only covers you for claims against you when you cause an accident and somebody is injured.
If someone is injured as a result of a car accident and the person responsible for the accident doesn’t have compulsory third party insurance, the injured person may be able to get compensation for their injuries from a public fund called the nominal defendant. The nominal defendant may recover the debt from the uninsured motor vehicle’s owner or driver (or both).
If you cause an accident and damage somebody else's car (or home or belongings) it can become very expensive if you‘re not insured. Third party property damage insurance covers all claims made against you for damage caused to other people's property. It doesn’t cover you for damage to your own vehicle.
Comprehensive insurance covers you for damage to your vehicle regardless of who caused it. If you’re in an accident, you’ll only have to deal with your insurance company to get your car repaired.
For more information see car accidents.
Most policies won’t cover you if you drive while under the influence of alcohol or drugs. Check your insurance policy and get legal advice.
For more information see drink and drug driving.
Your insurance policy may allow the insurer to refuse a claim if your car was driven by an unlicensed driver when the accident happened. Check your insurance policy and get legal advice.
For more information see traffic offences.
You need to tell the insurer if you make any modifications to your car, for example, if you mechanically accessorise your car or change it from the manufacturer's original specifications this may allow an insurer to refuse a claim under the policy.
If you have a dispute with your insurance provider, you should attempt to resolve your dispute through the insurer’s internal dispute resolution process. If you can’t resolve the complaint with the insurer, the AFCA can resolve complaints and disputes between you and the insurer. Get legal advice.
The AFCA can also help you if you have a dispute with another person's insurance company about motor vehicle property damage. Their role is to help resolve complaints between you and your insurer. If the matter doesn’t settle, they can make a determination. This will be binding on the insurer if you accept it. If you do not agree with the determination you can reject it and take your dispute to court.
You should get legal advice before lodging a dispute with the AFCA.
The AFCA can help with complaints or disputes about life insurance cover and some types of superannuation. Get legal advice before lodging a dispute with them.
If your complaint is about private health insurance, which involves a private hospital or medical practitioners, the Private Health Insurance Ombudsman may help you.
You may need legal advice if you:
We may give legal advice about insurance claims that have been refused or unreasonably delayed.
The following organisations may also be able to give you legal advice.
Caxton Consumer Law Service gives advice about consumer credit legal problems including insurance disputes.
Cairns Community Legal Centre – Consumer Law Service gives advice about consumer credit and consumer law matters for socially and financially disadvantaged community members.
Insurance Law Service gives free legal advice to anyone in Australia on insurance law or about resolving a dispute with an insurer.
Queensland Law Society can refer you to a specialist private lawyer for advice or representation.
These services may also be able to help. They don’t give legal advice.
Insurance Council of Australia is the industry body for general insurance and has information for consumers about insurance on its website.
Australian Securities Investment Commission (ASIC) has information about all types of insurance and superannuation on its MoneySmart website.
AFCA investigates complaints about financial services including banks, financial institutions and insurance companies.
Private Health Insurance Ombudsman investigates complaints about private health insurance providers.