What to do now
Official AFCA pages: How to complain, Time limits for complaints. ASIC MoneySmart: Problems with insurance and Complaining about an insurance claim. General Insurance Code of Practice: Insurance Council of Australia.
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Get the decision in writing today. If the insurer told you by phone, ask for a written letter or email that explains which policy terms apply and why your claim is declined, reduced, or delayed. Keep every document.
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Lodge a written IDR complaint with the insurer. Use the insurer's complaints page or contact details (ASIC says check the insurer's website or your policy documents). Say clearly that you are complaining. Give your policy number, claim number, what happened, why you believe the decision is wrong, and what you want (pay the claim, review the decision, explain the delay). The insurer must acknowledge within 1 business day and respond within 30 calendar days (ASIC RG 271 for general insurers).
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Diary the response clock. If the insurer has not responded in 30 days, or responds but you are unhappy, you can take the complaint to AFCA. Note the date of the insurer's final decision letter so you can track AFCA time limits.
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Lodge a free AFCA complaint if unresolved. AFCA is the free, independent dispute body for financial complaints. Time limits from the insurer's final decision: 2 years generally, or 6 years from the event that triggered the claim if you did not get a final decision or did not know you could complain (AFCA). Lodge online: Make a complaint or call 1800 931 678 (9am to 5pm weekdays). AFCA can order the insurer to pay or reconsider.
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Keep paying premiums where cover must stay live. Letting the policy lapse during a dispute may harm your claim or future cover. Check with a lawyer if you are unsure whether to stop paying.
This is legal information about insurance complaint paths in Australia, not personal legal advice.
What AFCA covers
AFCA handles complaints about most personal insurance in Australia (AFCA):
- General insurance: home and contents, car, landlord, travel, pet, health insurance gap cover (financial-loss claims). Does not cover private health insurance premiums or fund complaints (that is the Private Health Insurance Ombudsman).
- Life insurance and income protection (total and permanent disability, trauma, death benefit).
- Superannuation death and disability claims where the super fund bought a life insurance policy.
AFCA monetary limits
Per AFCA (check current figures on the AFCA website):
- Most general insurance disputes: up to $1.263 million (total claim amount that AFCA can consider).
- Home-building insurance disputes (shoddy work, incomplete build): AFCA can award up to $631,500 per claim (compensation cap).
- Life insurance and income protection: generally no monetary limit for the claim amount.
- Non-financial loss (distress, inconvenience): AFCA can award up to $6,300, no matter the claim size. This limit does not cap the underlying financial claim.
If your claim is larger than AFCA's limit, you may need a court or tribunal. AFCA will tell you if your complaint is outside jurisdiction.
Time limits for AFCA complaints
AFCA publishes two main clocks (AFCA time limits page):
- 2 years from the insurer's final decision. The final decision is the last letter or email where the insurer said no or made a final offer.
- 6 years from the event that triggered the claim, if you did not get a final decision or did not know you had a right to complain (AFCA says this is usually in cases of non-disclosure or delayed claim notification).
If you are near a deadline, lodge now. AFCA can sometimes accept late complaints if there is a good reason (fairness exception).
Worked example with dates
- 1 March 2026: storm damages your roof. You lodge an insurance claim.
- 15 March 2026: insurer emails that your claim is declined because the policy excludes wear and tear, not storm damage. You disagree.
- 16 March 2026: you email an IDR complaint to the insurer, saying the damage was storm-caused and you want the claim paid.
- 17 March 2026: insurer acknowledges your complaint (1 business day clock met).
- 14 April 2026: insurer sends a final IDR decision letter upholding the decline. You remain unhappy.
- 15 April 2026 onwards: you can lodge an AFCA complaint. The 2-year AFCA clock runs from 14 April 2026 (final decision date), so you have until 14 April 2028 to lodge with AFCA. Lodge sooner rather than wait.
IDR response times (ASIC rules for general insurers)
ASIC Regulatory Guide RG 271 (soft cite: ASIC IDR requirements). General insurers and financial services firms must:
- Acknowledge an IDR complaint within 1 business day.
- Respond with a final decision or progress update within 30 calendar days.
- If they cannot meet 30 days, tell you why, give a new timeframe, and remind you of your right to go to AFCA.
Life insurers follow similar clocks. Check your complaint acknowledgement for the promised response date.
General Insurance Code of Practice
Many Australian insurers are members of the Insurance Council of Australia and follow the General Insurance Code of Practice. The Code sets service standards: clear policy information, fair claims handling, and timely IDR. If the insurer breaches the Code, note that in your IDR or AFCA complaint.
Keep evidence
Collect and keep:
- Policy documents (certificate, product disclosure statement, any endorsements).
- Claim forms and supporting documents (quotes, photos, police report, medical records).
- All emails, letters, and claim-reference numbers.
- The insurer's decision letter(s) and any IDR response.
- Dated notes of phone calls (who you spoke to, when, what they said).
AFCA and the insurer will want this evidence.
If you never had insurance or the insurer collapsed
If you never had a policy with that insurer, AFCA and IDR will not help (no customer relationship). If the insurer is insolvent or cancelled by ASIC, check whether a statutory compensation scheme applies. Soft cite: ASIC MoneySmart, Failed financial firms.
Related consumer paths: Chargebacks and debit card disputes (if you paid a premium by card and got no cover), Unfair contract terms under Australian Consumer Law (policy term fairness), and Faulty goods: major vs minor problems and refunds (non-insurance consumer guarantees).