AFCA is the independent external dispute resolution scheme that resolves complaints between consumers and financial firms, including insurance disputes, providing fair and binding determinations.
AFCA (Australian Financial Complaints Authority) is a free external dispute resolution scheme established in 2018. It resolves complaints between consumers and financial firms, including all insurance disputes. AFCA is independent of any insurer.
AFCA consolidated three previous schemes:
AFCA considers legal principles, industry Codes of Practice, and what is fair in the circumstances. The scheme is funded by financial firms through membership and case fees.
A policyholder's income protection claim was denied after a two-year delay; AFCA found the insurer failed to properly investigate and awarded $180,000 in back-payments plus compensation for stress
AFCA overturned a TPD claim denial where the insurer disputed the medical evidence, finding the policyholder met the policy's any-occupation TPD definition based on independent specialist reports
In a disputed business interruption claim during COVID-19, AFCA determined the policy wording covered pandemic-related closures, requiring the insurer to pay the claim
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