Home insurance ombudsman

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Do you have a complaint about your home insurance provider? Here’s how the Financial Ombudsman Service Australia can help.

Home and contents insurance offers critical financial protection for every Australian home owner. However, sometimes the level of cover provided, or the treatment you receive from your insurer, falls short of expectations. If you have an unresolved complaint about your home insurance policy, the broker that sold you the policy, or your treatment at the hands of the insurer, the Financial Ombudsman Service (FOS) Australia can provide independent dispute resolution.

Read on for more information on how FOS works, and when it might be of help.

What is an ombudsman?

An ombudsman is an official or body that provides protection for an individual who is trying to resolve a complaint or dispute with a group or organisation. Ombudsmen are impartial and independent, providing a dispute resolution option that is a cheaper and easier alternative to going to court.

Is there a home insurance ombudsman?

Under Australian law, insurers must have an internal dispute resolution process and an independent external dispute resolution scheme. If you disagree with an insurer about their refusal to pay a claim, you can take your complaint to FOS.

The role of FOS is to resolve complaints between consumers and financial services providers, which includes home insurance providers. It offers an independent and impartial examination of any dispute you are having with your home and contents insurance provider, and the service is free of charge.

While mediation between the two parties is the first course of action, if a suitable agreement cannot be reached, FOS can make a determination. For example, the ombudsman may rule that the insurer must pay a claim it has refused to settle. FOS decisions are legally binding for the insurance company.

Why should I use an ombudsman?

There are many benefits if you employ FOS to help resolve a dispute with your insurer. These include the following:

  • It protects your rights. Trying to settle a dispute when it’s just yourself against the might of a big insurance company can be confusing and overwhelming. An ombudsman can offer guidance and ensure you get a fair go. They understand the ins and outs of insurance law and can help investigate your complaint without you being required to hire a lawyer.
  • It’s free. FOS offers its service to consumers free of charge. The costs of running the service are paid for by its members, which consist of financial services providers such as banks, insurers and credit providers.
  • It’s independent. The ombudsman acts as an independent and impartial body. This ensures that the process is transparent and that you are not unfairly discriminated against. Decisions are reached based solely on the facts of each dispute.
  • You can avoid going to court. Using an external dispute resolution service is a much easier solution than taking your dispute to court. Not only does it save you money, it can also take some of the stress out of the situation.
  • Decisions are binding for insurers but not for consumers. When FOS reaches a decision on a dispute, that decision is legally binding for the insurance company. However, as a consumer you are not bound by the decision.

When would I use an ombudsman?

If you’re unhappy with the products or service offered by your home insurance provider, your first option is to go through the insurer’s internal complaints resolution process. If the matter isn’t resolved to your satisfaction, you can then take your dispute to the ombudsman.

You can choose to use an ombudsman for any of the following situations:

  • You believe your home and contents insurance claim has been unfairly refused.
  • You’re unhappy with the amount paid out for a home insurance claim.
  • You have received incorrect verbal advice from the insurer about your policy, such as the premium amount being misrepresented.
  • You believe your insurer has breached a legal obligation or duty.
  • A delay or an error in customer service from your insurer has caused you to suffer a financial loss.
  • A home and contents insurer has refused to insure you.

What types of disputes are excluded?

There are some types of dispute that FOS is unable to consider, including the following:

  • Your dispute is with an insurer or business that is not a member of FOS.
  • Your dispute has already been dealt with by a court, tribunal, arbitrator or other external dispute resolution service.
  • Your dispute relates to some commercial general insurance products.

What type of advice will be offered?

FOS offers fair and independent advice and dispute resolution services. An ombudsman may recommend a wide range of actions, such as the following:

  • The insurer must pay your claim.
  • The insurer must increase the amount paid for your claim.
  • One of the parties must pay a fee.
  • A fee amount should be varied or waived.
  • An insurance contract must be reinstated or adjusted.

What are the most common complaints received by ombudsmen?

The most common complaints about home and contents insurance centre around claims, either because a claim has been refused or because the consumer is unhappy about the amount paid. Of the 6,411 domestic insurance disputes FOS received in the 2015/16 financial year:

  • 26% were concerning home building insurance
  • 7% were in relation to home contents insurance
  • 71% related to the financial services provider’s decision, the vast majority of which involved a claim being denied.

Other complaints centred on the service provided by an insurer (19%), the charges imposed by an insurer (5%) and an insurer’s failure to disclose important information (2%).

FAQs


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William Eve

Will is a personal finance writer for finder.com.au specialising in content on insurance. While he cannot give personal advice to clients, Will enjoys explaining the intricacies of different types of protective cover to help individuals and businesses find affordable cover that won't leave them underinsured.

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4 Responses

  1. Default Gravatar
    FayeNovember 21, 2017

    I had water in the lounge room ceiling after a hail storm, with damage to a wall so that painting is necessary. The painter has been told to only paint one wall. This seems to me to be a very unprofessional approach and will not return my room to its original condition, as there is no possible way that the old and new paint will match. Is this an acceptable approach by the insurance company?

    • Staff
      MayDecember 12, 2017Staff

      Hi Faye,

      Thank you for your inquiry and sorry for the delayed reply. Just to confirm though that you’ve reached finder, we are a comparison website and can offer general advice to answer your question.

      Well, we may not be able to tell if the approach of your insurance company on painting one wall (only) is acceptable or not. While most home insurance companies would cover damages caused by storms like hail, it would still depend on the level of cover you took. Damage cover is usually included as standard with some high-level policies, and is available as an extra-cost option on others. It is well worth contacting your insurance company to confirm if this would the case with them.

      Cheers,
      May

  2. Default Gravatar
    liyoSeptember 7, 2017

    My insurer for a home claim has been approved, I caused damage to my neighbour’s fence accidentally. The insurer wants my neighbour to pay the cost of half their fence, my neighbour is refusing to pay, fair enough it is not his fault. So the insurer is asking me to pay. Is this right?

    Thanks,
    Liyo

    • Staff
      LiezlSeptember 7, 2017Staff

      Hi Liyo,

      Thanks for reaching out. I’m afraid we won’t be able to tell if this is right or not as this will actually depend on the term and conditions of your policy agreement with the insurance company. It’s a good idea to check your policy for details relating to exclusions and excess. You may also ask your insurer to review their decision and if you’re still unhappy with the outcome you may escalate it to insurance company’s dispute resolution team or reach out to Financial Ombudsman Service.

      I hope this has helped.

      Cheers,
      Liezl

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