Living with a policy · Ring VI
When something goes wrong
Start with the insurer, or the super fund if your cover is through super: under the Life Insurance Code of Practice, the insurer acknowledges a complaint within 24 hours (or one Business Day), or as soon as practicable, and gives you a final written response within 30 calendar days (or 45 days, where possible, if a super trustee owns the policy). If you are still not satisfied, you can take the complaint to the Australian Financial Complaints Authority (AFCA), which Moneysmart describes as free, independent dispute resolution.
General information, not advice. A complaint about your own claim may turn on details only a lawyer or financial counsellor can weigh; Moneysmart notes you may be able to get free legal advice from a community legal centre. The official guides are Moneysmart’s how to complain and AFCA.
Four rings out from the problem
-
First
Tell the insurer or fund what is wrong
Moneysmart says the first step is always to contact the business, explain the problem and say how you would like it fixed. Often a phone call, email or online chat is all it takes.
The Code says the insurer will not discourage you from making a complaint. If it can’t resolve the complaint when you first contact it, it explains its complaints process and tells you how to access the Code.
-
Then
Make a formal complaint in writing
If a call or email doesn’t fix it, Moneysmart suggests a formal complaint in writing, known as internal dispute resolution. It suggests including:
- the word “complaint” in the heading or subject line
- your name, contact details and the date
- a clear explanation of the problem and the outcome you want
- copies of relevant documents, keeping the originals and a copy of your letter.
-
While it is handled
What the insurer does with it
Under the Code, the insurer gives you the name and contact details of the person handling your complaint, who will not be the person whose decision or conduct you are complaining about. It only asks for and relies on information relevant to the complaint.
It can close a complaint within 5 Business Days only if it has resolved it to your satisfaction, or given an explanation or apology where it can’t reasonably do more. Even then, it gives you a written response if you ask for one, or if the complaint is about hardship, a declined claim, the value of a claim or a super trustee’s decision.
-
If it is not resolved
Take it to AFCA
Moneysmart says an external dispute resolution scheme can help if the business didn’t respond within a reasonable time, if you are not happy with how it dealt with your complaint, or if you are not happy with its offer. For insurance and super, that scheme is AFCA, which considers complaints about insurance and superannuation among other financial services.
There may be a time limit for taking a complaint further. The Code says the insurer’s final response must tell you about your right to go to an external dispute resolution body, how to contact it, and any time limit for doing so. You can start a complaint on AFCA’s website.
The timeframes, side by side
| Step | Timeframe | Clause |
|---|---|---|
| Acknowledging your complaint | Within 24 hours (or one Business Day) of receiving it, or as soon as practicable | 7.2 |
| Closing a complaint quickly | Within 5 Business Days, only if resolved to your satisfaction or explained | 7.10 |
| Final written response from the insurer | Within 30 calendar days | 7.13 |
| Documents the insurer relied on | Within 10 Business Days of your asking | 7.14 |
| Final written response, policy owned by a super trustee | Within 45 calendar days of the insurer or trustee receiving it, where possible | 7.17 |
What the final response contains
The Code says the insurer’s final written response includes the action taken or the reasons for its decision, a response to the issues you raised with a summary of the information relied on, an acknowledgement that you can ask for those documents, and your right to take the complaint to an external body, with how to contact it and any time limit.
If the insurer can’t respond within 30 calendar days because the complaint is complex or there are circumstances beyond its control, it tells you before the time is up why there is a delay, that it will keep you updated, and that you may have the right to go to an external dispute resolution body.
Complaints about a declined claim
When the insurer gives its final decision on a complaint about a declined claim, or about the value of a claim, the Code says it will tell you which of three things it will do: reopen or reassess the claim, keep its original decision, or overturn it. If it reopens or reassesses the claim, it also gives you the name and contact details of the claims assessor who will deal with you. How claims are decided is in making a claim.
When a super fund owns the policy
Most super funds offer life insurance to their members, and the Code treats a policy owned by a super trustee as a group policy. For a policy a super trustee owns, the Code says you can complain to the insurer or to the trustee. Where possible, the trustee gives a final written response within 45 calendar days of either of them receiving the complaint, and if you tell the insurer the trustee hasn’t responded in that time, the insurer will tell you that you can ask the trustee to explain the delay in writing.
For super death benefit claims, Moneysmart suggests asking the fund what stage the claim is at, making a complaint to the fund if needed (asking for its complaints process in writing), and then considering external dispute resolution. It also suggests keeping a simple timeline of dates, calls, emails and documents sent.
A breach of the Code is a separate path
If you believe an insurer broke the Code itself, anyone can report an alleged breach to the Life Code Compliance Committee, which can investigate and, for significant breaches, impose sanctions. The Life CCC may also decide that your matter belongs in the insurer’s own complaints process and refer you there. Reports go through the Life CCC’s report-an-issue page. More on what the Code promises is in the Code that sits at the heart.
If you need a hand
Moneysmart notes you may be able to get free legal advice from a community legal centre if you need help with the process. ASIC also publishes a financial complaints data dashboard showing trends such as why complaints are made and how long they take to handle.