Insurance and your consumer rights
Learn about what automatic consumer rights you have with an insurance product and where to go if you have an issue with your insurer.
When you pay a regular amount to an insurer, known as a premium, you are protected from losses that can include:
- property damage
- theft
- disaster, or
- illness.
Some insurance is required by law, for example, compulsory third-party motor vehicle insurance, others, like private health insurance, are encouraged, and other insurance policies are entirely voluntary.
Different organisations look after the different insurance questions and complaints.
Who to talk to if you have an issue with an insurer
Your insurer
You should first contact your insurer.
All insurers are required to have an internal dispute resolution service, and this is usually the fastest way to resolve an issue. If you are still unable to resolve the issue, find the appropriate authority for your matter.
Australian Financial Complaints Authority
The Australian Financial Complaints Authority (AFCA) is a not-for-profit external disputes resolution scheme that deals with complaints from consumers and small businesses about insurance.
Contact AFCA for more information.
Australian Prudential Regulatory Authority
The Australian Prudential Regulatory Authority (APRA) can help you with issues regarding life insurance and superannuation.
Contact APRA for more information.
State Insurance Regulatory Authority
The State Insurance Regulatory Authority (SIRA) can help resolve disputes relating to:
- workers compensation
- home building compensation
- motor accident CTP insurers.
SIRA regulates:
- workers compensation
- home building compensation insurance
- motor accidents CTP (green slip) insurance in NSW.
SIRA also investigates system fraud.
Visit the website for more information.
Medicare
Medicare is the universal health care system in Australia. Medicare provides rebates for scheduled fees and also helps pay for some or all the costs of health care services.
If you have an issue regarding a Medicare claim, benefits or would like more information about Contact Medicare for more information.
Commonwealth Ombudsman
The Commonwealth Ombudsman is an independent body that can look into complaints about a private health insurance arrangement. Complaints must be about a health insurance arrangement. Complaints can be about a health insurers, brokers, healthcare providers or hospitals. The Ombudsman does not take complaints about the quality of service or treatment by a provider.
Contact the Commonwealth Ombudsman for more information.
NSW Fair Trading
We can help you with your consumer rights and protections under Australian Consumer Law.
If you believe an insurer has breached Australian Consumer Law, you can:
- call us on 13 32 20, or
- make a complaint online.
Your consumer rights
Under Australian Consumer Law, most products or services bought in Australia after 1 January 2011 come with automatic consumer guarantees.
Proof of purchase and documentation
You have the right to receive proof of purchase. Businesses must give you a receipt for goods or services valued at $75 or more. You can ask for a receipt for a transaction under $75 and the business must give it to you within 7 days.
If the service has a warranty, it will give you some extra protection against faults or defects. Warranties generally have terms and conditions attached and it’s your responsibility to be aware of these.
Advertising
Advertising can be a powerful means of persuasion, so it’s important it is truthful, accurate and easy to understand. Australian Consumer Law protects consumers from deceptive advertising claims and conduct.
Businesses are not allowed to make false or misleading representations about their products or services.
The remedy if something goes wrong with your insurer
The remedy when things go wrong will depend on whether the problem is major or minor.
You are entitled to an appropriate remedy from the business when the product or service you purchased does not meet one or more of the consumer guarantees.
This might be:
- a refund
- cancellation and replacement
- further service to rectify the problem
- reimbursement for damages and consequential loss in some cases.
The remedy will depend on whether the problem is:
- a major problem, or
- a minor problem.
You can find out more by visiting our repairs, replacements and refunds page.
Making a complaint
Steps to follow if you have an insurance complaint:
- Contact your insurer.
- Ask for a review using the insurers internal dispute resolution scheme if your concerns were not properly addressed.
If you cannot resolve your matter, submit your complaint by using our form.
By mail
Post your complaint form and documentation to:
NSW Fair Trading
PO Box 972
Parramatta NSW 2124
Ask a question
If you are unable to find the information you need, you can call us between 8:30am to 5pm on Monday to Friday. You can also use our form to make an enquiry.