Report a concern

Our role is to monitor compliance with the Code. We do not resolve individual concerns with insurers.

If you are seeking an individual outcome, such as an apology, compensation or reconsideration of your claim, you should raise this with your insurer first. If you are not happy with the response from your insurer, you may lodge a complaint with the Australian Financial Complaints Authority (AFCA).

Remember to provide as much information about your concern as you can.

To review your concern, we will need:

• The name of your insurer.
• Details of your concern (including what you have done to let your insurer know about it and what your insurer has done in response).
• Any identifying information, such as a claim number, policy number or a complaint reference number. This helps us if we need to contact your insurer about it.
• Any supporting documentation you have, such as a claim outcome letter.
• Your consent for us to use the information you provide in considering and investigating the concern.

We can investigate allegations of Code breaches by insurers that subscribe to the Code.

However, we cannot investigate every allegation we receive.

If we investigate and find that the insurer has breached the Code, we will work with the insurer to find and fix the root cause and minimise its reoccurrence.

We can impose sanctions on Code subscribers in certain circumstances.

We cannot act if the insurer does not subscribe to the Code. See the Insurance Council of Australia’s list of current Code subscribers.

Our powers are set by the Code and our Charter.

We cannot:

• Resolve or assess the merits of the dispute with your insurer
• Provide you with an outcome on your claim
• Review AFCA Determinations
• Create any legal entitlements or rights of action for you
• Advocate for you or provide you with legal or financial advice.

First, we notify you when we have received your concern. We may contact you if we need additional information.

Once we have considered your concern, we will let you know what we have decided to do with the information you provided.

We may commence an investigation

We generally investigate an alleged breach if the concern shows clear signs that the insurer has breached the Code and we think this breach may cause serious consumer detriment.

If we decide to investigate your concern, we will contact you or your authorised representative to explain the next steps. When the investigation is finished, we will let you know the outcome.

We may notify the insurer about your concern

We may decide not to investigate your breach allegation but notify your insurer about your concern. We may follow up on what action the insurer has taken in relation to your matter at a future time.

We may decide to use the information for future inquiries

We cannot investigate every concern we receive. In cases that we do not investigate, we will use the relevant information in your concern for future inquiries.

Our inquiries are an effective way for us to investigate multiple allegations of certain Code breaches. When establishing inquiries, we prioritise serious and systemic matters that pose the greatest detriment to consumers.

If you do not authorise us to share the information you provide us with your insurer, our ability to investigate may be limited.

For assistance, please call 1800 931 678 and ask to speak with the Code Compliance and Monitoring Team.

If you need assistance in a language other than English and need an interpreter, please call the Translating and Interpreting Service (TIS) on 131 450. Give TIS our contact number, 1800 931 678, and ask to speak with the Code team.

By contacting us and reporting a concern, you agree to us collecting any information you provide. All information provided to us is handled and protected in accordance with our Privacy Policy.