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TOR: Lodging GI Disputes

Obligation to inform consumers of the time limit for lodging general insurance disputes

Financial services providers (FSPs) have an obligation to inform applicants about the time limit for lodging disputes with the Financial Ombudsman Service (FOS).

FOS’s Terms of Reference

Paragraph 6.2 of our Terms of Reference states the time limits for lodgement of disputes with us.  The time limit stated in paragraph 6.2b) applies to general insurance disputes (and various other disputes). 

 

Under paragraph 6.2b), we will consider a dispute if it is lodged before the earlier of:

  • 6 years after the date when the applicant first became aware, or “should reasonably have become aware”, they suffered the loss, and
  • if the applicant received an ‘IDR Response’ (as defined in paragraph 14.1) from the FSP, 2 years after the date of that response.

 

Paragraph 6.2 allows us to consider a dispute lodged after the time limit if we consider that exceptional circumstances apply.

FSPs’ obligation to inform applicant of time limit

When an FSP reviews a matter through its internal dispute resolution (IDR) process, it is required to inform the applicant of the applicable time limit for lodgement with us as well as the steps in the dispute resolution process.

 

Our Operational Guidelines provide the following guidance on what should be included in an IDR Response (in the guideline to paragraph 6.2):

 

 

An IDR Response should include the wording provided below or words having the same effect:

  • We have completed our review of your complaint in accordance with our internal dispute resolution process;

  • Our final decision in relation to your complaint is:

  • You should be aware that because this is our final decision, if you wish to pursue this complaint further by taking it to the Financial Ombudsman Service, you will need to do so within 2 years of the date of this letter.

  • The Financial Ombudsman Service is an independent external dispute resolution scheme approved by the Australian Securities and Investments Commission. We are a member of this scheme and we agree to be bound by its determinations about a dispute.

 

FOS’s contact details are as follows:

Financial Ombudsman Service

GPO Box 3

Melbourne VIC 3001

Telephone:  1300 780808

Fax:   (03) 9613 6399

Web:   www.fos.org.au

Email:   info@fos.org.au

 

Reminder to general insurers

Prior to 1 January 2010, the time limit to lodge a general insurance dispute was three calendar months of receiving notice of the IDR decision. This changed on 1 January 2010 when the time limit became the limit stated in paragraph 6.2b) outlined above.

 

We have noted that some FSPs have failed to amend their final decision letters to reflect the change from three months to two years. This failure to provide the correct information could have an adverse impact on consumers and could amount to a systemic issue.

 

FSPs are therefore reminded to ensure all final decision letters include the correct information concerning the time limit for lodging disputes with us.