Settling Claim Disputes with the Car Insurance Ombudsman

Car insurance ombudsman

Have a dispute with your car insurance provider? Here’s what you can do about it.

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If your car insurance provider hasn’t held up its end of the bargain, then you may have valid grounds for a dispute. Financial service providers, including insurance companies, are required to live up to their obligations in good faith. Naturally, the exact obligations depend on which type of car insurance policy you have.

If you have a car insurance dispute, you can contact the Australian Financial Complaints Authority (AFCA) for a resolution. AFCA is responsible for settling issues between consumers and financial service providers. If you have exhausted all other options, then it might be time to give them a call.

Where to contact AFCA

Phone number: 1800 931 678
Website: www.afca.org.au

What can AFCA do?

The Australian Financial Complaints Authority (AFCA) is an impartial, non-profit organisation that offers dispute resolution to customers having difficulties with a financial service provider. Reputable insurers are AFCA members and they pay membership fees to ensure that AFCA services remain free for consumers.

When you go to the AFCA with a dispute, they will:

  1. Determine whether your car insurer, or financial services provider (FSP), acted fairly and promptly to resolve the claim. Familiarise yourself with what to do in the event of an accident to make sure you’ve taken the appropriate steps from the beginning.
  2. Look at which steps the FSP took to expedite repairs and help ease your burdens.
  3. If a cash settlement was offered, AFCA will determine whether it was a fair offer and enough to cover all the repairs.
  4. Decide whether you and the FSP tried to come to a reasonable solution first and whether any excuses given, such as difficulty finding spare parts for repairs, are legitimate.
  5. Determine whether either party is in the right and what kind of compensation is in order.

If they find that you’re in the right, AFCA can make the insurer take certain action including:

  • Paying your claim
  • Paying you a sum of money
  • Forgiving outstanding debt
  • Varying, reinstating or cancelling a contract
  • Repaying, waiving or varying a fee

What can’t AFCA do?

The Australian Financial Complaints Authority (AFCA) cannot:

  • Help with CTP insurance disputes. You will need to contact your state authority instead.
  • Decide on matters currently undergoing legal proceedings.
  • Offer assistance if the insurer is not an AFCA member. However, you can safely assume that all legitimate insurers are AFCA members.

What to do before contacting AFCA

Pay special attention to step 4 above and do not contact AFCA until you have first tried to come to an agreement with your insurer. It’s a good idea to use email when trying to resolve an issue as it automatically keeps written records, which may be important later if AFCA needs to make a decision.

  • If you have not tried to settle the issue with your insurer, then AFCA will not help.
  • After you have received a final answer from the insurer, you have two years to get in touch with AFCA if you want to pursue the issue.

What happens after I make a complaint to AFCA?

Generally, you should not make a complaint until you have been through the insurer’s internal dispute resolution process. Doing so streamlines the AFCA procedures, and shows that you have made an effort to reach an agreement.

In each stage, an agreement may be reached. If not, the dispute keeps progressing through the stages.

  • Registration: The AFCA will get in touch with you and the insurer, requesting that both of you respond. If you have tried internal dispute resolution, the insurer has 21 days to respond, if not, they have 45 days. During this period, the insurer may offer settlements, or they might otherwise look for ways to resolve the issue before the AFCA steps in.
  • Case management: The dispute will be allocated to a case manager. They will gather information on it and be in touch with both parties. The case manager will try to resolve the issue through negotiation, conciliation or by pointing out the relevant issues that might come into play if the dispute progresses to the decision stage.
  • Decision: Taking into account all relevant factors, situational, legal and otherwise, the caseworker will reach a decision. In complex cases this decision might end up in front of a panel rather than an individual.

You do not have to accept the decision. If you reject it, the insurer is freed from the terms of that decision and is not required to do anything in particular. Your remaining option is then to pursue legal action.

Your insurer does have to accept the decision. As AFCA members they are required to accept it. If you need a car insurance ombudsman to settle a dispute, there is a clear option available.

Is it time to dump your insurer? Find your new one here

Name Product Roadside Assistance Accidental Damage Storm Choice of Repairer Agreed or Market Value
Budget Direct Comprehensive
Optional
Optional
Agreed or Market
Finder's summary: Awarded the 2019 Finder Award for the Best Value Car Insurance, this policy offers solid coverage at a low cost plus you will get 15% discount on first year's premium when you take out a policy online. Budget Direct’s claims service has received a 4.2/5 based on nearly 5,000 customer reviews.

Who it might be good for: People who want a comprehensive policy without breaking the bank.
Bingle Comprehensive
Market
Finder's summary:Bingle consistently comes up as one of the cheaper insurers out there. It only covers the basics, so you don't get to choose your own repairer, you're not covered for personal items in the car and unless you add it as an option, you won't get a hire car if your car is stolen. But this keeps its premiums low.

Who it might be good for: Someone who wants a low-cost option that covers them for the basics.
Coles Comprehensive
Optional
Agreed or Market
Finder's summary: Coles have two-tiers of comprehensive car insurance to choose from. You'll earn double flybuys points at Coles supermarkets and you can get $10 off your Coles grocery bill every time you redeem 2,000 Flybuys points. If you're over 30, you can get roadside assistance free for a year.

Who it might be good for: Coles customers and Flybuys collectors.
Poncho Comprehensive
Agreed
Finder's summary: Poncho works like a monthly subscription – you pay monthly and can cancel and leave at any time. You can also list multiple cars and drivers under one policy, making it ideal for families and groups living together under one household.

Who it might be good for: People who want their car insurance month to month.
Woolworths Comprehensive
Optional
Agreed or Market
Finder's summary: Woolworths catches our eye due to some unique perks like a price-beat guarantee, where it'll beat any current comparable comprehensive renewal notice if you're over 25. You'll also get 10% off your grocery shop once a month and can add roadside assistance onto your policy for just $7.35 per month.

Who it might be good for: Woolworths shoppers and those that want to take advantage of its price-beat guarantee.
Qantas Comprehensive
Optional
Optional
Agreed or Market
Finder's summary: You'll be able to choose how comprehensive you want your cover to be with optional extras like choice of repairer and the option of agreed or market value. Plus earn Qantas Points for joining and paying your premium. Sign up by 2 May 2021, you can earn up to 30,000 Qantas Points (points awarded will be based on your premium). T&Cs and eligibility apply.
ahm Comprehensive
Optional
Both
Finder's summary: ahm comprehensive car insurance lets you choose higher excess to reduce your premiums plus you can get up to 15% off when you purchase a new car insurance policy. T&Cs apply. Additionally, their Fixed Kilometre Plan can save you up to 30% compared to their standard comprehensive cover.

Who it might be good for: People who drive less than 15,000 km per year.
Virgin Comprehensive
Optional
Optional
Agreed or Market
Finder's summary: Finalists for the 2019 Finder Awards for Best Value Car Insurance, Virgin Comprehensive provides a good level of cover for a decent price. Get 15% off on your first year’s premium when you purchase a new eligible comprehensive car insurance online. T&Cs Apply.
QBE Comprehensive
Optional
Agreed or Market
Finder's summary: QBE is a sustainable insurance company and also Finder's Green Insurer of the Year 2020 Award winner. This policy offers the highest level of protection available from QBE including three-year new car replacement. You can also save $75 when you purchase a new comprehensive policy online. T&Cs apply.

Who it might be good for: Those that are looking for a more environmentally friendly insurance choice.
Stella Comprehensive
Optional
Agreed or Market
Finder's summary: Stella’s a female-focused insurer. It'll cover you if your car is damaged as a result of domestic violence. It offers higher cover for baby gear than most, with up to $2,000 cover for prams, strollers and child seats. Get $50 cash back when you purchase online between 1 April – 30 June 2021 using the code STELLA50. T&C apply.

Who it might be good for: Someone who wants a female-centred car insurance policy (it will cover men too).
Youi Comprehensive
Optional
Agreed or Market
Finder's summary: Youi Comprehensive Car Insurance is one of the few providers to include roadside assistance in its policy. You'll also get access to YouiRewards which gives you discounts on furniture, parking and more. Youi also has a live chat feature on its site to talk through any questions.

Who it might be good for: People over 25 who want comprehensive cover with a focus on customer service
Australia Post Comprehensive
Optional
Agreed or Market
Finder's summary: Australia Post car insurance offers comprehensive cover for things like theft, fire, new for old replacement and emergency accommodation and transport. Cover also extends to anyone who uses your car, not just you.

Who it might be good for: If multiple people use the one car and you don’t want to worry about listing all drivers.
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22 Responses

    Avatarfinder Customer Care
    MayJuly 23, 2018Staff

    Hi Ron,

    Thank you for your inquiry.

    Sorry to hear that you’re having trouble with your claim. I would recommend getting in touch with the Financial Ombudsman Service if you want to dispute the way your claim is being handled. I know it would involve much of your time and effort but if this will resolve the issues on your claim, it would be worth speaking with FOS.

    Hope this will be sorted out soon.

    Best,
    May

    Default Gravatar
    HelenMay 18, 2018

    Hi, I purchased a brand new Mercedes in November 2017, came home to see a small damage on right side quarter panel and boot lid.
    Advised by Mercedes insurance at the time of claim back early April 2018 ( 14/4 )to take vehicle to there recommended repairer !!
    I was told my car would be finished (4/5) for pick up. During this period I was staying in contact with my repairer as to the process they were at with my vehicle. Come Friday (4/5) I received a phone call early morning from repairer saying the car won’t be ready till (8/5) when I asked why what’s the hold up I was told he wasn’t sure and would call me back ASAP. After 3 hours no call I personally went to my repairer to find my car back in pieces due to the manager himself not happy with the result of there repairs, when I asked why didn’t someone just say something this morning during our phone call the manager replied with we are really busy. Walking out and making phone calls to my insurance I was left with someone would contact me later that day.
    3 days later once again I’m calling my insurance back to see who’s looking after my claim I then managed to speak with the manager. I explained what was happening with my car as my repairer decided not to hand back my car due to unsatisfied results, then I was assured my insurance would step in and take it from here.
    Second time round my insurance told me it would be fixed to factory standards and be ready in a week. Finally new pick up date was (17/5) I come at midday to find the paint work way off my exterior side skirts aren’t clipped in properly they’ve basically sprayed the whole car to blend in there previous mistakes which now my vehicle has 3 shades. I was never informed of the repairs made around the whole car whilst the damage was so minor and only on right quarter panel and boot.
    My insurance states new for old on policy and repairs are factory standards, this is not the brand new vehicle I purchased less than 6 months ago. My car is still at repairer as I refused to take it home what’s my rights as I’m awaiting a phone call from the insurance as we speak can I push for a new car ????
    I’ve got photos throughout this process and lots of emails to my insurance stating how disappointed I am I’ve been given the run around for nearly 6 weeks and just want my car.
    My insurance is sending a senior to look at it today what are my rights as I don’t want a third attempt to get it right this time ???
    PLEASE HELP

      Default Gravatar
      NikkiMay 18, 2018

      Hi Helen,

      Thanks for your message and for visiting finder – the leading comparison website & general information service built to give you advice in your buying decision needs. How are you doing today?

      We’re sorry to hear the trouble you’ve been through, we know this is difficult & a big hassle to you.

      Please note that we’re a product comparison website and we do not represent any company we feature on our site. We provide general information on products to assist you in your buying decision process hence we cannot recommend product / service that is rightfully fit for you.

      Here’s what you can do:

      1. Review your policy with a legal adviser.
      2. Should your lawyer find any discrepancies to your policy, contact the complaints department of insurance company to lodge a complaint.

      Hope you find a resolve to this soon. Don’t hesitate to message us back if you have more questions.

      Cheers,
      Nikki

    Default Gravatar
    ThomasApril 3, 2018

    Hi!

    I have full comprehensive insurance. My vehicle was stolen 2 weeks ago. Insurance have told me the total loss. They also stated as a person cannot be charged to the theft, I have to pay the excess. Is this right even though it isn’t my fault?

    Thanks,
    Thomas

      Default Gravatar
      ArnoldApril 3, 2018

      Hi Thomas,

      Thanks for your inquiry

      Please note that the T&C of policies may vary extensively.

      Usually, Assuming the car is not recovered, you would usually pay the excess. If the car is recovered but damaged, then you’d pay the excess as part of the repair costs. You may need to pay the excess initially, but if it can be proven that the accident was the fault of anyone else involved in the claim (a ‘third party’) and they accept blame, then you (essentially, your insurance company) claims it back from the insurers of the driver who was at fault. Likewise, if there’s a dispute about who is at fault, you may have to pay excess initially until a decision is made. This may involve taking them to court if they refuse to give you the money. If you have motoring legal cover protection as part of your regular car insurance, this may cover the excess in some cases.

      It may be best to refer to the terms and conditions of your policy for more clarification about this.

      Hope this information helps

      Cheers,
      Arnold

    Avatarfinder Customer Care
    JonathanFebruary 22, 2018Staff

    Hi Tina, thanks for your comment. We are sorry to hear about your accident and hope you are okay.

    In regards to your policy and claim, it would be best to contact the Financial Services Ombudsman directly. Things you may like to have prepared beforehand would include:

    -Dates you contacted your insurer.
    -Staff/ conversation details when they told you three times that your policy was active during the period of accident.
    -Your insurance account details.

    I have emailed you the Financial Ombudsman Service for car insurance page.

    I hope this helps.

    Jonathan

    Default Gravatar
    robertFebruary 12, 2018

    im with real insurance. my car was stopped at a traffic light when it was rear ended by a road train. it was accessed as a writeoff. i have finally got my payment now. but my question is when i asked them to transfer my insurance policy over to my new car they said no it was now null and void even though it was insured until Dec 2018. i asked for a refund they said no. then they said if i was paying monthly i would still have to pay each month up until dec???? thats on top of my new policy. is this right. i also have home and contents with this company. thanks for any information Robert

      Default Gravatar
      JoelFebruary 23, 2018

      Hi Robert,

      Thanks for leaving a question on finder.

      Since you have been through your insurance’ internal dispute resolution process, it’s a good idea to use email when trying to resolve an issue as it automatically keeps written records, which may be important later if the FOS needs to make a decision. If you are convinced that you have a valid case, you can contact the Financial Ombudsman Service (FOS) for a resolution.

      Hope it helps.

      Cheers,
      Joel

    Default Gravatar
    BDecember 22, 2017

    my car was in an accident with another vehicle (not my fault) . insurer of the other vehicle ask me to get some quotes for the repairs ,they were $6000-$6500. The insurer said that they would write it off as a repairable write off and give me $7500. Now the insurer stated that the car is now a statutory write off which I do not want as the car is repairable and I can afford another new car

      Default Gravatar
      ArnoldDecember 23, 2017

      Hi Darrell,

      Thanks for your inquiry

      You may have valid grounds for a dispute. It would be helpful if you can learn what factors were the cause of the write off, what their criteria are for writing off vehicles. If you are convinced that you have a valid case, then you can contact the Financial Ombudsman Service (FOS) for a resolution.

      Hope this information helps

      Cheers,
      Arnold

    Default Gravatar
    CharliebearNovember 25, 2017

    My car was in an accident and badly damaged everyone thought it was a write off. My insurance company sent me to get an assessment and the mechanic said it was a write off. And would cost at least 7000 to fix. The insurance company don’t want to pay the market price because it is more than the repairs. They sent me to another panel beater / painter who is not one of their recommended repairers he said he will fix it for $7500. The 2010 legislation says that a vehicle is a write off – if it has three of the criteria (WOVs). My car has 3+…. the structure is damaged around the back door including the pillar between doors and the floor, the door is totally pushed in, the wheel is on an angle and the suspension is wrecked. The car will be unsafe if they just stretch the structure as it will be weak. Is’nt it illegal to fix a car that fits the ‘ damage criteria for statutory write offs’? What do I do?

      Default Gravatar
      MariaNovember 26, 2017

      Hi Charliebear,

      Thank you for your inquiry.

      I’m sorry to hear about your accident and your car’s present condition.

      It’s possible that your insurer has classified your car as a repairable write-off if the cost of salvaging the vehicle and then repairing it for road use exceeds either:

      – The car’s market value before it was damaged, if you have market value car insurance or
      – The sum insured if you have agreed on value cover

      This page on Written-off Cars might help you with information on what you can do with your written-off car.

      I hope this helps.

      Best,
      Maria

    Default Gravatar
    ChrisSeptember 6, 2017

    I had an accident that was not my fault. The car which has only covered 55k kms and was recently given a roadworthy, was damaged but still driveable. The assessor came and inspected the damage when i was not present and has assessed the vehicle as a total loss. I do not believe that the damage is more costly than the value of the car, and i want to have it repaired. What can i do to make sure the insurance company gets the vehicle repaired?

      Default Gravatar
      DanielleSeptember 7, 2017

      Hi Chris,

      Thank you for contacting finder. We are a comparison website and general information service, we’re more than happy to offer general advice.

      I would suggest that you contact your insurer and go through their internal dispute process to see if they will be able to assist you with getting the vehicle repaired. If you still have not reached an agreement, you can proceed by contacting the Financial Ombudsman Service (FOS) for a resolution.

      I hope this helps.

      Cheers,
      Danielle

    Default Gravatar
    TraceyAugust 8, 2017

    2 months ago my daughters car was rear ended, the lady was insured with RACQ but she apparently told them not to pay out the car as it was a right off.
    I need to know as the police and ambulance were called, but I have since found out they did not do a report on the incident. Is it true that people with insurance have the authority to not pay out for damage done to the other car when they are at fault.

      Default Gravatar
      JonathanAugust 9, 2017

      Hello Tracey,

      Thank you for your inquiry. Please be advised that you have reached finder.com.au and we provide generic advice.

      After the accident, the insurer will have vehicle assessors to validate whether the car is a write-off, and this is not just a discretion by the driver. Vehicle assessors would calculate the cost of repairs and make this judgment. They will inspect the overall condition of your vehicle and analyse the collision damage.

      Usually, these are the requirements for the claim:

      – Your RACQ policy number
      – Your vehicle registration number, make and model – and that of anyone else involved
      – The date and details of the incident
      – A Police Report Number (if applicable)
      – The drivers licence number, expiry, type and class
      – Residential address of you and anyone else involved in the incident
      – Contact details of any witnesses or other people involved
      – Details of any towing company used
      – Your paid invoices

      You can contact RACQ on 13 7202 or visit an RACQ branch for the review of the documentation.

      Hope this helps.

      Cheers,
      Jonathan

    Default Gravatar
    MaryJuly 24, 2017

    I was side swiped by a van , I got his phone number , license number, name…but not his address….I contacted my insurance company, put in a claim and was told I had to pay the excess and it was an at fault claim because they could not recoupe the cost of the repairs from the other party as they could not contact him…… because I had no address ….my insurance policy increased from $600 to $2200….and my rating went from 1-5…..I don’t believe this is correct, but they aren’t willing to change the insurance amount and they claimed I should rating protection….I have never heard of that….do you think I would have a case with the ombudsman…..thank you

      Default Gravatar
      JonathanAugust 3, 2017

      Hello Mary,

      Thank you for your inquiry.

      Please review the Terms and Conditions or the Product Disclosure Statement (PDS) of your insurance policy. It normally contains the dispute process on how to resolve these cases.

      Usually, after talking with Claims Team, you can escalated it to their internal dispute department who will take a second look. In the event that you’re still dissatisfied about the outcome, that’s the time you can proceed with the Ombudsman.

      Hope this helps.

      Cheers,
      Jonathan

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