Item 6 · Complaints
Complaints and AFCA
A problem with a funeral policy goes to the insurer first, then as a formal complaint in writing, and then, if it is still not fixed, to the Australian Financial Complaints Authority (AFCA). AFCA is free, and the life insurance complaints it considers include funeral policies.
Not legal or financial advice. Moneysmart’s how to complain page and AFCA’s own site are the official guides, and Moneysmart notes that a community legal centre may be able to give free legal advice.
The order things happen in
Tell the insurer
Moneysmart’s first step for any financial product is to contact the business, explain what went wrong and say how you would like it put right. Often a call, an email or a chat is enough.
Complain formally, in writing
If a call or email does not sort it out, Moneysmart says to make a formal complaint to the business in writing, a step known as internal dispute resolution. It says to put in the letter or email: the word “complaint” in its heading or subject line; your name, your contact details and the date; a clear account of what went wrong and the outcome you are after; and copies of the documents that matter, such as receipts, invoices, and bank or other financial statements. It also says to hold on to the originals of anything you send, and to a copy of the complaint letter.
Take it to AFCA
Moneysmart says an external scheme can help if the business did not answer in a reasonable time, or if the way it handled the complaint, or its offer, is not acceptable. For insurance, that scheme is AFCA.
Insurers that subscribe to the Life Insurance Code of Practice say they will give a final written response within 30 calendar days, unless a complaint is complex or held up by things outside their control, in which case they will explain the delay before the 30 days are up. The response will tell the person they can take the complaint to an external body such as AFCA, how to contact it, and any time limit for doing so. ASIC treats a request to return a product sold in breach of the hawking rule as a likely complaint too, which brings in the same complaints process.
What AFCA can look at
AFCA lists the kinds of insurance complaint it may consider, and the kinds it generally does not. Set against a funeral policy, its own descriptions read like this.
| The problem | AFCA’s position |
|---|---|
| A premium charged wrongly | Can be considered: premiums that were incorrectly applied or calculated. |
| Information left out, or wrong | Can be considered: information about the product or its costs that was not disclosed, or was misleading or incorrect. |
| A claim refused because the policy had lapsed or been cancelled | Can be considered: AFCA lists a claim denied on the basis that the policy lapsed or was cancelled, and decisions to cancel a policy. |
| A claim refused over a pre-existing condition or an exclusion | Can be considered. |
| A benefit or refund paid to the wrong person | Can be considered: a claim paid to someone other than the insured, or a refund given to another party. |
| Instructions ignored or delayed | Can be considered, for example a request to increase cover that was not acted on. |
| Only that the premium is too high | Generally not, unless the cost was not disclosed, was misrepresented or was applied incorrectly, or the firm breached a legal obligation. |
| A firm that is not an AFCA member, a matter a court has decided, or a complaint outside the time limits | Generally not. |
AFCA says the full detail is in its Rules, and that it may decline to go further with a complaint even when it is not excluded.
Complaining for someone else
A problem with a funeral policy may come to light after a death, when the person raising it is a relative rather than the policy owner. AFCA lets a person appoint an authorised agent or representative to act for them, using its Agent Authority form. In the Life Code, a representative can be a family member, guardian, interpreter, lawyer or someone with power of attorney, and the Code’s “you” can include a person entitled to a claim’s benefits who is not the policy owner.
At claim time the Code says the insurer will treat people with empathy, compassion and respect, will not discourage a claim, and will work on a way through if someone is struggling to provide the information it needs, which may include gathering it for them with their permission.
When the way it was sold is the problem
If a subscribing insurer finds that a policy was sold through an unacceptable practice, the Code lists the ways it may put that right, such as an apology, cancelling the policy with the person’s agreement, refunding premiums with interest, correcting information or paying a claim. The insurer will say that its proposed fix can be reviewed, and an unhappy outcome is then treated as a complaint.
Anyone can report a suspected breach of the Code to the Life Code Compliance Committee, the body that monitors it. Only that committee decides whether the Code was breached, though AFCA may consider whether an insurer met its Code obligations when it decides a dispute.
Help along the way
AFCA says people can reach it through a telephone interpreter or the National Relay Service, and that it has complaint forms in other languages. For First Nations people, Moneysmart points to ASIC’s Indigenous Help Line on 1300 365 957 (ASIC’s own Youpla page gives the same number for its Indigenous Outreach Program), and to Mob Strong Debt Help, a free legal advice and financial counselling service that covers funeral insurance.
AFCA’s own review of 2024–25 noted that limited internet access, lower awareness of AFCA and cultural considerations may mean many problems First Nations consumers face are never reported to it. AFCA takes complaints online, by phone, by email or by post, and from an authorised representative acting for someone.