Have a dispute with your travel insurance provider? Here’s how the Financial Ombudsman Service can help.
Travel insurance provides crucial financial protection against an extensive range of holiday risks. Interestingly, over 90% of travel insurance claims are paid, but if you’re part of the 10% that's had your claim unfairly rejected or the cover provided by your insurer falls short of expectations, you can go to the Financial Ombudsman Service (FOS) for help.
This guide explains what FOS is, how it works and how it can help resolve travel insurance disputes.
What is the Financial Ombudsman Service (FOS)?
FOS is an Australian ombudsman service that provides independent dispute resolution services to people having difficulties with a financial service provider. This not-for-profit, non-government service is funded by its member financial services providers, such as banks, insurers, credit providers, financial advisers and debt collection agencies.
FOS aims to quickly and fairly resolve disputes between consumers and financial services providers, using a minimum of formality and conducting itself as transparently as possible. The service is free to consumers and while you are not bound by its decisions, its decisions are legally binding on the insurance company.
When would I use the travel insurance ombudsman?
If you have any issues with your travel insurer, the first step is to raise them directly with the insurance provider. Every insurance company has its own internal dispute resolution process in place for dealing with customer complaints. You’ll find details of this process, including how you can lodge a complaint and how the complaint will be reviewed, in your travel insurance product disclosure statement (PDS).
The insurer will work with you to resolve the issue in a fair and timely fashion. However, if you’ve completed the internal dispute resolution process and the matter still hasn’t been resolved to your satisfaction, it’s time to take it to FOS.
You can choose to contact FOS in the following situations:
- You think your travel insurance claim has been unfairly refused.
- You’re dissatisfied with the amount your travel insurer has paid out for a successful claim.
- An insurer has refused to cover you and you’re unhappy with the reasons for the refusal.
- An insurer has breached its legal obligation to you.
- You’ve been given incorrect advice from the insurer about your policy.
- You’ve suffered a financial loss due to an error or customer service delay by your insurer.
How does FOS work to resolve disputes?
Once you lodge a dispute with FOS, the ombudsman will contact your insurer and ask for a response. If you’ve only recently lodged a complaint with your insurer about the problem, it has up to 45 days to respond; if the insurer has already provided you with a written response outlining its position, it has 21 days to respond to FOS.
FOS will then work with you and the insurer to try to resolve your complaint. The dispute resolution process may involve the following:
- Negotiation. FOS will discuss the situation with you and the insurer to see if a resolution can be reached.
- A conciliation conference. The conciliator is a professionally trained employee of FOS who facilitates discussion and helps both parties come up with options for a resolution.
- Providing a point of view on the merits of the dispute. This view will encourage the parties to reach an agreement and could be provided over the phone or as a written recommendation.
If none of the above strategies work and your dispute is still unresolved, FOS will then issue a decision.
What can FOS do to resolve my travel insurance dispute?
The remedy FOS will recommend will vary depending on the nature of your dispute. For example, if you’re found to be in the right, the ombudsman may recommend that the insurer pay your claim in full or refund a fee you previously had to pay.
Remember, you do not have to accept the ombudsman’s decision and have the right to take further action in the courts if you wish. However, the insurer must accept the decision handed down.
Are there any disputes FOS can’t help with?
FOS is unable to consider the following disputes:
- Matters relating to an insurance provider that is not a FOS member when the dispute is lodged
- Some matters which are the subject of legal proceedings
- Matters that have already been resolved by a court, tribunal or other external dispute resolution scheme
- Matters relating to some commercial general insurance products
What to do if your travel insurance claim is denied
Had your travel insurance claim unfairly denied? Here’s what you need to do:
- Find out why. Contact the insurer to request as much information as possible about the reasons why your claim was refused.
- Lodge a complaint with the insurer. If you’re unhappy with the reasons given, you can submit a complaint with your travel insurance provider through its internal complaints resolution service.
- Review the insurer’s response. See how your insurer responds to the complaint and review the reasons it provides for its decision.
- Lodge a dispute with FOS. If the matter hasn’t been resolved to your satisfaction, you can take your complaint to FOS. Disputes can be lodged online through the FOS website.
How can I contact FOS?
You can lodge a dispute online with the Financial Ombudsman Service.
If you’re unsure whether FOS will be able to help with your complaint, you can phone 1800 367 287 or access online live chat help from 9am to 5pm AEST/AEDT Monday to Friday.
