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Report a concern about an insurer

"*" indicates required fields

Before completing this form, please read Report a concern.

Your details

First name Last name

Email*

If you are reporting this on behalf of someone else, there are some additional fields further down where we ask you to put in the name of the person you are representing.

Phone

Preferred method of contact*

Phone

Insurer or brand name:*

We can only look into concerns if the insurer is a subscriber to the General Insurance Code of Practice.

Type of insurance policy*

Other - please specify*

We cannot consider the following products under the Code:
• Workers Corporation Insurance;
• Marine Insurance;
• Medical Indemnity Insurance;
• Motor Vehicle Injury Insurance; and
• Domestic Builders Insurance or Domestic Builders Warranty/Indemnity Insurance.

Policy number, claim number or complaint reference:*

This helps us if we need to contact your insurer about it.

Provide details of your concern.*

If possible, please address the following points in your response below:
• What happened
• How it affected you
• What steps you have already taken to resolve it
• If you have already raised the matter with the insurer, how the insurer responded
• Whether you were satisfied with the insurer’s response (if applicable)
• Whether you have already raised the matter with AFCA or any other organisation. If so, which one(s)
• What outcome you want
• How you think the insurer breached the General Insurance Code of Practice

Provide any supporting documents:

Provide any supporting documents. You can upload up to 15 files.

Drop files here or

Max. file size: 200 MB, Max. files: 15.

Authority to Code Governance Committee

Your consent to disclose the information to the insurer*

With your consent, we may disclose the information you give us, including your personal information and concerns, to the insurer. This allows us to raise the matter with the insurer and, where applicable, investigate.

Do you consent to us disclosing the information you give us, including your personal information, to the insurer (where applicable)?

Yes

Your consent to disclose the information to AFCA or a government agency?*

With your consent, we may disclose the information you give us, including your personal information and concerns, to AFCA or a government agency. This allows us to raise the matter with AFCA or a government agency for the purpose of dealing with the issue or as required or permitted by law.

Do you consent to us disclosing the information you give us, including your personal information, to AFCA or a government agency (where applicable)?

Yes

Are you raising this concern on behalf of someone else?*

Yes

Provide the name of the affected individual*

Email of the affected individual

Select your relationship with the affected individual:*

Other - please specify*

Do you have permission to raise this concern on their behalf?*

If the affected individual has not given you permission to raise this concern, it may affect our ability to consider it.

Yes

Has the individual consented to the Code Governance Committee disclosing their details and concerns to the insurer, AFCA or a government agency (where applicable)?*

If the affected individual has not provided consent, it may affect our ability to consider the concern.

Yes

Submit your concern*

By submitting this form, I consent to the Code Governance Committee using the information I provided to consider and investigate my concern in accordance with the General Insurance Code of Practice and the Code Governance Committee Charter. I also authorise my representative (or that representative’s organisation), or the Code Subscriber to exchange my information, including relevant personal information, to the CGC and other parties for the purpose of dealing with my concern, and as required or permitted by law. I understand that all the information I provided to the Code Governance Committee will be handled in accordance with the Code Governance Committee’s Privacy Policy.

Yes

Comments

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