How to settle complaints with the car insurance ombudsman?

An ombudsman, like the AFCA, offers consumers a way to complain about the providers of services, such as car insurance. They offer a complaint resolution process when you’re unhappy with any dispute resolutions provided by your insurer. AFCA is a non-profit and impartial organisation that aims to resolve disputes between financial service providers and consumers in Australia. They handle complaints of individuals and small businesses that employ less than 100 people. With car insurance being a financial product, AFCA is the car insurance ombudsman that impartially considers both sides and arrives at a decision based on the facts and circumstances of the complaint. AFCA works with both parties to achieve a fair resolution of the dispute as quick as possible.

Most car insurers will have internal dispute resolution processes that you should go through before approaching the AFCA. If this fails to provide a suitable resolution, you can seek out the AFCA’s car insurance ombudsman service. Once you’ve submitted a complaint with the AFCA, they will:

•  Determine if your car insurance company acted fairly and promptly to resolve your claim.
•  Look at the steps taken by the insurance company to expedite repairs and ease your difficulties.
•  If a settlement was made in cash, the AFCA will find out if it was fair and adequate to cover the necessary repairs.
•  Decide if you and your insurer tried arriving at a reasonable solution and check the legitimacy of any excuses that were given for a failure to resolve the issue.
•  Determine the integrity of each party and arrive at a fair decision, including any possible compensation.

If your claim is found to be valid, the car insurance ombudsman in Australia can ask the insurer to take the following actions:

•  Pay your claim
•  Repay, waive or vary a fee
•  Pay a specified amount to you
•  Vary, reinstate, or cancel your car insurance contract
•  Forego any outstanding debt

Before you contact the AFCA, it’s important that you try to resolve the dispute with your car insurer directly. It’s best if you communicate with the insurance company via email to ensure you’ve got written records showing your efforts to try to reach a resolution. The AFCA may ask you for these communications, so it’s ideal to have it all in writing.

Generally, you can contact the car insurance ombudsman within two years of receiving a resolution from your insurer or within six years of becoming aware, or reasonably aware, of the issue.

The AFCA is the financial services ombudsman, handling complaints for a range of fiscal issues. For car insurance, they may handle complaints such as:

•  Inaccurate calculation or charging of premium
•  Breach of privacy or confidentiality
•  Providing incorrect or misleading information
• Delay in claim resolution
•  Offering an unfair decision while assessing your claim, either by denying or incorrectly assessing the value of the vehicle or repair costs
•  Incorrectly deciding your liability in a car accident or insurance excess
•  Failing to take steps to facilitate your car’s repair or not trying to negotiate a fair solution

You shouldn’t make a complaint until you’ve tried reaching a resolution via the insurer’s internal process. If, after all your efforts, a resolution cannot be reached, you can make a complaint to the AFCA online, via email or via phone. Once you’ve lodged the dispute, it progresses through various stages as follows:

Registration

The AFCA contacts you and your insurer with a request to respond to the complaint. If you’ve tried the insurance company’s internal dispute resolution process, the insurer has to respond within 21 days. If you’ve lodged your complaint with the AFCA without going through the internal process, the insurer has 45 days to respond. During this time, your insurer may try to reach a settlement with you directly or look for other ways to settle the dispute without the AFCA’s involvement.

Case Management

If there is no resolution between you and your insurer, the complaint moves on within the AFCA. This means that the dispute is allocated to a case manager who gathers all the information and contacts both parties. They try to resolve the dispute via negotiation or reconciliation. If this fails, the case manager may point out relevant issues that may come into play if the dispute progresses to the next stage.

Decision

The case manager will then review all relevant information, including any legal and situational factors and issue a determination. In more complicated cases, a panel may make the decision instead of an individual case manager.
You’re not tied to the decision made by the AFCA. However, as a member of the AFCA, your insurer must accept the decision. If you reject the decision, your insurer is freed from any terms advised by the AFCA. You can then take legal action if you choose.

As the car insurance ombudsman, the AFCA can assist you in many different dispute resolutions with your car insurer. However, there are a few instances where the AFCA can’t assist you. These include:

• For any issues concerning Compulsory Third Party insurance, you’ll need to contact your local state authority.
• Offering legal or financial advice.Although they  may be able to refer you to someone.
• Assist in resolving any issues that are currently part of legal proceedings.
• Offer assistance if your insurer isn’t a member of the AFCA, but all legitimate insurers should be members.
• Help with any proceedings that have already been resolved via another ombudsman, tribunal, court or arbiter.

Before taking your complaint to the car insurance ombudsman you should ensure you’ve tried all other avenues to resolve your issue with your insurer.