This article is general information only and does not constitute legal advice. AFCA complaints involve strict time limits and procedural requirements that vary by circumstance. If you are considering lodging a complaint, seek advice from a qualified TPD or insurance lawyer before proceeding.
TL;DR — Key Points
- AFCA — the Australian Financial Complaints Authority — is a free, independent dispute resolution service that can overturn insurer and super fund decisions.
- You must first complete an internal review with your insurer or fund before lodging with AFCA (in most cases).
- Time limits apply: generally six years from the decision date, or two years from when you first became aware of your right to complain.
- AFCA can award compensation, require the insurer to pay a claim, and impose binding determinations.
- A TPD lawyer can help you prepare a strong AFCA complaint — and most work on a no win, no fee basis.
What Is AFCA?
The Australian Financial Complaints Authority (AFCA) is an independent, government-authorised external dispute resolution scheme that resolves complaints between consumers and financial firms — including insurers, super funds, and financial advisers. It replaced the Financial Ombudsman Service (FOS), the Credit and Investments Ombudsman (CIO), and the Superannuation Complaints Tribunal (SCT) in November 2018.
AFCA is free to use for consumers. It is funded by financial firms who are required by law to be members. Its decisions — called determinations — are binding on the financial firm if accepted by the complainant, and can require the insurer to pay a claim, provide compensation for non-financial loss, or reverse a decision.
For TPD and insurance claimants who have been rejected, AFCA represents a powerful avenue to challenge that decision without going to court — and at no cost to the claimant.
AFCA is one of the most effective tools available to Australian consumers challenging insurance and super fund decisions. Its determinations are legally binding on the insurer. If you are still making a superannuation TPD claim, our step-by-step guide walks you through it.
Before You Lodge: Internal Review First
In most cases, AFCA requires you to attempt an internal review with your insurer or super fund before it will accept your complaint. An internal review is a formal request for the firm to reconsider its decision — it must be conducted by someone who was not involved in the original decision.
Request an internal review in writing, including your claim reference number, the specific decision you are challenging, and any additional evidence or arguments you want the reviewer to consider. Keep a copy of everything you send and receive, including dates.
If the internal review does not resolve the dispute, or if the firm does not respond within a reasonable timeframe, you can then proceed to AFCA. Note that some matters — particularly older superannuation complaints involving decisions before 1 November 2018 — may be subject to different pathways or time limits.
The AFCA Complaint Process Step by Step
The AFCA process moves through several defined stages, and understanding each one helps you prepare effectively.
| Stage | What Happens | Typical Timeframe |
|---|---|---|
| 1. Lodge complaint | Submit complaint via AFCA online portal, phone, or mail | Immediately |
| 2. Registration & referral | AFCA registers the complaint and refers it to the financial firm for response | 1–2 weeks |
| 3. Firm response | Insurer/fund has opportunity to resolve or respond | 21–45 days typically |
| 4. Case management | AFCA reviews submissions, may request further information, facilitates negotiation | Weeks to months |
| 5. Determination | If unresolved, AFCA issues a binding determination | Varies by complexity |
Most complaints are resolved before a formal determination is required. AFCA encourages settlement throughout the process and many insurers will negotiate rather than face an adverse determination. However, if negotiations fail, AFCA will assess the evidence and issue a binding decision.
What AFCA Can and Cannot Do
Understanding AFCA’s powers — and its limits — is important for setting realistic expectations about what a complaint can achieve.
- AFCA can: Require an insurer to pay a rejected claim. Award compensation for non-financial loss (distress and inconvenience). Award interest on delayed payments. Require the firm to take specific action. Issue binding determinations up to its monetary limits.
- AFCA cannot: Award compensation above its monetary limits (currently up to $1,085,000 for insurance claims, with limits reviewed periodically). Investigate matters outside its Terms of Reference. Handle complaints about government agencies. Provide legal advice. Act as an advocate for either party.
The monetary limits apply to the compensation AFCA can order — not to the value of the underlying claim. If your TPD benefit exceeds AFCA’s limits, you may need to consider court proceedings to recover the full amount.
Time Limits — Critical to Get Right
AFCA’s complaint time limits are strict, and missing them can permanently bar you from using this avenue. The general rule is that you must lodge within six years of the date of the decision, or two years from the date you first became aware — or should reasonably have become aware — that you had grounds for a complaint. Whichever period ends later applies.
There are additional complexities for superannuation complaints. Matters involving decisions made before 1 November 2018 by the old Superannuation Complaints Tribunal may have different rules. If you are unsure whether your complaint is within time, seek legal advice immediately — do not wait.
Your super fund’s trust deed may also impose notification windows that are shorter than AFCA’s time limits. Failing to notify your fund of a potential claim within the required period (sometimes as short as two years after disablement) may give the insurer grounds to reject on procedural grounds, even before the AFCA issue arises.
If you have received a rejection letter and are considering an AFCA complaint, do not delay. Time limits can expire even while you are gathering information or waiting for a legal consultation.
Frequently Asked Questions
Is it free to lodge a complaint with AFCA?
Yes. AFCA is completely free for consumers. The scheme is funded by financial firms who are required to be members. There is no filing fee, no cost to have your complaint assessed, and no charge if AFCA makes a determination in your favour.
Do I need a lawyer to lodge an AFCA complaint?
You are not required to have legal representation. However, a TPD lawyer can significantly improve your chances of success by preparing a well-structured complaint, gathering the right evidence, identifying the strongest legal arguments, and negotiating with the insurer on your behalf. Most TPD lawyers offer a free initial consultation and operate on a no win, no fee basis. Our TPD compensation lawyers can assess your dispute and handle the AFCA process on your behalf.
How long does an AFCA complaint take?
Simple complaints may be resolved in a few weeks. Complex insurance or superannuation disputes can take six to twelve months or longer, particularly if the matter goes to a formal determination. AFCA publishes its average handling times on its website. Having complete, well-prepared documentation from the start tends to reduce delays.
What happens if AFCA decides in my favour?
If you accept AFCA’s determination, it is legally binding on the financial firm. The insurer or super fund must comply — including paying any benefit or compensation ordered. If you do not accept the determination, you remain free to pursue court action. The financial firm cannot reject a determination that you have accepted.
What if AFCA decides against me?
If AFCA issues a determination that is unfavourable, you are not bound by it — you can still pursue court action. However, the determination may inform the insurer’s litigation strategy. If the AFCA determination contains errors of law, there are limited avenues to challenge it. A lawyer can advise on your remaining options after an adverse determination.
Can I go to court instead of using AFCA?
Yes. AFCA is optional, not mandatory. However, AFCA is typically faster, cheaper, and less stressful than litigation. Many claimants try AFCA first and proceed to court only if AFCA does not resolve the dispute satisfactorily. A TPD lawyer can advise which pathway gives you the best outcome based on the specific facts of your case.
What if the insurer is not responding or is delaying?
You do not have to wait indefinitely for an insurer to respond before lodging with AFCA. If your insurer or fund has not responded within a reasonable timeframe — generally 45 days for insurance complaints — you can lodge a complaint with AFCA about the delay itself. AFCA can also address unreasonable delay as part of a broader complaint.
Does AFCA only handle TPD claims?
No. AFCA handles disputes across a wide range of financial products and services, including income protection, trauma insurance, life insurance, superannuation death benefits, banking, credit, and investments. For TPD claimants, AFCA is most commonly used to challenge rejected claims, disputed definitions, and unreasonable delays.
Key Takeaways
- AFCA is a free, independent dispute resolution scheme that can require insurers and super funds to pay rejected claims and award compensation — its determinations are binding.
- Complete an internal review with your insurer or fund first, then escalate to AFCA if the dispute is not resolved.
- Time limits are strict — generally six years from the decision or two years from when you first became aware of your grounds. Do not delay.
- AFCA can award compensation up to its monetary limits (currently $1,085,000 for insurance claims); claims above this may require court proceedings for the full amount.
- A TPD lawyer can significantly strengthen your AFCA complaint, negotiate with the insurer, and advise on whether AFCA or court action is the better pathway.
- If AFCA finds in your favour and you accept the determination, it is legally binding on the insurer — they must comply.
Last updated: 8 July 2026