Insurance claim complaints - how and when to lodge them

What is an insurance complaint?

An insurance complaint is a formal expression of dissatisfaction with any aspect of your insurer’s service, communication, decision-making, or delays. Under RG 271 and the General Insurance Code of Practice, your insurer must address your concerns and follow a defined Internal Dispute Resolution (IDR) process.

You can make a complaint about things like:

• Unreasonable delays in assessment or settlement
• Poor communication or lack of updates
• Disagreement about scope of works or valuations
• Denied claims
• Inadequate settlement offers
• Unclear or conflicting information from your insurer

You don’t need to use the word “complaint”, simply telling your insurer that you’re unhappy or want a review of a decision is enough to trigger their obligations.

Why should I lodge a complaint?

Many claimants feel reluctant to lodge complaints, but there are good reasons to do so, and doing it early can help move your claim forward.

Benefits of lodging a complaint:

• It triggers internal escalation within the insurer’s complaints team
• You are assigned a complaint handler or IDR specialist
• The insurer must give you a written response within 30 days

Lodging a complaint is your right, and it’s part of how insurers are expected to resolve issues under the Code of Practice.

When should I lodge a complaint?

There’s no need to wait until the end of your claim to complain. You could lodge a complaint at any time. 

Examples of when to consider lodging a complaint:

• Your claim is not progressing and you’re not receiving regular updates
• You were promised a follow-up but haven’t heard back
• You were denied a benefit and the reason is unclear or appears unfair
• The insurer is requesting unnecessary or repeated documents or investigations

If you’re experiencing repeated delays, vague communication, or decisions that don’t make sense, lodging a complaint could urge the insurer to take a closer look and respond formally. 

How can I lodge a complaint with my insurer?

You can lodge a complaint:

• By phone
• By email or online complaint form
• In writing

Once you do, the insurer must:

• Acknowledge the complaint within 24 hours (or as soon as practicable)
• Resolve the complaint within 30 calendar days, and provide a written outcome
• Keep you updated on progress every 10 business days if it’s not resolved quickly

These obligations come from ASIC’s RG 271 and the General Insurance Code of Practice.

What happens after I lodge a complaint?

Once you lodge a complaint:

• It is generally assigned to the internal dispute resolution (IDR) team (seperate to the claims team)
• The insurer must issue a final written response within 30 calendar days

The final response should set out:

• The insurer’s position
• Reasons for the decision
• Your right to escalate to AFCA if you’re not satisfied

If your complaint is resolved in your favour, the insurer may: 

• Revise or overturn a previous decision
• Offer a higher settlement
• Expedite the assessment or repairs
• Provide compensation for delays or poor service

What if the insurer doesn’t respond to my complaint?

If your insurer fails to:

• Acknowledge your complaint
• Provide updates
• Issue a final response within 30 calendar days

…you are entitled to escalate the complaint directly to the Australian Financial Complaints Authority (AFCA).

AFCA will take over the process and review the insurer’s conduct, evidence, and fairness. 

Does lodging a complaint affect my claim?

It shouldn’t. Lodging a complaint should not delay your claim or lead to negative treatment. In fact, the General Insurance Code of Practice requires insurers to: 

• Handle complaints fairly, honestly and efficiently
• Ensure complaint handling is independent of the original claim decision-maker
• Continue to progress the claim where possible, even if a complaint is in progress