Your complaint may be determined by an Ombudsman, an Adjudicator or an AFCA Panel.
AFCA’s Chief Ombudsman or their delegate allocates complaints to the appropriate type of Decision Makers, taking into account:
- the complexity of the complaint
- the amount of loss, as well as other potential consequences of the complaint
- whether the complaint raises a systemic issue
- whether the complaint raises new issues for AFCA of law or good industry practice
- considerations of efficiency.
Expertise and experience of AFCA Decision Makers
In appointing Ombudsmen and Adjudicators, AFCA’s Board of Directors considers the candidates’ objectivity, qualifications, experience and personal qualities. Our Ombudsmen and Adjudicators come from a variety of backgrounds including legal practice, industry and consumer organisations.
Once appointed, AFCA’s Chief Ombudsman (or delegate) must consider the Decision Maker’s expertise and experience when allocating complaints to be determined. This is particularly the case when an Ombudsman or Adjudicator works across different product streams and industries. The Ombudsmen and Adjudicators work closely as a group, with peer reviews of decisions before they are released, and the Lead Ombudsman ensures the quality of decision-making.
Find out more about the AFCA Decision Makers.
How does AFCA decide which Decision Maker will consider my complaint?
The Chief Ombudsman or their delegate decides whether a Determination should be made by a single Ombudsman, an Adjudicator, or an AFCA Panel. This decision is based on the factors outlined above. We aim to select the appropriate AFCA Decision Maker for each particular complaint.
- An Adjudicator is likely to be the AFCA Decision Maker for a complaint that has a small number of well-defined issues, and a low claim amount relative to our monetary jurisdiction.
- If a complaint is complex or involves a significant amount of money, it is more likely to be determined by an Ombudsman than an Adjudicator, because an Ombudsman typically has more expertise in relation to complex and large-value complaints. The selected Ombudsman would be expert in the law and industry practice relevant to the particular complaint.
- A general insurance complaint that involves an allegation by the insurance company of fraud on the part of the complainant is likely to be decided by an Ombudsman.
- A complaint that is about credit or deposit-taking is likely to be decided by an Ombudsman or Adjudicator.. If, however, the complaint relates to a margin loan (unless about a break fee) or the complaint is primarily about investment advice and the credit facility issue is an ancillary issue, the complaint may be decided by an AFCA Panel.
- If the complaint raises new issues for us, it may be that a multi-person panel of AFCA Decision Makers will determine the complaint. The panel would typically include an industry expert if the complaint were about a new industry product or service. If there are new issues relating to consumer behaviour or consumer impact, the panel might include a person who has consumer expertise.
Whether an Ombudsman, Adjudicator or AFCA Panel decides a complaint, the AFCA Decision Maker must consider the adequacy of the information that has been gathered and whether procedural fairness has been provided to the parties. If satisfied about these considerations, the AFCA Decision Maker will decide the complaint, applying the relevant decision-making criteria. Achieving fair outcomes for parties to a complaint is a key focus of our service, including our decision-making.
When a complaint will be referred to a Panel?
In most cases, a single Ombudsman or Adjudicator will have expertise and access to any relevant industry or consumer advice that is required to decide a complaint, without the need to convene an AFCA Panel.
However, we may elect to decide a complaint by an AFCA Panel where:
- It would be more effective to involve the specialist expertise of an industry or consumer representative directly in the decision-making.
- The complexity or significance of the complaint warrants it.
- It would be valuable to obtain differing views.
- The complaint raises circumstances that are largely the same as those raised in a considerable number of other complaints that we are considering, or expect to be submitted.
- The complaint raises complex or new issues under legislation.
- The issues in dispute are new to our jurisdiction, and until we have further experience in determining the issues a Panel may be a more appropriate means to deal with such complaints.
The AFCA Operational Guidelines provide detailed examples of when a Panel may be used.
We regularly review and consider whether the criteria for complaints decided by Panels should be adjusted, particularly in relation to superannuation complaints, as we gain further insight into the range of superannuation complaints lodged with AFCA.
For more information go to AFCA Panels.