General and personal insurance
AFCA can consider complaints from consumers about general insurance products for domestic and personal items. These include the following:
- Consumer credit insurance: A policy that covers you if something happens that affects your capacity to meet the payments on your loan or credit card.
- Home building: A policy that covers destruction or damage to a home building.
- Home contents: A policy that covers loss of, or damage to, the contents of a residential building.
- Motor vehicle: A policy that covers loss or damage to a vehicle with a carrying capacity of less than two tonnes.
- Personal and domestic property: A policy that covers loss or damage to property that is wholly or mainly used for personal, domestic or household purposes. This includes valuables, caravans and mobile homes, trailers, boats, horses, pets and mobile phones and other moveable property.
- Trust bond: A type of cover for residential tenants, where the beneficiary is the landlord or real estate agent and the tenant is the holder of the trust bond. The tenant pays a premium (normally up front) for the duration of the rental contract, and the insurance company assumes liability for any damages or outstanding rent at the end of the rental contract. While trust bonds are not an insurance product under the Corporations Act, they have similar features to insurance.
- Residential strata title: A policy that covers the Owners Corporation of large apartment block buildings that are occupied for residential or small business purposes.
- Sickness and accident: A policy that covers:
- the insured person from contracting a sickness, disease or injury
- death of the insured person because of the sickness, disease or injury.
- Ticket insurance: Insurance that provides cover where someone is unable to attend an event (for example a concert or sporting event) because of an unexpected event such as an accident, illness or transport delays. The insurance is often arranged when booking through a ticketing company.
- Travel insurance: A policy that covers things such as lost luggage, illness, loss or theft while you are travelling or any disruption to your travel plans.
AFCA can consider complaints from consumers about extended warranties purchased separately from the retail good. This is where the customer pays an additional fee in return for the warranty provider agreeing to repair or replace items such as:
- Brown goods – light electronic consumer durables (for example, TVs, radios, CD/DVD players, computers)
- White goods – heavy consumer durables (for example, air conditioners, refrigerators, stoves).
Professional indemnity insurance
- Medical indemnity insurance: Medical indemnity insurance protects a medical professional when they are sued for an act, error or omission in relation to health services. We can consider complaints about fees and risk surcharges if it is about medical indemnity insurance premiums.
Small business insurance
We consider issues relating to a range of small business insurance, including farm insurance – see the Information for small businesses page for more detail. Business insurance can include commercial vehicle insurance, industrial special risk, loss of profits/business interruption, breakdown of computers, electronics or machinery, theft, and fire or accidental damage.
- Consumer credit insurance: Usually pays monthly benefits to help pay interest on loans.
- Income protection: Income protection insurance pays a monthly benefit where the life insured is unable to work due to injury or illness. Business expenses may be covered separately or form part of the policy for self-employed.
- Annuities: An annuity is an income stream, which is paid at pre-determined intervals, at a predetermined rate, for either a specific period or for the life of the pensioner. Lifetime pensions or annuities provide income payments for the investor’s lifetime and for the lifetime of reversionary beneficiaries (if any).
- Endowments: Under endowment policies, the sum assured and any bonuses are paid on the death of the life insured or at the end of a set period, whichever occurs first.
- Funeral plans: A type of insurance cover that pays a lump sum on death.
- Scholarship funds: A fund to provide money for scholarships, bursaries or prizes.
- Term life: Term life insurance pays a death benefit if the life insured dies during the term of the policy (before the policy expires). See 'Whole of life' for distinction.
- Total and permanent disability: Total and permanent disability insurance (TPD) provides a lump sum payment if a person become totally and permanently disabled.
- Trauma: Trauma (or critical illness) insurance provides a lump sum benefit if a person is diagnosed with a specified illness or injury. These types of products cover major illnesses or injuries that will impact a person's life and lifestyle.
- Whole of life: A life insurance policy guaranteed to stay in force for the duration of the insured’s life, provided premiums are paid. See 'Term life' for distinction.
Types of complaints AFCA can consider about insurance policies
You may wish to complain about several issues arising from your insurance policy, including:
- Advice that was not provided to you, or that you received about the insurance policy that may have been inappropriate or misleading.
- Premiums that were incorrectly charged. We can also consider complaints about the incorrect application of a no claim bonus by an insurer or a broker – for example, if the insurer reduced or removed a no claim bonus discount due to an at fault claim, or the broker did not obtain a no claim bonus for you when you were entitled to one.
- Disclosures that the financial firm didn’t make such as incorrect, insufficient or misleading information about costs or fees, or about the product they provided to you.
- Decisions such as cancelling your policy, or denying all or part of the claim. This may include where a request to increase your insurance cover has not been actioned.
- Denial of your claim based on non-disclosure of a pre-existing condition or exclusion; driving under the influence; where loss or damage occurred as the result of a breach of the insurance policy or an excluded event (such as flood where flood is excluded); where the claim is alleged to be false or fraudulent; where the policy is claimed to be lapsed or cancelled; where you have been unable to prove that the loss has occurred or that the goods damaged or lost were yours.
- Instructions you gave the financial firm that it did not follow or delayed in following, or if the sum insured was not increased, or change of vehicle wasn’t noted on the contract.
- Privacy and confidentiality including disputes about privacy breaches and disclosure of personal information by an insurance company.
- Transactions such as overpayment or underpayment of an insurance benefit, or an insurance claim paid to someone other than the insured and/or a refund provided to another party.
Complaints AFCA can’t consider
If you have a complaint about money you owe that isn’t related to a financial firm (for example, if your complaint is about a telephone, electricity, gas or water bill), AFCA generally can’t consider your complaint.
There are other places you can ask for assistance to resolve your complaint.
We also can’t consider complaints that are only about the level of a fee, premium, charge, rebate or interest rate – unless your complaint is that the cost was not disclosed to you, was misrepresented to you, incorrectly applied, or if the complaint is about a breach of a legal obligation on the part of the financial firm.
We won’t consider complaints that we have already dealt with, unless there is sufficient additional information or different circumstances raised in the new complaint.
If you have previously had a complaint dealt with by a court, dispute resolution tribunal established by legislation or a predecessor scheme, we will not reconsider the complaint.
More information is available in our Rules (section C.1 Mandatory Exclusions). Even if a complaint is not excluded on a jurisdictional basis, we may decide not to consider the complaint any further if we consider it appropriate to do so.