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When a travel insurance dispute arises and the insurer’s internal dispute process fails to provide resolution, turning to the Australian Financial Complaints Authority (AFCA) can offer a path to justice. AFCA serves as an independent body that specialises in resolving financial disputes, including those related to travel insurance. Understanding the remedies available through AFCA can empower travellers facing insurance-related challenges.

1. Mediation and Conciliation: AFCA offers mediation and conciliation services aimed at facilitating constructive dialogue between the parties involved in a dispute. Through these processes, AFCA mediators work to identify common ground and negotiate mutually acceptable solutions. Mediation and conciliation can often result in expedited resolutions that satisfy both parties without the need for formal adjudication.
2. Formal Adjudication: In cases where mediation and conciliation are unsuccessful or impractical, AFCA may proceed to formal adjudication. This involves a thorough review of the evidence presented by both parties and a determination of liability based on relevant laws, regulations, and industry standards. AFCA has the authority to make binding decisions and impose remedies to address the grievances of the aggrieved party. Generally, decisions are made based on written submissions by both parties.
3. Compensation and Remediation: One of the primary remedies available through AFCA is financial compensation and remediation for the party that has suffered harm or loss as a result of the dispute. This could include reimbursement of out-of-pocket expenses, compensation for pain and suffering, or other forms of restitution designed to restore the affected party to the position they would have been in had the dispute not occurred. In some circumstances, you may be entitled to claim non-financial loss, such as when there has been an unusual amount of physical inconvenience, time taken to resolve a situation, or interference with your expectation of enjoyment or peace of mind.
4. Apologies and Corrective Actions: In addition to financial remedies, AFCA may require the party found to be at fault to issue a formal apology to the aggrieved party. Furthermore, AFCA may mandate corrective actions to prevent similar disputes from arising in the future. This could involve changes to internal policies and procedures, staff training initiatives, or other measures aimed at improving compliance and customer service standards.
5. Publication of Decisions: AFCA has the authority to publish its decisions on its website, providing transparency and accountability to the public. Publishing decisions serves as a valuable resource for consumers, helping to inform future decision-making and promoting industry-wide best practices.

Before lodging a complaint with AFCA, you should familiarise yourself with the available remedies. This will enable you to consider and gather the necessary evidence in support of the remedies sought. This might include receipts, medical reports, and statements. Remember, the burden is on you to prove the loss covered by the policy and any impact of the denial.

If you require any assistance with the AFCA process, contact Carroll & O’Dea Lawyers.

This article was published on 19 November by Carroll & O’Dea Lawyers and is based on the relevant state of the law (legislation, regulations and case law) at that date for the jurisdiction in which it is published. Please note this article does not constitute legal advice. If you ever need legal advice or want to discuss a legal problem, please contact us to see if we can help. You can reach us on 1800 059 278 or via the Contact us page on our website.